Author: The Beauty Nation

Menopause Aches and Pains

Aches and pains are usually the body’s way of indicating that something is wrong. But having said that, we must note that aches and pains grow more common in older people as muscles and joints age. Just like a young child or adult give a little grunt as they got up out of a chair or stooped to pick up something.

Aches and pains can mean lots of things.

When there is inflammation, it indicates that the body is trying to repair injured tissue, which may have gotten that way by overuse or underuse. Inflammation in the joints is called arthritis; in the tendons, tendinitis; in the bursae (small sacs that cushion the movements of muscles), bursitis. Pain is a cardinal sign of inflammation for any number of reasons–nerves relay.

Menopause Cramps

Cramps or spasms are sudden contractions that may occur in any muscle and at any age. They occur most often in the calves of your legs, feet, and fingers and are usually due to a mineral deficiency like calcium, magnesium, or potassium. Hormone imbalances also cause leg cramps.

Women are more likely to have muscle cramps during and after menopause. This is because the circulatory system which, in youth, is adequate enough to carry off the blood chemicals that are generated by fatigue no longer does its job as well as we age.

Cramps in the legs and feet seem to occur most often at night, in bed, and can usually be alleviated if you stand up flat on the floor. Gently stretch the area during a cramp and to prevent future cramps, stretch before going to bed.

For cramps in the legs, you may have to rub vigorously to soften the muscles. Cramps in the hands and fingers can occur any time you use your hand in an awkward position. Again, stretching your hand out flat against a surface usually takes care of the cramp. Be sure that before you walk, run, or do any strenuous exercise, you do some mild stretching exercises to loosen up those muscles.

Conventional medical treatment usually consists of quinine, muscle relaxers, and pain relievers, which may have undesirable side effects or be ineffective. Natural therapies offer a side-effect-free approach to relieving and preventing cramping pains and are frequently very effective.

Menopause Dizziness

Some women report that they experience light-headedness or dizziness when they have a hot flash and when hormone changes occur just before or after a period. This is probably due to vasodilation which diverts blood to the skin surface, or to changes in the central nervous system brought about by hormone imbalance.

However, dizziness has many causes. Low blood pressure or a poorly responsive sympathetic nervous system causes light-headedness when you rise quickly from a lying or sitting position. This causes a momentary decrease of blood flow to the brain and is called postural (or orthostatic) hypotension. Other causes of dizziness are stroke, medications and drugs, hormone imbalance, inner ear problems, and other medical conditions.

Menopause Headaches

While almost everyone gets a headache at one time or another, some women are more prone to headaches, and if you are one of them, this may indicate that the symptom is your way of reacting to some form of stress. While some women report increases in the number and severity of headaches around the menopausal years, even more, say that the headaches that plagued them just before, during, or just after their periods for years nearly disappeared once their periods stopped for good.

Headaches that appear for the first time or intensify around menopause seem to be related to different hormone balances. The estrogen in hormone replacement therapy (HRT) may cause headaches.

There are two main categories of common headaches: muscle contraction or tension headache; and vascular or migraine headache. Sinus headaches and headaches due to eyestrain are also very common. Very often headaches are a mixed variety.

Menopause Tension Ache

Muscle contraction or tension headaches are the most common type of headache, this usually feels like a dull ache with some tightness and tenderness at the temples, around the forehead, or where the skull meets the neck. It may be due to mental stress from, for example, overwork, or the mundane stress of everyday life such as being stuck in traffic.

A tension headache may also be the result of physical stress, such as too little sleep, a long tedious drive, or poor posture. Sometimes both mental and physical stresses are involved, as when sitting at a desk or straining at a computer for long periods of time in order to meet a deadline.

Under stress conditions, the body reacts by tightening the muscles in the scalp, jaw, neck, shoulders, and back; eventually, the muscles protest from the constant contraction. They stay sore and tight and squeeze the nerves and blood vessels that feed muscles and other soft tissues, causing radiating pain that you can feel anywhere in your face and neck.

Menopause Migraine

Migraine is a French word derived from the Latin word hemicrania, which means “pain in half of the head.” This type of headache usually affects only one side of the head, bringing severe throbbing pain.

Before the headache begins, there may be visual disturbances such as visions of lights, bright or geometric shapes and lines, and “tunnel” vision, or sensations of a strange taste or odor, tingling, dizziness, slurred speech, ringing in the ears, and weakness in a part of the body. As the headache progresses, there may be nausea, vomiting, chills, and extreme fatigue. This type of headache is associated with the spasm of blood vessels.

However, what actually causes the pain is unknown. We do know there is an inflammatory response involving many biochemicals. A migraine may last for hours or days and may be triggered by hypersensitivity or allergic reactions to foods, alcohol, bright lights, some medications, or loud noises.

Some women also experience migraines due to hormonal fluctuations such as occur with the menstrual cycle or menopause; the culprit seems to be too much estrogen in relation to progesterone, and progesterone therapy sometimes helps these women.

Menopause Hot Flashes & Hot Flushes

About 65-75% of women experience hot flashes at some point during menopause. Hot flashes vary widely from woman to woman in their intensity, frequency, and duration. Some people make a distinction between a hot “flash” and a hot “flush.”

You may experience a hot flash as a passing feeling of warmth over your face or upper body, with perhaps a little perspiration forming on your upper lip which usually isn’t noticeable by other people. Or you may experience a hot flush, during which you literally become drenched in sweat, followed by chills, after excessive perspiration has lowered your total body temperature. But often no distinction is made between the two extremes, making it difficult to truly understand the scope and depth of this menopausal symptom.

While a hot flash may simply cause one woman’s face to turn rosy, in other women hot flashes are accompanied by distinct changes in heart rate and blood pressure. Some women become very uncomfortable and find hot flashes distressing and embarrassing, but others are able to ride the waves of sensation and even enjoy them. Most women come to recognize the particular warning signs that precede their own hot flashes.

Feelings of tension and anxiety are common, and there are also physical signs that a hot flash is imminent; these include nausea, dizziness, heart palpitations, and tingling in the fingers. Hot flashes typically last several minutes, although a few women may experience them for as long as an hour.

We think that hot flashes are brought on by changes in the hypothalamus, the gland in our brain that connects our nervous system to our endocrine system and regulates many body functions including body temperature and the release of sex hormones.

Sudden changes in hormone levels most likely trigger a neuro-chemical response by the hypothalamus which temporarily affects its ability to regulate body temperature. A normal, comfortable room temperature suddenly feels like a tropical heatwave to your body, and your body temperature actually rises. Your system takes “appropriate” steps to combat this situation: your blood vessels dilate and you perspire to cool your body, triggering a hot flash.

Women usually begin to experience hot flashes as monthly menstruation becomes irregular, and continue to experience them for about 2 years. However, in some women, hot flashes persist for up to 10 years. They are usually more pronounced at the beginning of menopause, and then taper off as your body adjusts to hormone changes.

It helps if you can acknowledge that hot flashes are often a normal part of going through menopause. Don’t try to deny them; in fact, many women find relief simply by discussing hot flashes and other symptoms with friends who are going through the same process.

