September 11, 2024 • 48 mins
In yet another episode of our 2024 Sex Positive September celebration, we’re discussing the ways in which our sex lives change and evolve as we get older. While the symptoms women experience during menopause and perimenopause can cause our sex lives to shift in some challenging ways, that doesn’t mean you still can’t embrace sexual vibrancy no matter the age. Joining me for today’s conversation is the New York Times Bestselling author of "Grown Woman Talk," Dr. Sharon Malone. Dr. Malone is a nationally known expert in women’s health, serving as the Chief Medical Advisor at Alloy Women’s Health, a telehealth company that focuses on women over 40.
Dr. Malone and I chatted about all things menopause & sex, including how to combat some of the various symptoms that can make the idea of having sex less than appealing. We also discuss the importance of continued OBGYN visits even as you reach the end of your reproductive years, plus all the reasons why grown womanhood is something to look forward to, not to fear.
About the Podcast
The Therapy for Black Girls Podcast is a weekly conversation with Dr. Joy Harden Bradford, a licensed Psychologist in Atlanta, Georgia, about all things mental health, personal development, and all the small decisions we can make to become the best possible versions of ourselves.
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:11):
Welcome to the Therapy for Black Girls Podcast, a weekly
conversation about mental health, personal development, and all the small
decisions we can make to become the best possible versions
of ourselves. I'm your host, doctor joy Hard and Bradford,
a licensed psychologist in Atlanta, Georgia. For more information or
(00:32):
to find a therapist in your area, visit our website
at Therapy for Blackgirls dot com. While I hope you
love listening to and learning from the podcast, it is
not meant to be a substitute for a relationship with
a licensed mental health professional. Hey, y'all, thanks so much
(00:57):
for joining me for Session three seventy six of the
Therapy for Black Girls Podcast. We'll get right into our
conversation after a word from our sponsors.
Speaker 2 (01:05):
Hi. I'm doctor Sharon Malone and I'm on the Therapy
for Black Girls Podcast. I'm in session today unpacking how
our sex lives change as we age.
Speaker 1 (01:24):
And yet another episode themed to our twenty twenty four
Sex Positive September celebrations, our annual campaign centering the importance
of black women's pleasure, agency and sexual liberation. We're discussing
the ways in which our sex lives change and evolve
as we get older. While the symptoms women experience during
menopause and perimenopause can cause our sex lives to shift
in some challenging ways, that doesn't mean you still can't
(01:47):
embrace sexual vibrancy no matter the age. Joining me for
today's conversation is the New York Times bestselling author of
Grown Women Talk, Doctor Sharon Malone. Doctor Malone is a
nationally known expert in women's health, serving as the chief
Medical Advisor at Alloy Women's Health, a telehealth company that
focuses on women over forty. Doctor Malone and I chatted
(02:08):
about all things menopause and sex, including how to combat
some of the various symptoms that can make the idea
of having sex less than appealing. We also discussed the
importance of continued obgy in visits even as you reach
the end of your reproductive years, plus all the reasons
why grown womanhood is something to look forward to, not
to fear. If something resonates with you while enjoying our conversation,
(02:30):
please share with us on social media using the hashtag
TVG in Session, or join us over in the Sister
Circle To talk more about the episode. You can join
us at Community dot Therapy for Blackgirls dot Com. Here's
our conversation. Thank you so much for joining me today,
doctor Malone.
Speaker 2 (02:49):
Thank you for having me.
Speaker 1 (02:50):
Yes, we had a chance to chat briefly. We met
earlier this year at the Accelerator conference in Florida. I
didn't get a chance to hear you talk, so I'm
excited to chat with you today.
Speaker 2 (03:00):
Well, I've got lots to say. So you're in love,
So I wonder.
Speaker 1 (03:05):
If you could start by telling us a little bit
about what sparked your interest in women's health.
Speaker 2 (03:10):
You know what, I have been in women's health for
so long I can't even remember the beginning of it.
