Pleasure in menopause (beyond sex)

For decades, talking about menopause and the changes it causes in women has been a taboo and neglected topic. Fortunately, from that "women's stuff", we are moving towards a new era where importance is beginning to be given to this vital stage, which involves, beyond the often caricatured hot flashes or the better-known osteoporosis, a whole series of hormonal changes that affect women's overall health and lives. A physiological transition that Laia Blanco, Inés Ramírez, and Stéphanie Kauffmann discuss with rigor and in a very didactic and understandable way in the book "Placer en la menopausia" (Plataforma editorial), a guide that proposes women face this stage of life with well-being, pleasure, and fullness, goals that can be achieved if understood and managed appropriately. As Inés Ramírez explains, "there are a whole host of symptoms linked to menopause that are underdiagnosed and still very taboo. Hence the need to talk about this topic. And we do so from the observation and experience of all the years we have spent in consultations, seeing women who suffer from all these symptoms associated with genitourinary syndrome of menopause".

The three of them are the founders of one of the first centers specializing in the pelvic floor in Spain, RAPbarcelona, which they created over twenty years ago when no one was talking about incontinence or sexual desire during menopause and when there were still few studies, few resources, and much silence on the subject. Ramírez, Kauffmann, and Blanco state that women continue to need clear, rigorous, and understandable information about their pelvic floor, their sexuality, and the changes they experience during perimenopause and menopause. Aware that their consultation is private and that not all women can afford to access it, they launched Pelvify (https://pelvify.com), an online project to bring knowledge and self-care to all women. And self-care and self-knowledge are also two of the pillars of the book, as Laia Blanco points out, "it is absolutely therapeutic. Understanding and knowing your body is already part of the therapy, because when you do, you start making good decisions in your daily life and correctly managing symptoms".

In the book, which they would like many men to read too, they acknowledge that there are things women cannot control, such as age or hormonal changes, but they assure that it is possible to choose to ask for help to understand what is happening or to take measures to strengthen the pelvic floor or improve lubrication, for example. And they provide very graphic data: "50% of women entering menopause will surely have genitourinary syndrome of menopause and 90% will have at least one very bothersome symptom in the vulvovaginal area." Data that they would like, as Stépahnie Kauffmann explains, "to be able to reduce through primary prevention, starting from 35 or 40 years old, to be able to reach this decline in estrogen that we experience in menopause in the healthiest way possible. And this includes lifestyle habits such as hydrating well, working the pelvic floor muscles, recognizing the area, touching yourself, stimulating yourself...". As the physiotherapists rightly say, "everything in the body that is not thought about, not touched, and not moved, atrophies. And this is a reality as solid as a temple. And it's never too late to start."

Menopause involves a reconfiguration of the body and identity for which no one has taught women how to navigate. Physiotherapists insist that it is necessary to learn to accompany the changes the body experiences, understand them, and improve what is modifiable while attenuating what is not. They recommend leaving taboos and shame aside and consulting a health professional when necessary. However, they also engage in self-criticism and acknowledge that "healthcare professionals are a huge barrier for women to express themselves or have good results when they have expressed some symptomatology related to sexuality, for example, because since they are not very trained in this matter, they do not have resources to know how to help, and this closes doors." What is needed is "to ask a lot, because asking is a way to break the taboo. And it must be done naturally, as if we were talking about any other part of the body."

"The pleasure of being well"

In short, they maintain that "the book is not just about sex. It is about being well in the vulvar, vaginal part, about women's quality of life. In short, about the pleasure of being well." In this sense, they speak of a pleasure that must be understood beyond desire and sexual satisfaction and that includes, for example, the pleasure of walking without burning, of not losing any urine when sneezing or of being able to get aroused without pain. They insist that suffering any of these symptoms "is not normal and we should not accept it. We must know to be able to detect and seek consensual solutions adapted to everyone." In relation to sexual pleasure, it is also a new stage that often calls for new forms of pleasure and connection, delving into aspects that perhaps in previous stages had not been so present, such as playing with the senses. On this path, they propose learning to explore and recognize one's own body, while recalling that the hormonal changes of menopause do not only affect the menstrual cycle and mood, but also have a direct and profound impact on sexual response, on how desire appears, on how arousal is maintained and on how orgasm is achieved or not.

In short, a book that aims to try to rebuild body self-esteem to begin a new stage built on knowledge, autonomy, and self-love. As the authors claim, the book's intention is to "reclaim this part of the body that has been stolen from us. Reclaim it, make it yours, master it. It is another part that you must know. But we also want to validate that all these are real symptoms, because women have been very pathologized with all these symptoms. It is a real problem and tools must be provided to solve it. And one last thing: get moving. There are tools to improve and with a little effort, we will see great changes. We always say that the pelvic floor is very grateful".