Hot flashes are the single most identifiable symptom of the onset of menopause and they are also the most readily relieved by any number of appropriate approaches. Some women turn to hormone replacement therapy (HRT) to control hot flashes. HRT does indeed provide relief from hot flashes but it is not right for every woman, and debate continues over its overall safety. Fortunately, there are many natural, holistic ways to cope with hot flashes.

We have met very few women who couldn’t correct their hot flashes naturally, without resorting to potentially hazardous hormone therapy.

Menopause Night Sweats

When hot flashes occur at night, they are called night sweats. Many women experience hot flashes both day and night, but in some women, hot flashes never occur in the day at all. There is tremendous variation among women in the intensity of night sweats, from needing to get up and change one’s sleepwear and bedding, to just throwing off the bedcovers, to toweling off your neck and chest.

Although women who experience hot flashes during the day may be annoyed and inconvenienced that they occur in public, night sweats can wake you up several times a night, disturbing your sleep and leading to insomnia and all of its irritating accompanying symptoms.

Menopause Cause Digestive Problems

The digestive system, as most of us know only too well, is remarkably reactive to emotional and physical distress. As if that wasn’t bad enough, as we age, some of its functions slow down, and we find that we’re not able to eat as much as we used to without gastric discomfort, or we become constipated, as waste products move more slowly through the colon.

Sluggish bowels, it appears, are more than uncomfortable. They increase the risk of diverticulosis and possibly colon cancer, a leading cause of death among both men and women of middle age and beyond.

Progesterone

This hormone is also important for a woman’s health during and after menopause. As explained, progesterone influences your mood and protects against several serious health problems. Your menstrual cycle, skin, and breasts together with estrogen, progesterone regulate your menstrual cycle. Estrogen stimulates the uterine lining to grow while progesterone ensures that it sheds in monthly periods (if no conception occurs, that is).

If you’re familiar with hormone replacement therapy, you know that taking estrogen can increase your risk for uterine cancer, unless you also take progesterone (or another progesterone, that is a substance with a similar effect) to protect you against a potentially harmful build-up of tissue in the uterine lining.

One sign that your progesterone levels are too low during menopause is that you begin to have more painful menstrual periods, with uterine cramps. Low progesterone-to-estrogen ratios may in some cases be associated with a serious medical condition known as dysfunctional uterine bleeding (DUB), which is characterized by heavy, erratic bleeding. Progesterone doesn’t actually seem to play a direct role in preventing vaginal dryness or pain, despite the claims of some health professionals.

Progesterone prevents vaginal dryness and pain

When women take progesterone, their bodies convert some of it to estrogen, which does have a protective effect against vaginal dryness and pain. While estrogen makes women feel sexier, progesterone is likely to have the opposite effect. It tends to moderate the effects of estrogen and testosterone.

In fact, progesterone is given to sex offenders to decrease their sexual thoughts, desires, and satisfaction. This loss of libido may be accompanied by depression. This is why some women with low estrogen but adequate progesterone feel depressed and have decreased libido.

Progesterone increases your body’s metabolic rate and literally warms your body.

The higher metabolism and body temperature are accompanied by more blood flow to the skin, and an increased ability to sweat and lose the extra heat through the skin. Although it is under debate, progesterone’s effects on the skin may be partly responsible for hot flashes. Also, this is why some women who experience low progesterone menopause types have cool skin.

If your progesterone levels fall too far during menopause, you can feel anxious and irritable, have trouble sleeping, or suffer from feelings of confusion, depression, or mood swings. These feelings can become exhausting if the imbalance goes on too long. A drop in your progesterone level can actually cause you to go through symptoms that are similar to those experienced in withdrawal from sedatives or alcohol. Progesterone is also involved in the regulation of appetite.

Low progesterone menopause

Types can have a decreased appetite. Your bones, although its effects are not as well-known as estrogen, progesterone protects against osteoporosis. Like estrogen, progesterone protects bone, but in a different way. Estrogen restricts the breakdown of old bone cells while progesterone stimulates the growth of new ones.

Some animal studies suggest that high progesterone levels are able to maintain or increase bone formation even when there is low estrogen. However, other researchers have found that progesterone alone does not have a positive effect on bone mineral density and bone volume, two measures of bone strength and health. There is also evidence that estrogen enhances progesterone’s bone-building power.

Testosterone

The “male” hormones that are related to sex drive, muscle strength, and vaginal health; are also converted to estrogen by our fat cells. Just as we usually think of testosterone as a “male” sex hormone, but every woman has it, too.

You need testosterone for the proper function of the brain, heart, bones, and many other tissues.

After menopause, your testosterone levels may remain adequate to your needs, but if the hormonal changes don’t go smoothly you may end up with too much or too little. When it comes to testosterone, the adrenal glands do not appear to be equipped to make up for a total loss of ovarian testosterone (some ovarian testosterone is usually needed. But if the adrenal glands produce a lot of androstenedione, the building block (precursor) from which both testosterone and estrogen are made the result may be too high a level of testosterone in the body.

There is growing evidence that testosterone is the most important hormone for maintaining sex drive in women, just as it is in men. Before, during, and after menopause, testosterone boosts a woman’s libido.

Too little testosterone

Can leave a woman feeling uninterested in sex. Too much can make her feel edgy and aggressive, even if her level of desire is just fine. Testosterone also has important effects on the vagina and vulva. The vaginal and vulvar atrophy that can occur with menopause are often at least partly caused by testosterone deficiency. Like estrogen, testosterone directly affects the tissue of the vagina and helps keep it healthy.

Testosterone deficiency

Can cause a medical condition called lichen sclerosis, in which the labia and vulva become thin and fragile. This ailment creates chronic inflammation, itching, and pain, and, in severe cases, significant scarring and changes in the tissue. Testosterone ointment has been used to treat this condition. Testosterone also maintains muscle tone, and a loss of it can contribute to the aging of your skin. Low testosterone can also contribute to stress incontinence or other bladder control problems.

This hormone also greatly influences motivation, drive, and confidence, and perhaps even feelings of self-worth. In moderation, testosterone can be very beneficial for your skin. Proper testosterone levels work with estrogen to preserve skin collagen and thus protect against wrinkling and aging. When testosterone levels are low, the skin is affected by a loss of collagen and muscle tone.

Decreased testosterone levels

May be partially responsible for the increased dryness of the skin that can occur during and after menopause. The sebaceous glands, which excrete lubricating oil-like substances from the pores onto the skin, often work less efficiently after menopause due to low testosterone. On the other hand, too much testosterone isn’t good for your skin, either. The signs include excessive oiliness, acne, and increased hair on the face or body. High levels of testosterone in women can also result in a thinning of the scalp hair, a condition called androgenic alopecia.

We learn that cessation of menstrual would also mean the cessation of ovarian activity. The ovary being both an endocrine and an exocrine gland, its function is not restricted to ovulation; it also collaborates with some of the other endocrine glands. The cessation and deficiency symptoms of this activity during the climacteric may therefore lead to disturbances involving other hormone-related functions.