But I'm an obgyn. I had been in private practice
for almost thirty years and had been in residency for
four years before that. But even before becoming a doctor,
I am the youngest of eight children, and I am
(03:31):
the last of five girls in a row. So my
entire upbringing has been very, let's just say, woman centric,
and I think that my family history really as I've
watched my older brothers and sisters, in particularly my mother,
who passed away at the young age now of fifty seven,
(03:53):
I grew up understanding that there was really something that
was getting in the way of our health and how
we were able to survive or thrive. And my job
was to make sure that the kinds of things and
the care that my mother got, which I think was
really insufficient, didn't get replicated in the next generation. So
(04:13):
that's really the core of why I got involved in
women's health, and I have never looked back. It has
been really the joy of my life.
Speaker 1 (04:21):
I love that. And not only are you focused on
women's health, but you have a particular specialty in working
with women over the age of forty. So tell me
more about that, Niche.
Speaker 2 (04:30):
As I told you, I started practicing. Oh my god,
it's hard to believe you'd have to apply the COVID discount.
When you realize it's like, oh yeah, you got to
add those four years onto anything else you've been doing.
But I started practicing back in nineteen ninety two, and
when I joined my practice, I inherited the practice of
(04:51):
two much older physicians. So from the moment I started,
I had patients of all ages. So usually as a
young physician, you start out and you start out with
young patients and then you all grow up and get
older together. But on day one I had eighty year olds,
I had fifty year olds, and I had eighteen year olds.
So being involved in menopause and perimenopausal care has always
(05:14):
been a part of my practice in obgyn. It's not
just the delivering baby's part, it's what happens to women
after they're done with their reproductive years. And I think
that today that art has really been lost because we
don't talk as much about women's health over forty what
(05:35):
happens when you're done, And I think most of us
think of going to the obgyn for a couple of reasons.
You go for your pap smear, you go to make
sure you get contraception, and you get through a pregnancy.
And then once women get done with their childbearing, they
tend to fall off and they don't follow up as much.
And I think that there are a couple of reasons
(05:57):
for that. One, you think you don't need to go
because why do I need to do that now I'm
done with my children. But there's also a lack of
guidance that really happens for women after they're forty. It
seems as if the things that were interesting about you
are no longer And I think that nothing could be
farther from the truth. So if you have a doctor
(06:18):
who is really not speaking to you about what that
means to age and to age healthfully, then you need
to really reassess whether or not that particular doctor is
right for you, because this is the most important time
of your life. This is where what you do and
how you do it really really matters.
Speaker 1 (06:37):
Can you say more about that doctor, Malone? Because I
think you're right there's a lot of focus on those
child rearing child age years, but when you are starting
mini hall then later there isn't as much conversation. So
what makes that such a critical point in a woman's life.
Speaker 2 (06:52):
Well, because you don't think about it, but we are
going to spend anywhere from a third to half of
our lives in our post reproductive years. You're going to
spend more time there. And as we couple that with aging,
that is when you can get away with murder until
you're forty. You can not care of your gil self,
(07:13):
not get enough sleep, not do all the things you're
supposed to do, and really function relatively well. But when
you get to be over forty, that's when you really
start to pay the price for some of these behaviors,
and that's when it matters. It matters how you take
care of yourself. It matters what kind of guidance you get,
because I think most of us want to do better.
(07:36):
Who wants to feel bad? No one, But I think
what happens to us as we age, particularly as women,
we accept that feeling bad is part of just growing old.
I don't think that we envision another way to age,
and particularly when we come from families where we have
(07:58):
seen what aging looks like, and for most of us,
particularly in black families, it's usually not good. We are
dealing with chronic illnesses. By the time you look at
your parents, it's high blood pressure, it's diabetes, it's dialysis,
it's strokes, it's all of those things that we think
are inevitable. But leading up to that, those real, honest
(08:20):
to God productive years that you have between say forty
and sixty sixty five before you sit down to retire,
those are the years when you should be at your
peak functioning. So I don't want any woman to go
into perimenopause and menopause one unaware of the kinds of
(08:41):
things that you will encounter. That's number one and two.
