Sex For Dummies. Dr. Ruth K. Westheimer

of menopause. As I said, menopause takes a few years to settle in, and during that time a woman who had regular periods all her life may find that they suddenly become irregular. So if you are of menopausal age and your periods stop for two or three months, don’t assume that you won’t have any more. You very well may ovulate again, and if you have unprotected sex, then you may find yourself changing diapers at a much later age than you ever intended. Under the medical definition, a woman reaches menopause when she hasn’t had a period for 12 months, so never consider yourself to be into the menopausal years until that period of time has elapsed.

      Hormone replacement therapy

      Medical science found a way of alleviating many of the symptoms of menopause through hormone replacement therapy (HRT). Studies proved that having a woman take estrogen to replace that hormone she is no longer producing alleviated many of the symptoms of menopause, as well as protected against certain kinds of cancers, especially cancer of the cervix. But other studies subsequently have shown an added risk of various diseases, including heart attack and breast cancer, for some women using HRT. This very confused picture means that any woman beginning menopause should consult her doctor to find out what options are available to her. You may decide against HRT, or if you have severe menopausal symptoms, you may opt for short-term therapy. To relieve vaginal dryness only, a very small dose of estrogen applied directly into the vagina can relieve this problem without adding significant risk (see Chapter 19).

Because I’m not a medical doctor, and because the news about HRT seems to change regularly, that’s all I’m going to say about the physical effects of menopause. (If you’re a woman approaching the proper age bracket, I recommend that you go out and buy Menopause For Dummies, 2^nd Edition, by Marcia Jones, PhD; Theresa Eichenwald, MD; and Nancy Hall, MS [Wiley] to better understand all the changes happening to your body. Then talk to your gynecologist to get the latest information about HRT and to help you decide whether to use the treatment.) The issue of menopause and sex, however, is a topic that I cover in Chapter 19. I’ll give you a preview of that discussion by saying that my philosophy is a very positive one concerning sex in the later years.

Breasts: Hanging in There

      I certainly can’t give you a road map to the intimate female anatomy without giving you at least a quick tour of the Alps — or, for some of you, the Appalachians. As you should realize, breast size is of no consequence, except to those men who’ve spent too much time staring at so-called men’s magazines. Breasts are certainly an erogenous zone, however, and because they do stick out, even while under wraps, they’re one part of the body that gets noticed whether you’re clothed or not.

      Feeding babies

      The main purpose of breasts is to feed babies because after a mother gives birth she lactates (that is, makes milk) provided that the baby starts to suck at the nipples. This miraculous process is not only good for the baby’s health but also for the mother’s because breast-feeding gets rid of the excess fat she accumulated during her pregnancy.

      Strangely, for a period of time in the 20th century, Western women gave up the process of feeding their babies from the breast. But more and more women are returning to this method.

      

If any of you have heard that a mother who is breast-feeding can’t get pregnant, think again. Women have a tendency not to ovulate while breast-feeding, but this tendency isn’t an absolute, as many a woman has discovered too late.

      Getting sexual pleasure

      The breasts of male and female children are the same. But when a girl reaches puberty, first her nipples and the areola, the darker skin around the nipple, begin to enlarge. As her levels of the hormone progesterone increase, the underlying tissue grows, producing a full breast.

The nipples hold a concentration of nerve endings, and most women’s nipples get erect when they become aroused. As an erogenous zone, a woman’s breasts serve both the male and the female; men get excited by looking at and fondling breasts, but women also enjoy the sensations.

      

Many women who masturbate fondle their own breasts and nipples.

      Checking for breast cancer

      The bulk of the breast is composed of fatty tissue. Because our bodies often store any toxins that we absorb in fatty tissues, the breasts are a common cancer site for women.

One woman in nine will develop breast cancer in the United States. Because of this risk, every woman must examine her breasts once a month, starting by the time she’s 20. Figure 3-5 shows one technique of checking your breasts for signs of cancer.

      Illustration by Kathryn Born

      FIGURE 3-5: Regularly examining your breasts for signs of cancer is an important part of staying healthy.

      You should be consistent about the time of the month you conduct this exam because your breasts change as you go through your menstrual cycle. The most accurate time to check is just after your period. By examining your breasts at the same point in your cycle, you can make a more accurate comparison.

      When checking your breasts, you are looking for anomalies — things that feel strange — basically a lump of some sort. If you find something, don’t panic. Most lumps are not at all dangerous, but you should consult with your physician as soon as possible. And if what you find is an early sign of cancer, be thankful that you did locate it early because, in most cases, it’s treatable.

      

You should also have regular breast exams by a health professional, who may detect something that you would miss, and go for a mammogram whenever your physician instructs you to do so. The older you are, the more important these exams become, and the more regular they should be. After a woman turns 40 she should definitely go once a year (though some say that waiting until you’re 50 to begin getting tested annually is okay), and that rule applies to even younger women if they are in a high risk group. You may be in a high risk group if

       You have a family history of breast cancer.

       You have never been pregnant.

       You had your first child after age 30.

       You began menstruating before the age of 12.

       You’re obese.

       You eat a high-fat diet.

       You’ve already had cancer in one breast.

      Check with your doctor to determine the best regimen for you.

      Be proud of your breasts

      Whatever the size of your breasts, they can provide pleasure to both you and your partner. Although small breasts may not get much recognition when you cover them with clothes, after you uncover them in front of a partner, he or she probably won’t care about your cup size. So never feel ashamed of your breasts, but flaunt them at the appropriate moment so they get their due.

These days it seems that more and more women, and more and more young women,