In normal menopause circumstances

These complaints are far from serious. But sudden menopause in the case of ovaries that have previously functioned normally and efficiently is likely to produce more serious complaints than a gradual transition because the endocrine system requires a certain amount of time to re-establish its equilibrium after the elimination of ovarian activity. Thus this diminishing of estrogen is an important distinction because hormonal changes are the only one that has great effects in a woman’s body.

By the time most women reach their early forties, they have ovulated regularly for almost 30 years. At this age, the ovaries gradually begin to produce less estrogen. In the transition to menopause, ovulation happens less frequently, and some months pass without an egg being released at all.

Imbalance sex hormones

There is also a reduction in progesterone production as well. When progesterone and estrogen levels are low, the pituitary gland tries to compensate, leading to irregular periods as hormone levels fluctuate. Eventually, the ovaries stop producing eggs.

Menopause usually occurs between the ages of 40 and 60, with 52 being the average age. When a woman has ceased having menstrual periods, she is considered post-menopausal.

Estrogen or Female Sex Hormone

All your life, this hormone has been quietly, profoundly affecting your health and well-being in a number of ways. Estrogen as common term, refers to a group of sex steroids, produced in both men and women, but women produce more. From your menstrual cycle to your brain, bones, and heart, estrogen plays many important roles in the body. As you go through menopause, your body’s estrogen levels change. The effects can be quite noticeable.

The first sign of menopause

For many women, one of the first signs of menopause is a menstrual cycle that changes in length, becoming either shorter or longer. Estrogen maintains the regular length of your cycle. As menopause approaches and estrogen levels fall, the amount and length of bleeding in a period may become erratic. The shifting of estrogen levels can result in changes in neurotransmitters. This hormone maintains the structure of your vulva and vagina.

When estrogen levels are low

Both the inner and outer labia shrink, and the vulva becomes thinner. The vagina’s mucous membranes shrink and become thinner and smoother. The vagina produces less lubrication, and the pH of the vagina changes, making it more vulnerable to harmful bacteria such as E. coli, which increases the risk of urinary tract infections.

Estrogen seems to have a direct effect on the libido, and not just because it makes sex more comfortable by keeping the vagina healthy and well lubricated. Estrogen makes women feel sexier; many premenopausal women notice a surge in sexual interest around ovulation when their estrogen level is at its peak. A decline in estrogen levels can make a woman less interested in sex.

Decreased estrogen levels cause shrinking of the urethra, which can lead to bladder control problems as well as urinary tract infections. During puberty, estrogen causes the growth of the breasts and the milk-producing breast ducts. Once the breasts are developed, estrogen plays a role in maintaining their size and density.

When estrogen levels fall during menopause, the breasts may shrink. As estrogen stimulates some cell growth, estrogen may play a role in the development of certain forms of breast cancer. However, new research suggests that it is actually abnormal metabolism of estrogens that results in increased cancer risk and that some metabolites of estrogen can actually decrease the risk of breast cancer.

Estrogen contributes to the health

Of the skin, which is largely made of a protein called collagen. The amount of collagen in the skin is maintained by estrogen and decreases after menopause. It increases the water content of the skin, thus contributing to its thickness and softness. Estrogen also increases the number of blood vessels in the skin. This increase in blood vessels makes the skin feel warmer and is one of the factors that cause hot flashes.

Many women find that when their estrogen level goes down, they get depressed. We know that it affects a number of neurotransmitters that influence mood, memory, and motivation.

Estrogen is mood-elevating effects

Estrogen improves memory

Estrogen promotes mental functions

Many studies have shown that estrogen improves verbal memory and helps one learn new things. There is also evidence that estrogen enhances a woman’s reasoning, formation of new concepts, and fine motor skills

Estrogen helps the brain function properly by stimulating nerve growth and maintenance. An important area of current inquiry is whether estrogen protects against Alzheimer’s disease and other severe age-related mental impairment. Alzheimer’s disease affects women more often than men, and that postmenopausal women who take supplemental estrogen have a lower risk for Alzheimer’s than women who don’t.

Estrogen prevents osteoporosis and heart disease

One of the most common reasons for taking estrogen is to prevent osteoporosis and heart disease. Estrogen protects your bones and heart, and when your estrogen levels drop during menopause, your risk of serious health problems increases. Estrogen helps maintain your bones by restraining the activity of special cells (known as osteoclasts) that break down bone tissue.

It may also promote the formation of new bone cells. When you enter menopause, your bones can rapidly deteriorate as your body’s lower estrogen levels allow too much bone to be broken down. Research has demonstrated that estrogen-deficient women are much more vulnerable to bone loss than women with sufficient estrogen.

Estrogen prevents cholesterol

There is also evidence that women become more vulnerable to heart disease once estrogen level begins to drop. Some of the reasons for this increased risk are believed to be due in part to changes in lipids (fat molecules) in the blood. Cholesterol is the chief blood lipid. Estrogen lowers “bad” cholesterol levels and prevents it from being oxidized, a change that makes it more harmful to the walls of the blood vessels. Thus estrogen increases “good” cholesterol and has a positive effect on other important lipids and components of the blood.

Estrogen supplementation after menopause has also been found to help reduce high blood pressure and improve blood flow to the coronary arteries. Another health risk to consider is insulin resistance. Insulin resistance increases the risk for heart disease and other serious health problems. And estrogen protects against insulin resistance.

Estradiol

Of the three types of estrogen, estradiol is the most powerful; it is produced primarily by egg follicles in your ovaries.

Estradiol role in the reproductive or menstrual cycle, estradiol affects many other parts of your body. It stimulates the development of your breasts and keeps your uterus, vagina, urinary tract, and surrounding pelvic muscles and tissues toned and firm.

Estradiol influences also your central nervous system, bones, hair, and skin

During menopause, fluctuating hormones lead to a group of fairly predictable symptoms in many women, but the frequency and intensity vary considerably.

Estradiol’s most common and noticeable changes are in menstrual patterns, hot flashes, shrunken genitals, bladder problems, sleeping disorders, fatigue, emotional changes, loss of libido, and increment of other serious diseases.

Being one of the most hormonal compounds in your body, virtually all your (female) body’s systems are affected by its presence; heart or cardiovascular system, nervous system, skin, skeleton, reproductive organs, tissues, and urinary system. So, when the ovaries stop releasing eggs and producing estrogen, these systems are all affected.

Premature menopause

Women who go through menopause in their 30s or early 40s are missing out on estrogen for a longer period of time than their peers. As a result, they may lose more bone density or experience vaginal atrophy, or even see an increase in cholesterol levels sooner than most women who go through menopause at later years.

Surgical menopause

Some women had a complete hysterectomy in which the ovaries, as well as the uterus, are removed are often needed estrogen replacement. The reason is the same for women who experience menopause at a young age. The estrogen depletion affects many body tissues and may prematurely age women. Doses of estrogen are typically higher for hysterectomized women due to surgical removal of the ovaries brings on sudden menopause.

Signs and symptoms of menopause

These general complaints, as we have already mentioned, frequently commence before menstruation has ceased, and may continue long after menopause. Finally, the body becomes accustomed to the elimination of ovarian activity, a new equilibrium establishes itself among the endocrine glands other than the ovaries, and the complaints disappear. There is much disturbance in which the deficiency symptoms during menopause may appear.