If you do encounter these things. I want you to
know that, yes, it's normal, but suffering is not normal.
And that is where we have got to get out
of that mindset that as you enter perimenopause and menopause,
suffering is just the latest in the continuum of things
(09:04):
that women suffer from, starting from the moment we get
our periods, and we just sort of take that as normal.
And I'm here to say, no, no, no, let's not
do that. Let's understand that this is the time when
we really can have a lot more control over our
lives and how we age.
Speaker 1 (09:23):
Thank you so much for that. So we've had a
couple of conversations here on the podcast about menopause and
that whole process. But for those who maybe haven't listened
or haven't heard you explain it, can you say a
little bit about what signals to us that we are
entering a period of perimenopause.
Speaker 2 (09:37):
In menopause, Yes, perimenopause is a word that a lot
of women hadn't even heard of before let's say four
or five years. It didn't really enter the lexicon. We
kind of knew what menopause was, but we thought that
menopause was something that happened to old ladies. It's like,
oh yeah, menopause. You know you're fifty sixty when that happens,
and not really the tran transition, which is what perimenopause is.
(10:03):
It is that time between your peak reproductive years, which
usually they start at puberty and probably peaks in about
your early to mid thirties. So perimenopause is that period
between your peak reproductive years and the end of your
reproductive years, which is what really marks the beginning of menopause.
(10:23):
So menopause is easy because we know what that looks
like and what it means. Menopause means the age at
which you've had your last period, and it's confirmed when
you've gone twelve months and you haven't had another period,
but in that perimenopausal phase, which for most women can
last anywhere from four to seven years, but for African
(10:46):
American women that transition can take ten years. So let's
do a little simple math. If I tell you the
average age of menopause, which means the aged which you've
had your last period, is fifty one, that means for
Black back women, the average age of starting that process
can be as early as your early forties or in
(11:07):
some women even their mid thirties. Because the one thing
that we do know about how the lived experience of
being a black woman in this country affects us and
it affects all of our aspects of our health, but
it actually shows itself in perimenopause as well. We tend
to enter that phase earlier, it tends to last longer,
(11:29):
and the symptoms that we normally associate with menopause, like
hot flashes and night sweats and mood swings, those symptoms
tend to be more severe for African American women. Now
did anybody tell you that? Did anyone mention, Oh, by
the way, not only is this going to happen for
you earlier, but it's going to last longer, and it's
(11:49):
going to be more debilitating. And we've all seen someone
they've got their fan out, you know, they're fan in
their sweating. There are clearly not having an enjoyable moment,
but they don't know what to do about it. Whenever
I see that, I want to go and tap them
on the shoulder and say, girl, this can go on
for a very very long time. And not only that,
(12:13):
but we know what to do about it because hot
flashes and I want to say this again and again
throughout this conversation. Hot flashes are not benign. They're not
just annoying, and they are, but they are sometimes harbingers
of things that can affect your long term health, such
as it increases your risk for cardiovascular disease, increases your
(12:38):
risk for sleep disturbance, which of course creates fatigue and
stress and lack of performance on the job, you get
brain fog, on and on. But I think the big
things increases your risk for type two diabetes and increases
your risk for Alzheimer's. So there are a thousand and
one reasons why if you are bothered by the hot flashes,
(13:02):
you at least deserve a conversation with your doctor about
how to treat them and what the hot flashes mean.
Because it gets back to what I was saying, is
that we expect to suffer and we think of perimenopause
and menopause and all the symptoms that we have, and
actually they're over thirty four. Symptoms of menopause is not
(13:25):
just the hot flash, but we don't realize it because
just because you're not having hot flashes does not mean
you are not in perimenopause. You're still imperimenopause, even if
you never have a hot flash. But all of these
things brain fog, changes in libido, dry itchy skin, loss
of hair. I mean, that's a big problem for women
(13:47):
who are transitioning. I say, hair loss where you want
it and hair growth where you don't. There is also
the aging of your skin. And a lot of women
have libido and vaginal dryness, irritation, and urinary symptoms as
a result of this. So it's a lot. It's a lot.
