A Country Where You Once Lived

IT STARTS when you’re thirteen, and those tight shorts make your crotch wet when you ride your bike. You like these shorts, the way they make you feel this new way: sexy. You fall asleep at night thinking about sex. You listen to songs that encourage you to think about sex, and you discover you can even think about it at church and in the classroom without anyone knowing, if you keep a certain demeanor and cross your legs a certain way.

Eventually you start having almost as much sex as you used to think about, but you still keep fantasizing about the sex you’re not having and reminiscing about what you’ve had, remembering the exact details: the dimensions of the lips, the shape of the tongue and how it first entered your mouth, the precise smell of the shoulders and neck, each lover’s body, as poet Jack Gilbert writes, a country in which you lived for a time.

All your life, you think, you’ll want it. You think the wanting will be a constant companion, like a faithful dog. You think you’ll always be up for it, through sickness and health. Oh, sure, as you get older, there are times when you feel less like having sex, or times when you get bored with your lover, or depressed, but then you just find a new partner, and there’s sex again. You are sure it will never go away. You know this because movies and tv and advertisements for Viagra tell you that old people have sex too, that it is not strange to have sex after you get old. You decide you will be an old woman who still has sex. You will have sex until you die. Maybe, in fact, you will have it on your deathbed. You will die a well-fucked woman.

You are so determined to keep on having sex that, when you find yourself in a long relationship in middle age, it’s difficult to acknowledge that your desire for sex is starting to wane. You explore sex toys and read books about how to spice up your sex life. There’s a kind of desperation in your search for ways to make yourself want it the way you once did. You feel like a nonbeliever who continues to go to church because she can’t admit she’s lost faith.

Your strategies seem to work for a while. As long as you keep changing partners, or having long-distance relationships where the sex is only every other weekend, everything is fine.

But then you marry late in life, and you don’t want to change partners, and all of a sudden (or so it seems) you can’t keep up with your husband’s desire, and you are mortified. It’s like a terrible secret: you feel not yourself, freakish, and, worst of all, boring.

You’re able to talk yourself into sex for the sake of your marriage and out of love for your husband, but it’s not pleasant because, although you don’t want to admit it at first, penetration has started to hurt. No longer do you welcome that once-sacred entering, in fact. It’s as if your whole body cringes when he tries, and sometimes — and now we’re getting to the part that no one prepares you for, not mothers or aunts or even kindly physicians — sometimes you bleed when you have sex because, as a male doctor explains to you later, your vagina has “atrophied.” Your body, the doctor says, is experiencing penetration as physical trauma.

How can this be? You are still a young — or youngish — woman. But when you get home and phone your mother, who is the only one outside of your husband you can tell about this, she says the same thing happened to her at the same time, in her early fifties. (Why didn’t you tell me this before now? you think, as if you could have somehow prepared for this moment.)

“I haven’t had sex in twenty-four years,” she says in a cheerful way — a fact that is really not at all helpful at this point.

You begin to notice that there are an awful lot of men your age who are with significantly younger women, and you are starting to understand why. Your vagina has shrunk — there’s no other word for it — and every act of sex is as painful as the first time, maybe more so. You think the inside of your vagina must look like a shrunken morel. You examine it in a mirror to see if it looks any different on the outside, but it doesn’t. You look at your face, too, in the mirror, and think you are still beautiful in a deep, older-woman kind of way, but you feel awful. You wish the word atrophied did not exist.

The male gynecologist you consult says atrophy is common in women your age, and he gives you a prescription for some hormonal cream — much safer than orally administered hormones, he assures you. He recommends an over-the-counter vaginal lubricant and tells you to be patient.

“If you were seventy-five,” he says patronizingly, “this wouldn’t be a problem.”

You want to hit him.

“It’s the lowered estrogen levels,” he continues, “that cause dryness of the vagina, which can cause severe burning, discharge, and dyspareunia” [dis-puh-ROO-ne-uh], the clinical term for painful sex. Though you wish he would speak to you in a way that acknowledges you are a suffering patient and not a medical student, you are grateful for the information.

You go online to learn more, careful to visit only sites such as the Mayo Clinic and Medscape, where the comments are written by physicians and make reference to clinical trials and papers. One doctor writes that chronic and progressive vaginal atrophy is the twenty-first-century health issue affecting quality of life for women. Researchers conservatively estimate that 50 to 60 percent of postmenopausal women experience it, although it’s difficult to get accurate numbers because many are too embarrassed or ashamed to talk about it.

The Mayo Clinic confirms that thinning, shrinkage, and inflammation of the vaginal walls are due to a decline in estrogen levels as you age. Both sites suggest hormone-replacement
therapy, creams, and gels. Ads pop up that promise relief. One shows an attractive older woman with gray hair smiling and blowing bubbles. You hope that the cream will work for you and that you will soon be blowing bubbles again, because the latest study shows that women on hormone-replacement therapy are more susceptible to heart disease, breast cancer, stroke, and blood clots.

You try the hormone cream and the lubricating gel for a few months, but they don’t seem to help much. Your vagina just doesn’t want to open the way it once did, and the pain remains. You keep trying, though, hoping that continued intercourse will force it to stay open. Finally you decide it’s time to find a new gynecologist. A friend recommends a woman doctor she’s been seeing for some time: “She’ll be more understanding.”

Dr. Hugo looks to be in her late fifties. She has a head of curly locks, full lips, and an intense, seemingly genuine interest in you. After she performs the exam, she peels off her plastic gloves and says, “You can still have sex. I can get two fingers in you. Some women with atrophied vaginas, I can’t even get one finger in. But if you don’t keep having sex, you’ll even­tually lose the ability to be entered at all.”

You discuss the pros and cons of hormone therapy, and you decide it’s worth the health risks to give it a try. She also prescribes a stronger hormone cream and a special vaginal ring that exudes hormones over a period of three months. The ring looks like a doughnut.

“The same thing happened to me,” Dr. Hugo says as she’s writing out your prescriptions. “I married in my fifties, too, and couldn’t keep up with my husband. The cream, the rings, and the hormones will help with the physical pain.”

“What about desire?” you ask.

“It differs with each woman.”

“How long did you stay on hormone therapy?” you ask.

“Three years,” she says.

You are afraid to ask what she did after that.

Personal. Political. Provocative. Subscribe to The Sun and save 55%.

PRINT

E-MAIL

SHARE

PDF

WRITE TO THE EDITOR

SUBSCRIBE