Is menopause a sign of aging or hormone imbalance?

Although science has been studying aging for decades, we’re still not sure what aging actually is, let alone what causes it. One theory is that to a certain extent aging is genetically pre-programmed: our cells are destined to give out according to a fixed timetable and witness our dwindling supply of eggs.

One influence on aging seems to be cellular damage by toxic oxygen molecules called free radicals. The free radical molecules are missing an electron, and they try to replace their missing electrons by robbing electrons from molecules in healthy cells. Then the robbed molecule tries to rob another electron, and so on, creating a damaging free radical chain reaction in our bodies.

The damage cripples our cells in several ways. It injures the cell membrane and the genetic material contained in DNA (deoxyribonucleic acid). As a result, cells die, malfunction, and replicate themselves imperfectly. Eventually, entire organs and organ systems work less well than they used to.

This accumulation of tissue damage may explain at least some of the signs of aging such as sags and wrinkles, age spots, failing eyesight, weak muscles, and poor stamina, and poor memory. Excessive free radical damage has been linked with abnormal, accelerated aging and many degenerative diseases and conditions such as cancer, heart disease, immune dysfunction, arthritis, lack of energy and stamina, failing memory and concentration, and even diabetes and osteoporosis.

Free radicals are created in our bodies by environmental pollution, radiation, stress, poor nutrition, and our own metabolism. We need some free radicals for normal metabolism and our bodies have mechanisms for controlling them so they don’t get out of hand (like keeping a beach fire within a fire ring) with antioxidants.

Antioxidants are enzymes the body produces or nutrients such as vitamins C and E and beta-carotene; their molecules are capable of losing electrons and “quenching” free radicals without starting a chain reaction. But this system can be overwhelmed by excessive free radicals, which end up injuring our cells. These free radicals are the Hormones.

It has long been known that the time of the change is influenced by a number of factors. Heredity, health, lifestyle habitual, race, climate, food, and constitutional characteristics all play a part in menopause.

Menopause and Climate

In Italy, a warm climate frequently delayed menopause. While women of the South reach sexual maturity, and also lose their attractiveness, earlier than women of the North. However, other investigators have been unable to discover any variation. In our view, it is far more probable that differences in the ages when menopause occurs depend not so much on climatic as on racial and hereditary characteristics.

For instance, if a woman born in the South, who has reached puberty at an early age, gives birth to a daughter in a northern climate, the latter will not follow the native rule in those regions as regards the commencement of menstruation, but will also menstruate earlier. The daughters of these children, though they may also be born in the North, will similarly menstruate considerably earlier, just like their grandmother. The same applies to the climacteric which as a regular rule follows the female family type, and is unaffected by purely local factors.

Menopause and Culture

That menopause in different races occurs at different ages has been known for a long time. Chinese women seldom menstruate longer than until the age of forty. Menopause in Japanese women occurs towards the end of the forties, while an investigation as to the time of menopause in North American Indian women has shown that it often occurs as late as the early fifties and that these women continue to menstruate at an age when women of our own race have long passed the climacteric.

Menopause comes particularly early in women of the black race. For instance, the women of the Woloff tribe have their change between the ages of thirty-five and forty. The women along the Sierra Leone Coast are also said to cease menstruating at an average age of thirty-five.

The reproductive capacity of the women of some Indian peoples is also said to cease earlier than in Europe. Generally, it is safe to say that the climacteric occurs the earlier the more primitive the race to which a woman belongs, and that “the earlier life develops the earlier it decays.

Menopause and Lifestyle

Certain observations confirm the view that the mode of life also influences the time of menopause. It has been asserted that menstruation frequently ceases earlier in working-class women. That undernourishment and overstrain or stress, which frequently occur among working-class women, are conducive to earlier menopause, is of course, obvious. Nevertheless, cases are not rare in which overworked women experienced menopause later than usual.

Constitutional factors naturally play an important role in the earlier or later appearance of the climacteric, but comparatively little is known on this subject. Some authors hold that menstruation continues longest in big-boned, not-too-fat women with dark hair.

That menopause frequently comes early in the case of infantile individuals, is comprehensible, since impeded general development would naturally lead to an early cessation of the inadequate function of the ovaries. Women with masculine characteristics also frequently incline to early menopause.

It is generally agreed that women who begin to menstruate early usually continue to menstruate fill later in life, while women who begin to menstruate late usually cease to menstruate early. A further factor affecting the time of the climacteric is represented by a series of diseases of the genital organs.

Severe illness of any kind or other exhausting occurrences that may bring about an early change of life is, of course, only natural. But trauma violent impressions of a psychical nature may also lead to sudden menopause, as has been observed in numerous cases.

Sudden fright, fear, grief, and worry are psychical traumas that may cause a temporary cessation of the menses even at the age of sexual maturity, but at an advanced age they may bring about final menopause and a definite cessation of the menses.

Menopause and Food, Nutritional Supplement

You walk into a health food store and feel overwhelmed by the walls of supplements. Or you have a friend who swears by a certain multi-vitamin and mineral supplement. New articles are always coming out touting this vitamin or that.

We take supplements to prevent illness or certain diseases, boost our body system, or simply keep up with sufficient calcium and vitamin C that we can’t achieve just by eating natural food.

Some nutritional supplements can help minimize menopausal symptoms or slow down the aging process. To eat healthily during this transition, you’ll probably need to consult nutritionists, health specialists as well as general practitioners on whom you can rely for guidance and advice. If the aging body does not get enough nutrition, health will deteriorate faster.

Therefore proper eating in the early years should be taken note of. That is why children and young adults are encouraged to drink more milk, eat more food with soy, vitamins, and minerals. These accumulations will help in health when you reach menopause and into later years.

As we know, the most striking symptom indicating the change of life is the sudden or gradual cessation of the menses at a suitably advanced age. As regards the manner of this menopause cessation of the menses, the most varied types (types of menopause) have been observed.

Sign of menopause

In some cases where menstruation ceases gradually, this occurs in such a manner that the menstrual flow recurring about every four weeks becvulvaomes less and less intense; and finally ceases altogether; while in other cases not only are the duration and intensity of the menstrual flow reduced, but the interval also becomes longer and longer, until the menses finally cease and the menopause occurs.

It may even happen that the menses apparently stop completely for a longer or shorter period, and then recur at regular intervals, and finally cease altogether.

However, experience has proved in connection with the after type of case that the resumption of menstruation is often due to a pathological process, so that a thorough examination and careful observation of the patient.

Symptoms of fake pregnancy

Sometimes there is a sudden and final cessation of the menstrual flow, mostly accompanied by more or less serious general complaints. The woman concerned may interpret the absence of the menses, as a sign of pregnancy, and this may be accompanied by all the symptoms of “fake pregnancy.”

A medical examination in such cases will immediately reveal the truth. Sudden and final cessation of the menses may often be observed in cases of premature climacteric. However, although the cessation of the menses is the most obvious symptom, it is not the only one that appears during the period of the change.

There are, in addition, changes in the genital of the woman, consisting in processes of retrogression due to the stoppage of ovarian activity, the ultimate cause of which is still unknown. In this connection it should be noted that although the shrinkage, referred to above, commences with the stoppage of ovarian activity, it only concludes very late in life, steadily increasing from this starting point.