And because we don't really know that these things have
(14:12):
easy remedies. And the easy remedy for it is since
it's a hormonal issue, you know, what's happening to you
in perimenopause is not that your hormones are gone. Well,
they're not gone, they're just erratic. And that's why. Also
one of the symptoms that women get during perimenopause is
very irregular periods. Your periods may come too soon, they
(14:36):
may last too long, it may be too heavy. Women
will come in and said, I've been bleeding for three weeks.
All of these things are indicators that your hormones are
just out of whack. They're too high one day, too
low the next, and everything in between. And for women
who are complaining when they go to their doctor and
(14:56):
they'll say, well, doctor, I have hot flashes, or I'm
gaining weight, or any of the other thirty four symptoms
that you may have. A lot of times the doctor
that you see does not recognize it as such, because
all they're thinking about as well, are you getting your
period or is your period regular? And if you answer yes,
then it would not be uncommon for you to get
(15:19):
an answer like, well, it can't be menopause. It's like no,
but it's menopause adjacent this thing called perimenopause. And so
after you've gone through this entire transition, which like I said,
can take as long as ten years, then what happens
are you over it? Well, a lot of women will
(15:39):
continue to have symptoms even after they've had their last period.
So this notion that it is something to be endured
or something that you will get over, I want to
sort of disabuse everyone of that notion. Because menopause process
is complete, you will continue to have the us of
(16:00):
that lack of estrogen and you will be that way
for the rest of your life. So for anybody who says, oh,
I didn't have menopause or I'm over it now. No,
you may be over your hot flashes, but you are
not over all the other signs and symptoms and health
issues that are associated with menopause.
Speaker 1 (16:20):
Got it, so, doctor Malone, how often are people coming
to you to talk about So you gave some symptoms
around vaginal dryness, changes in libido, which is of course
what we want to spend more time talking about today.
How often are patients coming to you talking to you
about those symptoms in particular?
Speaker 2 (16:36):
Well, you know whether they bring it up or not.
Eighty percent of women will experience either vaginal dryness, painful sex,
itchy dry vulva, or urinary symptoms as in frequent urinary
tract infections or urinary frequency and urgency. And that has
even a separate name for itself. It's called the genital
(16:58):
urinary Syndrome of menopause. Now that's a mouthful, so we
just say GSM. That means that the lack of estrogen
will affect your genital system. It affects your urinary system
and even your external genitalia. So I told you eighty
percent of women will experience, in some form of fashion
some combination of those symptoms well, a lot of women
(17:22):
are embarrassed. You may not bring it up, and you
look at what is advertised on TV, and you'll understand
how common the problem is. And remember how many incontinence
products there are advertised every time you look around, gotta go,
gotta go, and here's some new underwear that you can
put on because you're leaking. But no one really talks about, Okay,
(17:46):
why and better still, if that many women are having
these problems, what are we doing about it? And again
it gets back to the same thing that we're talking about.
What undergirds all of this is at menopause, the lack
of estrogen. So when you're having painful sex, when you
are having dry, itchy volvas, it is the lack of
(18:10):
estrogen because all of that tissue is estrogen sensitive. And
as a matter of fact, when you are just using
lubricants or creams or gels or that kind of stuff
to treat the symptoms, you're doing just that. You're just
treating the symptoms. You are not addressing the root cause.
And for most women, the simple solution is you can
(18:33):
use topical or local estrogen, which means just an estrogen
cream or tablet or a ring just in the vagina.
And this is even for women who either choose not
to take hormone replacement therapy after menopause or have reasons
why they should not take. But at a minimum, every
(18:54):
woman should have these issues addressed. And if you don't
bring it up to your doctor, it's not uncommon that
doctors won't ask because we've got so many other things
to talk about. And I have to give my colleagues
a little bit of a break here, not my gyn colleagues,
because they should be asking. But you're internist or you're cardiologists,
(19:15):
they're never going to ask you about whether or not
you have painful sex, or whether or not your vagina's dry.
