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Section 16
Menopause: Social Expectations, Women’s Realities

Question 16 | Test | Table of Contents

Introduction
Menopause creates tension between a woman’s expectations, social expectations, and the particular realities of each woman’s circumstances. Understanding these tensions is essential to effective mental health assessment and treatment. With respect to sexuality, for example, there may be a cultural or personal expectation that sexual desire will wane with increasing age, while in fact a woman’s libido increases – or a woman may expect to retain an active interest in sex, but experience physical and psychological changes that decrease her interest. A woman may experience the maturation and departure of her children from the family home as liberating, although she is expected to mourn over her "empty nest." Most women expect their marriages to last throughout life, but mates can be lost to divorce or death around the time of menopause. Unfortunately, ruptured marriages are associated with a significant loss of income, confronting women who expected to be financially secure at this time of life with adverse circumstances and even poverty. The ethos of a given subculture may demand that a menopausal woman provides child care for grandchildren, while she would prefer to pursue other interests, or to earn money for herself and her family. Conversely, her children may pressure her to find new interests or take on major career responsibilities, while she would prefer to enjoy her home and spend time with her grandchildren.

Sexuality
We are accustomed to referring to sexuality as a human ‘need.’ There is no doubt that some people, at least, pursue sexual activity as they would food or shelter. However, there is no way to determine what kinds or frequencies of sexual activity are "normal". At best, we can try to determine what is normative, or average. We do not have empirical evidence that the absence of sexual activity causes disease or disability. There is evidence, however, that human touch is therapeutic, and that most people, both men and women, continue to be interested in, to engage in, and to enjoy, sexual relationships well into old age.

Although many couples report they maintain sexual relationships as they age, social attitudes towards sex have changed drastically over the lifetimes of today’s menopausal, and even more for post-menopausal, women. Television and motion picture depictions of nudity and sexual intercourse that were banned thirty years ago are commonplace today. Cable television stations carry pornographic material, and, on the internet, pornography sites are among those most frequently visited. While most women, menopausal or post-menopausal, would not have dreamed of discussing explicit sexual issues with their mothers, their daughters take sexual discussions for granted. While post-menopausal women grew up believing that sex before marriage was unacceptable (though they may have engaged in it anyway), today’s young women, with the exception of fundamentalists of various faiths, probably consider premarital sex normative. Ingrained reticence about sexuality inhibits many menopausal women from presenting their sexual concerns to their physicians.

Physicians and other clinicians, with very little data with which to establish norms, tend to resort, consciously and unconsciously, to their own experiences, beliefs, and prejudices when counseling patients. Given the current state of knowledge, it is not possible to state that any given level of sexual activity is or is not normal. We can only know what distresses a patient.

For many people, maintaining sexual interest and activity into and beyond menopause is a sign of vitality. Sexual attractiveness is a cardinal value for women. Popular media advertisements for hormone therapies and other menopause "remedies" stress their positive impact on sexiness. Losing sexual desirability is synonymous with becoming old, which, in North America, is synonymous with becoming ugly, irrelevant to the culture, and facing impending death.

The youth culture
The old woman is a marginalized, even demonized, figure in much of Western society. Many of the frightening characters in children’s fairy tales are elderly women: the witch who captures Hansel and Gretel, the wicked stepmothers who persecute Cinderella and plot to eliminate Snow White because they are younger and prettier than themselves and their rivalrous daughters.

Images of beautiful young women are used to sell products. Youth and beauty are synonymous. However, the social stature of mature women in the Eastern Hemisphere differs markedly from that in the West. Young women may be regarded as beautiful, but in patrilineal societies they move to their husbands’ family homes at marriage, and are subjugated to their mothers-in-law. Only as they bear children – or sons in particular – do they acquire status and power, especially as they acquire daughters-in-law of their own.

The medical profession, in its zeal to adopt the use of hormones at menopause, has contributed significantly to the youth culture by advancing the concept that it is only through the miracles of modern medicine that women survive beyond menopause at all. They cite and misinterpret statistics about average life expectancy in the past as compared with today. Those averages, however, are the products of high infant and maternal mortality, and infectious disease and not of the spontaneous disintegration and death of women as they reach menopausal age. The survival of women beyond menopause is advantageous to the survival of the species. Children require nurturing in order to reach reproductive age. If women died at menopause, in the absence of effective contraception, they would leave children behind. Women are sources of knowledge and support for childbearing and childrearing that are critical to future generations. Even now, many grandmothers are called upon to assume part or all of the childrearing responsibilities for their grandchildren.

Social prejudice against aging is not only culturebound, but also gender-bound. The thought of an older woman with a younger man is disgusting to many people, while couples consisting of older men and younger women are not only accepted, but even admired. The use of new technologies by menopausal women wanting to bear children is viewed negatively, while fatherhood among men in their eighties is often viewed as a sign of vigor and virility.

The empty nest
Until very recently, the departure of maturing children from the family home was seen as traumatic for mothers. Episodes of depression in menopausal women were attributed to the "empty nest." When women’s activities are limited to home and family, and their identities limited to parenthood, the loss of role, status, and identity might predispose some of them to depression. However, many women who have devoted much of their youth to caring for their children report being relieved of those responsibilities and having time to relax, earn income, and/or pursue their own interests.

There are several other realities confronting women at the same time that their children are leaving home. Some women are widowed. Some husbands leave their wives, inflicting a narcissistic injury, as well as loss of companionship, loss of
expectations, and a sense of abandonment. Women in these situations may find themselves without marketable skills; this can be a major problem. A significant percentage of elderly women in the United States lives in poverty.

Personal Reflection Exercise #9
The preceding section contained information about women’s social expectations and realities during menopause.  Write three case study examples regarding how you might use the content of this section in your practice.

QUESTION 16
How is the social prejudice against aging in women gender-bound? To select and enter your answer go to Test.