Menopause Stages

Strictly speaking, menopause is your final menstrual period. It is an event you can determine only in retrospect. Although most people use the term menopause to identify the years surrounding this event, what we commonly refer to as menopause actually has several phases.

1. Premenopause occurs before menopause and is the time during which brain hormones begin to increase and ovarian hormones estrogen and progesterone begin to decrease. Menstrual periods may begin to become irregular. Most women become premenopausal after age forty.
2. Perimenopause is the term used to identify the approximately two years before and after your final period, and is the time when most of the physical signs of menopause occur, such as hot flashes and irregular periods. In some women, perimenopause lasts longer. Menopause is your final menstrual flow; this can only be identified with certainty one year after the fact. For example, average age of menopause in the United States is around fifty.
3. Postmenopause, or the climacteric, refers to the years after your last menstrual period. Your body continues to undergo hormone-related changes, but these tend to be more gradual and subtle. Although it is impossible to predict when you will experience menopause, there are some guidelines. You’ll probably undergo menopause around the age your mother did, unless you’ve smoked quite a bit, which hastens menopause.

If a woman had a hysterectomy, it can hasten menopause or even immediately stopped menstruation too, and so can giving birth to twins. Being overweight, on the other hand, helps delay it.

Menopause and genital change

1. Menopause Vulva
   The layer of fat in the region of the mons Veneris and in the large lips of the vulva may start to shrink. The vulva may become smaller and flabbier, the small lips become withered and change into thin folds. The fatty glands, formerly present in more than adequate amounts, may disappear almost completely, so that there are only remnants of them left.
2. Menopause Vagina
   The vagina may gradually lose its internal folds and become smooth. Its membrane looks dry. It is thinner and less muscular than before. In the course of the further process the vaginal tube gradually shrinks, becomes narrower, shorter, and less elastic.
3. Menopause Uterus
   The uterus, at the beginning of the change of life, frequently contains an increased supply of blood, so that this organ increases in volume. Soon, however, the uterus also shrinks, and its muscles gradually atrophy as a result of slow degeneration at certain points. The uterus consequently becomes considerably smaller, thinner and narrower, and acquires a flat appearance. The shrinkage of the oviducts is characterized by the fact that the tubes become thinner and shorter, their cross section gradually decreasing.The principal change in the ovaries of a woman during the menopause consists in the fact that they cease to produce follicles. The connective tissue predominates and is strikingly coarse. Further, there are certain changes in the blood vessels, and from the blood vessels this degeneration progresses to the tissue, which assumes a peculiar glassy appearance.
4. Menopause Ovaries
   The ovaries become smaller and coarser and are frequently flattened. Their surfaces become pitted, so that they sometimes resemble the stone of a peach. The changes in the genital organs are accompanied by changes in the appearance of the woman concerned, which start during her menopause and almost imperceptibly develop into those changes which are commonly known as senility. In a few cases the climacteric coincides with incipient senility, but in the majority of women at this age there is a series of characteristics that have nothing in common with senility. As they vary according to the individual and are frequently connected with constitutional factors, which are important.
5. Menopause Weight Gain
   The general changes in these women during menopause are very slight, and the “crisis” passes over them almost unnoticed. The fat deposits all over the body increase, but without disturbing the shape of any part, states that all the soft curves and which men find so attractive in women.
6. Menopause Breasts, Menopause Abdomen, Menopause Hips, Menopause buttocks
   Even the face remains smooth and even, resembling during this period that of a child. But most parts of the body literally slide down, and that, in particular, the cheeks, throat, breasts, abdomen, hips, and buttocks become less elastic and flabby, which leads to the sagging not only of the abdomen, but also of the chest.
7. Menopause Skin
   During menopause, this congenital flabbiness becomes intensified. The tension and elasticity of the skin is reduced, so that it is incapable of bearing the peculiar fat deposits collected under the skin. The form of the fat that forms during the climacteric is also characteristic. It appears in the form of lumps of fat, and differs very considerably from the continuous layers of fat of previous years. These accumulations of fats usually occur on the cheeks and under the chin, the temples usually remaining free.The result is the characteristic shape of the face, with pendent fat cheeks and a lump of fat under the chin, covered with atrophied, wrinkled skin. Frequently there is also an accumulation of fat on the neck, but the skin usually remains more supple than on other parts. Similarly, there are accumulations of fat above the collar-bones, which persist even if the rest of the body is lean to the point of emaciation.
8. Menopause Arms
   On the arms, however, the roundness of previous years usually disappears, the skin becoming flabby and pendent, and the muscles soft. The breasts also become considerably fatter and pendent, the areola diminishes and loses its original shape. The accumulation of fat in the buttocks and hips, accompanied by loss of suppleness in the skin, causes these groups of muscles to move sideways and downward, thus distorting the form of the feminine body.
9. Menopause causes other changes
   Women, with certain masculine characteristics even during the period of sexual maturity, during the period of the change they develop definitely virile characteristics which give them their peculiar impress. They are generally tall, lean, big-boned women, who even during the menopause transition incline to leanness rather than to the accumulation of fat. The face assumes a distinctly masculine character, the features becoming sharper and more distinct, and an abnormal growth of facial hair may also appear, or, alternatively, a darkening of the existing growth.
10. Other menopause symptoms are
    The coarsening of the voice (in some cases), due to changes in the larynx, and, in the majority of cases, an almost complete disappearance of the mammary glands.
    The nipple on the other hand, becomes more prominent, and the areola becomes darker and, sometimes, studded with hair. The growth of hair over the rest of the body, including the sexual organs and the legs, becomes intensified, and dirty-brown spots may appear on the back and elsewhere.

Female menopause, is it nature’s mistake?

The prevalent medical view holds that nature didn’t mean for us to live long after our reproductive days are over. Throughout much of history, women died before menopause because of disease, childbirth, infections, and a slew of other medical problems that Western medical care can now cure or prevent.

As early as 1900, American and European women lived to an average of only forty-five. Others say menopause and the climacteric are nature’s way of being smart. Perhaps menopause evolved in humans because by giving us a period of life when we could no longer reproduce, it free us from late-born children or distractions of additional pregnancies or more of our own young ones. It allowed us to accumulate more wisdom and gave us time to transmit cultural knowledge to the next generation.

Healthy menopausal women often have plenty of hormones for everything but childbearing. Nature continues to provide us with estrogen, only at lower levels. After our ovaries no longer produce significant amounts of estrogen, the adrenal glands, when healthy, take over. They produce hormones, such as androstenedione, which are converted into estrogen by fat cells and in other parts of your body such as muscle, liver, kidney, brain. The estrogen produced by extra fat cells may explain why many women who weigh more are reported to have an easier time adjusting to menopause.

Commonly known as the “change of life,” it is the period in a woman’s life when her reproductive capacity ceases, the ovaries ceasing to mature ova and to render them capable of fertilization, in addition, it also stops producing the hormones estrogen.

It is a biological transition, which, all-woman will experience in her 40s to 50s. The most obvious phenomenon is the cessation of menstruation. The duration of this transition period varies from person to person and the changes may go on gradually for 10-15 years.