But your gynecologists should, which is why I get back
to you can't stop going to the gynecologists just because
you're done having your kids, because there are other things
that come up in midlife that do need to be addressed,
(19:36):
and a lot of times your gynecologist is the most
appropriate person to bring that up with. HM.
Speaker 1 (19:42):
You know, doctor Malone, as you're talking about some of
these other thirty four symptoms of menopause, you're sharing, like
the mechanics that may make sex painful or difficult. But
some of the other things that you're mentioning, like hair
laws or weight gain like also play into I think
some of the mental health components that may be connected
to sexual activity. Can you speak to that a little absolutely?
(20:03):
I mean, think about none of these things happens in isolation,
and one thing affects the other. And the thing that
I didn't mention of those thirty four symptoms, the other
thing that really picks up in perimenopause is really a
lot of either depression, anxiety, irritability. I mean, they really
peak in midlife as you are making this transition. So imagine,
(20:28):
let's just start with the hot flesh, because everybody understands it,
all right, you have a hot flash. Now you've got
night sweats, you didn't get a good night's sleep, You're fatigued,
you're irritable, you got brain fog. And you go through
this day after day, month after month. You're not feeling
your best self. You're certainly not going to exercise because
(20:51):
you're tired, and you're gonna make bad choices. You don't
feel well. So we self medicate with things, some people
with alcohol, some people with food, some people with drugs,
whatever it is. We are constantly trying to get to
a point where we say, I just need to feel better. Now,
is that any recipe for anybody who wants to be
very sexual? When you think about it, it's like.
Speaker 2 (21:13):
I'm mad, I'm hot, I'm tired, And at the end
of the day, after you've gone through all of that,
then somebody says, oh, yeah, wouldn't this be a great idea?
Probably not, okay. I mean, a tired woman is not
going to be at her peak sexual best. And that's
why you can't just say I'm just going to take
(21:36):
care of the weight gain issue. Okay, well that's fine,
but what about all the other stuff? Because they all
play into each other, and they feed into each other,
and it really creates a really negative doomsday loop for
women in terms of how we feel. And as I said,
this is something that if there's a message there, and
there are a lot of messages I want to get
(21:57):
out there. But the good news is that we are
really trying to show women a different path forward and
to get you out of the mindset that old. I'm
old and creaky. I'm sixty five years old. I mean,
Kamala Harris is almost sixty. Michelle Obama, all of these
(22:18):
women who are out there that are saying, no, this
can and should be the best time of your life.
It should be something to look forward to, not something
to dread. And whether or not this part of your
life is good or bad is really going to be
dependent upon how we navigate it, and a lot of
(22:39):
times most of us just don't know how. And it's
not your fault. This is the kind of thing that
we don't talk enough amongst ourselves, and we don't talk
enough intergenerationally because I think for many of our mothers,
they didn't really know that there was an option, and
for many of them there really was. That's not an option.
(23:01):
So you know, that kind of acceptance of not being
your best self is something we've got to get out
of the mindset of. And so that's why if I
sound passionate about this, it's because I am. Because I
really want every woman to make the decision that's right
for you. And I think for all of these thirty
(23:22):
four symptoms of menopause that we talked about, the most
effective treatment for the symptoms of menopause is hormone therapy.
You know who gets that message least of all Black women,
but that's my job. Make sure you know when to
access what is important. What are the things that you
(23:46):
think are the reasons why you can't take unless knock
down those myths one at a time.
Speaker 1 (23:51):
More from our conversation after the break, but first, a
quick snippet of what's coming next week on TVG My.