Just as the commencement of ovarian activity during puberty is diagnosed from the first menstruation, it is customary to diagnose the beginning of “the change,” at a suitable age, from the most obvious phenomenon, the gradual or sudden cessation of menstruation. However, the end of menstruation is not a wholly correct conclusion and it is not the only symptom.

There is no predicting your own menopause may be long or short, bumpy or smooth. Nor can you foresee the time when you will begin it.

Some women may be able to rely on their mother’s history as foreshadowing, but it does not always follow that a daughter’s menopause mimics her mother’s pattern. Your mother may have had a hysterectomy, in which case you have no precedent for the timing of natural menopause, which usually happens around age 40s.

Many women have had surgical menopause, where the ovaries, as well as the uterus, are removed, and for them menopause is immediate.

Early menopause

before age of 45, is also not uncommon and may take by surprise a woman who’s been trying to conceive. Women who have been amenorrheic (without menstrual periods) because of over-exercising or anorexia nervosa may be dealing with the same issue of estrogens depletion that a 50-year-old menopausal woman is.

Replacing estrogen becomes more important because of the extended number of years without it. So the issues of women who are going through natural menopause often align with concerns of those younger women who are already dealing with the consequences of hormone loss.

Due to decreasing and imbalance of female sex hormones, it gives rise to some discomfort to the female body. It is difficult to establish that the period of change in all cases precedes old age, as the transition often reaches into old age. It marks the commencement of the aging of the entire body, and particularly of the genital organs. Whenever and however menopausal changes appear, it can be valuable to have information beforehand, and while you’re experiencing menopause.

Studies have shown that women who are prepared to take charge of their own health care tend to do best through the menopausal passage. Information can function as your survival kit as you negotiate your way through this very important change in your life.

Menopause begins at

Statistical investigations of menopause have provided us with some information concerning the average age of menopause. Thus a considerable amount of clinical material has been sifted with a view to establishing the commencement, duration, and cessation of menstruation. The average age was 47.25 years which tallies with the general view that the change in our latitudes usually takes place between the ages of 45 and 50.

1. 3.65% of cases at the age of 40 years.
2. 20.5% of cases at the age of 40 to 44 years.
3. 44.19 % of cases at the age of 45 to 49 years.
4. 30.01 % of cases at the age of 50 to 54 years.
5. 1.64 % of cases at the age of 55 to 57 years.

It is also observed the occurrence of the climax between the ages of forty-five and fifty in 54.15 percent of cases; in 18 percent. of the cases, menopause occurred later, in 34.85 percent before the age of forty-five. The average age for the first menstruation in Europe is fourteen and for the cessation of the menses, around forty-six years. However, the normal range of fluctuation in respect of menstruation is from the tenth to the twenty-first year, and in respect of the menopause, from the thirty-sixth to the fifty-sixth year.

What is Menopause?

Women often feel confused about just what this important passage will do to their lives and how they should approach it. Part of the reason is that no one (doctor, friend, or scientific study) can tell a woman what her own menopause will be like. Every woman goes through menopause in a unique and different way.

Some of the natural changes of aging appear concurrently with menopause, so it may be difficult to separate the signs and symptoms related to menopause from other changes that may warrant medical attention.

Menopause marks the beginning of the second half of life or the turning of life. Although this change is to be expected, our society tends to be to ignore and exaggerate its importance. And because we are so youth-orientated, most viewed menopause as aging.

Instead, why not rejoice in the arrival of menopause?

It is time to say goodbye to heavy periods, PMS, reproduction, and sexual desirability.

Becoming well informed is not easy. To whom can we turn for reliable, safe, and personalized health care information. For whatever reason, most women are not getting all the information they need about menopause from their doctors.

Research has revealed that only about one-third of women in menopause receive education about the process from their doctors. Many feel hesitant about talking to their doctors and they have trouble finding a doctor who would simply listen to their concerns. Not all doctors think menopause should be treated since it is a natural process.

Most menopausal women are prescribed HRT and they wondered whether it’s really possible to find some answers elsewhere. Those facing menopause often have a feeling of uncertainty. They may fear the loss of control or feeling “out of sorts.” Having no set expectations makes the anticipation worse.

While a minority of women report no symptoms of menopause, the usual course is that a woman will begin feeling changes during perimenopause, which can last from two to five years leading up to menopause.

Just like during puberty, the preparation of the entire organism for the phase of sexual maturity is gradual, so the transition to the changes characteristic of menopause takes place gradually, producing a series of symptoms known as climacteric symptoms.

It would be difficult to establish that the period of change in all cases precedes old age, as the climacteric often reaches old age. It marks the commencement of the aging of the entire body, and particularly of the genital organs.

Positive menopause approach

Menopause is not a disease or a medical condition. There is nothing dreadful about it but rather a time of physical, spiritual, emotional, and freedom. If you haven’t agreed with me, think about all the positive physical changes in menopause.

No more period cramps, tampons, or pads, no embarrassing leaks and stains, no PMS, no more painful swollen breast, migraine, and mood swings! And the happiest freedom, no more fear of pregnancy. Some women enjoy greater sex with newfound freedom.

As we mature, we become more accepting of our appearances. Many women choose this special time to rediscover their life, and dreams and find their inner self, the inner beauty. Let your inner beauty shine with strength, wisdom, and experience. Get basic knowledge of menopause and it will help you understand how it can affect you on related problems and treatment.

Usually of the dull, aching variety, develops for some men who spend a significant amount of time in sexual play or in reading pornographic literature, concurrently maintaining erections for lengthy periods of time without ejaculating within the immediate present.

Frequent returns to excitement or even plateau-phase levels of sexual stimulation without ejaculatory relief of the accompanying testicular vasocongestion can cause aching in either or both testes, particularly in younger men.

Testicular pain

Relief is immediate with ejaculation, which disperses the superficial and deep vasocongestion and returns the testicles to their normal size. No permanent damage is occasioned by maintaining chronic testicular congestion for a period of days.

Men with this syndrome of testicular pain occasioned by long-maintained sexual tension are in the minority. Usually, the syndrome of involuntary testicular pain is relieved somewhat as the man ages.

There are painful reactions that develop during or shortly after the coital connection that particularly reflect the influence of the vaginal environment. These situations are mentioned only in passing, but the therapist should keep in mind the fact that the basic pathology involved rests within the vaginal environment.

Many men complain of burning, itching, and irritation after coital connection with women contending with chronic or acute vaginal infections.

Not infrequently small blisters appear on the glans penis, particularly around the urethral outlet. If there are any abrasions on either the glans or shaft of the penis, secondary infection can occur in these local sites.

The same type of irritative penile reaction may develop from exposure to a noninfectious vaginal environment as a response to the chemicals in contraceptive creams, jellies, foams, etc. It may not be the female that responds in a sensitive manner to an intravaginal chemical contraceptive agent but rather her male partner.

Sensitivity to intravaginal chemical contraceptives is seen quite frequently in males and, if symptoms develop, the contraceptive technique should be changed.

The same sort of irritative penile reaction can be elicited by a repetitive pattern of vaginal douching. There are some douche preparations to which not the female but the male partner becomes sensitive. Not infrequently, vesicles form on the glans penis. If these blisters rupture, the raw areas on the glans are quite painful, particularly during sexual connection.

In the actual process of ejaculation, there are many situations that return painful stimuli to the involved male. If the individual has had gonorrhea there may be strictures (adhesions) throughout the length of the penile urethra, and attempts to urinate and/or ejaculate may cause severe pain spreading throughout the penile urethra and radiating to the bladder and prostate.

Infection in the bladder, the prostate, or the seminal vesicles

There may be the sensation of intense burning during and particularly in the first few minutes after ejaculation. Particularly if the offending agent has been the gonococcus, the pain with ejaculation sometimes is exquisite. Immediate medical attention should be given to any complaint of burning or itching during or immediately after the ejaculatory process.

There is a spastic reaction of the prostate gland seen in older men during the stage of ejaculatory inevitability.

In this situation, the prostate contracts spastically rather than in its regularly recurring contractile pattern, and the return can be one of very real pelvic pain and/or aching radiating to the inner aspects of the thighs or into the bladder and occasionally to the rectum. This pathologic spastic contraction pattern can be treated effectively by providing a minimal amount of testosterone replacement therapy.

Care should be taken to evaluate the possibility of concurrent infection in the prostate. Occasionally, chronic prostatitis has caused significant degrees of pain during an ejaculatory process.

As a point in differential diagnosis, the painful response with prostatic infection is with the second, not the first, stage of the orgasmic experience, while that of prostatic spasm has just the reverse sequence. Careful questioning usually will establish specifically the timing in the onset of the painful response and thus suggest a more definitive diagnosis.

Benign hypertrophy of the prostate gland primarily and carcinoma

The prostate rarely may be responsible for the onset of pain with the ejaculatory process. The pain is secondary (acquired) in character and radiates to the bladder and rectum. Usually confined to older age groups, the onset of this type of dyspareunia should be investigated immediately by the competent authority.

This review of the major causes of dyspareunia has been primarily directed toward the female partner, for from her come by far the greater number of complaints of painful coital connection.

However, male dyspareunia no longer should be ignored by the medical and behavioral literature. The review of the etiology of male dyspareunia has not been exhaustive, nor is it within the province of this text to do so.

In concept, the entire chapter has been designed to suggest to co-therapists, faced daily with a myriad of problems focusing upon both male and female sexual dysfunction, that there are physiological as well as psychological causes for sexual inadequacy.

Combined pelvic and rectal examinations for the female and rectal examination for the male partner are a routine part of the total physical examination provided for both members of any marital couple referred to the Foundation for treatment of sexual dysfunction.

To attempt to define and to treat the basic elements of sexual dysfunction for either sex without including the opportunity for thorough physical examination and complete laboratory evaluations as an integral part of the patient’s diagnostic and therapeutic program is to do the individual and the marital couple a clinical disservice.

Many men are distracted from and even denied effective sexual functioning by painful stimuli occasioned during or after sexual functioning.

The symptoms will be described in relation to the anatomical site of pain, the external anatomy, such as the surface of the penis and the scrotal sac, or the internal anatomy, such as the penile urethra, the prostate, or the bladder.

No attempt will be made to provide definitive discussion for the varieties of male-oriented dyspareunia. Situations are mentioned only to emphasize their existence and to provide the therapist with an awareness of the fact that, in truth, there are “badly mated” men.

External anatomy of the penis

Many men complain of severe sensitivity of the glans penis, not only to touch but to any form of containment (including intravaginal retention) immediately after ejaculation. This severity of glans pain recalls the intensely painful response that may be elicited from the clitoral glans when it is approached during forceful male manipulative attempts to incite sex-tension increment for his female partner.

Once a man is fully aware that immediately after his ejaculatory episode there may be exquisite tenderness of the glans, he realizes that he must immediately withdraw from intravaginal containment. Generally, there is marked variation in the severity of the individual response pattern.

Men noting variation in the severity of glans pain have no pre-ejaculatory warning of the intensity of the particular response pattern, which may range from minor irritation with containment to crippling pain with the slightest touch.

The glans occasionally is irritated rather than protected, as might be presumed, by a retained foreskin. Two men have been referred to the Foundation complaining that relief from painful stimuli immediately after ejaculation can be obtained only by retracting the foreskin well back over the glans and in this fashion relieving the irritation of glans confinement.

There are occasional irritative responses created by the retained foreskin of uncircumcised men. In almost all instances these irritative responses have to do with a lack of effective hygienic habits.

Primarily, smegma and, secondarily, various bacterial, trichomonal, or fungal infections sometimes collect beneath the foreskin. If the foreskin is not retracted regularly and the area is washed with soap and water, chronic irritation can easily develop.

With chronic irritation or even frank infection present, there usually will be pain with coital thrusting or with any form of penile containment. In almost all instances the dyspareunia responds readily to adequate cleansing principles.

Phimosis

A tightness or constriction of the orifice of the prepuce clinically is marked by a foreskin that cannot be retracted over the glans penis.

With an excessively constrained foreskin, infection is almost always present to at least a minor degree, and penile irritation is a consistent factor for men so afflicted. Adhesions frequently develop between the foreskin and the glans proper so that there is no freedom of movement between the two structures.

Engorgement of the penis with sex-tension increment may bring pressure to bear on the foreskin constraint of the glans. Without freedom of foreskin movement, this constriction frequently causes local pain with penile erective engorgement.

When any male is diagnosed as having a degree of clinical phimosis sufficient for chronically recurrent infectious processes and/or pain or irritation with coital connection, circumcision certainly is in order.

There are also occasional men with a true hypersensitivity of the penile glans. These men are almost constantly irritated by underclothes or by body contact. They are continually aware of a multiplicity of irritants and are particularly susceptible to trauma to the glans.

One man referred for consideration found glans constraint in the vaginal environment intolerable. There was constant blistering and peeling of the superficial tissues of the glans surface. Despite a history of numerous changes in sexual partners, the postcoital results were identical. This individual simply could not tolerate the natural pH levels of the vagina.

Since the reaction was confined to the glans area and never involved the penile shaft, there is room for the presumption that if he had not been circumcised routinely, he might not have been so handicapped. Protective coating of the glans area precoitally resolved his problem but was a nuisance factor for him and possibly for his sexual partners.

There are occasional instances of referred pain from the posterior urethra (usually occasioned by posterior urethritis) that produce pain in the glans penis. Very rarely, this type of glans pain is a factor in coition.

Peyronie’s disease

Produced by induration and fibrosis of the corpora cavernosa of the penis and evidenced as an upward bowing of the penis, plus a gradually increasing angulation to the right or left of the midline, makes coital connection somewhat difficult, and in advanced stages coition is virtually impossible.

There also may be pain attached to attempts at coital connection due to the unusual angulation of the penis creating resultant penile shaft strain, both with inserting and with thrusting experience.

Penile chordee

Downward bowing or curved penis, is seen rarely in situations of penile trauma and only occasionally with neglected gonorrheal urethritis. Consultation has been requested by four men with severe penile chordee as a post-traumatic residual.

In two instances the fully erect penis was struck sharply by an angry female partner. The remaining two men each described severe pain with a specific coital experience. During uninhibitedly responsive coital connection with the female partner in a superior position, the penis was lost to the vaginal barrel.

In each case, the women tried to remount rapidly by sitting down firmly on the shaft of the penis. The vaginal orifice was missed in the hurried insertive attempt and the full weight of the woman’s body was sustained by the erect penis.

Each of the four men gave the remarkable verbal description that he felt or heard “something snap.” Shortly thereafter an obvious hematoma appeared on the anterior or posterior wall or lateral walls of the penile shaft.

Over a period of weeks, as the local hemorrhage was absorbed, fibrous adhesions developed, and with subsequent scar formation, there slowly developed a downward bowing and (in three cases) mild angulation of the penis.

Urologists state that due to the type of tissue involved in the penile trauma, there is little to offer in the way of clinical reprieve for men afflicted with these embarrassing erective angulations (Peyronie’s disease or chordee).

Attempts at surgical correction currently are of relatively little value and do not infrequently make the situation worse. Any of these situations create responses of pain and tenderness during both masturbation and coital connection.

It always should be borne in mind that the erect penis can be traumatized by a sudden blow, by rapidly shifting coital position, by applying sudden angulation strain to the shaft, or from violent coital activity that places sudden weight or sudden pressure on the fully erect penis. The unfortunate residuals of such trauma have been described above.

Direct trauma of the penis occasioned by major accidents, war injuries, or direct physical attack sometimes requires that treatment for sexual dysfunction be patterned to include marked variation in the anatomical structuring of the penis. In anatomical deformity of the penis, the complaint of dyspareunia can be raised by either the male or female sexual partner.

A disease in which implants of endometrial tissue spread throughout the pelvic viscera and their protective covering, the peritoneum. When examined microscopically, this ectopic tissue resembles the lining of the inner cavity of the uterus.

The tubes, ovaries, broad ligaments, omentum, and the posterior wall of the uterus may be involved by firm fibrous adhesions. There are even many instances of tying together omentum and bowel with the reproductive viscera into large pelvic masses.

The etiology of endometriosis has not been fully established. It would not serve the purposes of this text to enter into a detailed discussion of the subject. Although endometrial implants appear in many anatomical areas other than the pelvic viscera, consideration will be focused alone on local pelvic implants.

Even if there are no major adhesions in the pelvis, there are at least minor elements of continuous local peritoneal irritation. Endometrial nodules usually can be felt most effectively with the simultaneous manual pelvic-rectal examination.

Again, the pain created by intercourse is due to the constriction and immobilization of the peritoneum and the firming up of the soft tissues of the pelvis by adhesions.

The pelvic structures have progressively less facility to distend, expand, and move freely as the endometriosis progresses. There is consequently more local tissue resistance to involuntary vaginal expansion, uterine elevation, and male pelvic thrusting.

In all situations that create chronic irritation of the pelvic peritoneum, fixation of the uterus, or constriction of the vaginal barrel, pain with intercourse is a relatively constant finding.

Treatment For Endometriosis

is it either medical or surgical depending upon the degree of soft-tissue and pelvic visceral involvement?

But once endometriosis has developed to a point at which there is significantly severe pain in response to coital activity, there must be the definitive treatment of the condition, or the individual woman will have little hope of relief from the symptoms of progressively increasing dyspareunia.

Post Surgical Dyspareunia

There are three important sources for acquired dyspareunia following removal of the uterus for specific organ pathology.

(a) dyspareunia results from thoughtless surgical techniques. Physicians, when performing a hysterectomy, may overlook the fact that the cervix enters the vagina through the superior wall of that organ.

When the wound in the vaginal barrel is repaired after removal of the cervix, if care is not taken to retain a superior position for the vaginal cuff, the scarred area, instead of being retained in the superior vaginal wall, may be pulled into the depth of the barrel by tissue constriction or by excessive folding or removal of vaginal tissue.

Postoperatively when the husband thrusts deeply into the vagina, the penis can come into contact with the resistant scarred area. There is a little residual facility for involuntary vaginal distention in the area of the surgical scar.

Therefore, dyspareunia of significant proportion develops occasionally as a post-surgical complication. Since this unfortunate result usually does not develop for months or even a year after surgery, the operating surgeon may never be made aware of the acquired dyspareunia.

(b) opportunity to acquire dyspareunia is occasioned by the surgical indications for removal of the ovaries at the time the uterus is removed, or for that matter, at any time. If post-operative sex-steroid replacement is not initiated, many women will develop senile changes in the vagina and, in time, secondary dyspareunia.

(c) dyspareunia after hysterectomy rarely comes to the attention of the operating surgeon. The etiology of the acquired dyspareunia may be subjective in origin.

If the woman facing a hysterectomy and/or removal of the ovaries is not reassured with her husband that there need not be a reduction of sexual drive or orgasmic facility after surgery, her fantasy and her friends’ “old wives’ tales” may, by the power of suggestion, create fears of sexual performance for the anxious woman.

If she feels that she is going to be castrated, and sex-steroid-replacement therapy is not explained and offered as indicated, she well may believe that after surgery there will be a loss of ability to respond in a sexually effective manner in the future. What is worse, an uninformed husband may have similar concepts.

If anything, sexual responsivity should be higher shortly after than immediately before surgery. The pelvic pathology for which the hysterectomy or oophorectomy is indicated usually detracts from sexual effectiveness by creating a state of ill health which, in turn, reduces innate sexual tension.

When the offending condition is removed and the general state of health consequently improved, there usually is a reawakening of sexual interest. If women are not reassured before surgery, many presume that, in the future, intercourse will provide no return for them or for their husbands, or that intercourse will even be painful.

Any woman has only to be sure that she will be distressed by future coital connection to take a long step toward acquired dyspareunia.

Syndrome of The Broad Ligament

There are, of course, many factors other than the major ones of infection, endometriosis, post-surgical objective and subjective complications, and the syndrome of a broad-ligament laceration that create painful stimuli from irritated peritoneal and pelvic soft tissues in response to coital connection.

These include tumors of the uterus, such as myomas (fibroids), ovarian cysts and solid tumors, and, carcinoma of the female reproductive tract.

Any of these tumor growths occasionally incite the onset of the complaint of acquired dyspareunia. Those interested can find more definitive evaluations of this physiological source of dyspareunia in current gynecology textbooks.

Thus, the basic premise with which the Foundation approaches the problem of dyspareunia is one of elimination of possible pathological reasons for the complaint. If a woman complains of pain with intercourse, her complaint is accepted at face value, and steps are taken to identify the biophysical source of the coital distress.

The diagnosis of psychosomatic dyspareunia, unquestionably of the moment in the sexual-response field, must be made by exclusion. To assign subjective origins to pelvic pain, regardless of the patient’s personality structure, without definitive physical evaluation of the pelvis, can result in clinical mismanagement of patients.

Certainly, there are times when, after every effort has been made to establish the physical source of the pelvic pain, subjective etiology for the complaint will be considered strongly. But the initial biophysical investigative effort must be made by the competent authority.