Speaker 3 (23:58):
Mom's sister was and is a journalist. Her name is
Soladette O'Brien, and she traveled to cover Hurricane Katrina, and
she was there for months on end, at times living
out of cars, to cover the story, to put other
people's voices out on a national platform. And I don't
(24:19):
think I would have had the words for this at
the time, but I do remember getting the impression or
just having the feeling that, Wow, it is so amazing
that when there is a problem, there are people who
run toward it instead of running away from it, and
that at a time when so many people were trying
to figure out how to leave this city, I had
a loved one, an aunt, who was there actually recording
(24:42):
and documenting and showing people every day why they couldn't
look away from what was happening there.
Speaker 1 (25:00):
So, doctor Malone, can you talk about why black women
are not getting prescribed it as much. Is it just
good old fashioned racism or is there something else going on?
Speaker 2 (25:09):
Oh? Yeah, two things can be true. Okay, And let
me tell you there was actually a study that came
out twenty two years ago, the Women's Health Initiative, which
put this out there in the universe that estrogen causes
cancer and it doesn't have any benefit in long term help.
That study came out twenty two years ago. Well, I
(25:31):
had been practicing for ten years before that study came out,
and so I had a very different experience. And remember
I told you I had been treating women with menopause
since the first day I started, and so we were
taught something very different in terms of how to prescribe
hormone therapy what it was for. We were taught that
(25:51):
not only did it relieve the symptoms it does it
did then still does, but it also decreased the risk
of cardiovascular disease. And that was the big push about
why we were really advocating that women take it, because
more women die from heart disease every year, anywhere from
two to seven times more women die of heart disease
(26:12):
than die of breast cancer. So if you had something
that was going to decrease your risk of cardiovascular disease. Yay,
everybody should take it, right, But that study that came
out twenty two years cast doubt on that assertion that
it decreased the risk of cardiovascular disease. But it did
more than that. It cast doubt on that, and it
(26:34):
also throughout there. Oh yeah, and by the way, it
increases your risk of breast cancer. Now, neither of those
turned out to be true, and there was argument about
it from the very beginning. But you know how it is,
bad news travels fast and it's sticky. Even though we
in medicine and even in academic circles have been refuting
(26:57):
that for twenty two years, ever really made it out
into the universe. Everybody remembers when you get indicted. Nobody
remembers when you got to quit it. And that's the
hormone story. So we have an entire generation of doctors
that don't know how to prescribe and still will tell
you that to this day, Oh no, you can't have
(27:19):
hormones because your mother had breast cancer. That kind of problem.
So that is true for all women, okay, all women.
And here's where the racism piece comes. In if it's
true for all women, then it's twice as bad when
it comes to Black women. And that is culturally educationally,
(27:39):
both on the part of physicians and on the part
of women. It sort of creates that perfect storm for
the people suffering the most getting the least. And that
is the story of just about any condition that you're
talking about when we're talking about African American women.
Speaker 1 (27:56):
Got it. So, when the chances of getting pregnant are
less likely, right, typically in perimenopause menopause age, I think
a lot of women say like, oh, I don't need
kind OFMS, I don't need other protections, but we know
that the rate of STIs are also higher in older populations.
Can you talk a little bit about the continue need
for protection.
Speaker 2 (28:16):
Yes, okay, there are two kinds of protection, and perimenopausal
women need both because remember I told you that that
period of time between your peak reproductive years and no reproduction. Okay,
well that's a long span in between, and decreased fertility
does not mean no fertility. So even when you are
in perimenopause, you still should be using some reliable birth control.
(28:40):
And if you don't believe it, well, yours truly I
am that child that my mother was probably wishing for
menopause and she got me instead. My mother was almost
forty five when I was born. And it's funny because
now the family stories make sense to me because as
I was growing up, and I told you, I'm eight
of eight and the next sibling to me is seven
(29:01):
years older than me, and so the family stories I
always heard were, oh, we didn't even know your mother
was pregnant, And I was like, she probably didn't know
either until it was too You know, here, I am
so to all my perimenopausal ladies, it's decreased fertility, not
no fertility. So if you need reliable birth control, use that. Now,
(29:24):
if you have a male partner, and you and that
male partner are not in a monogamous relationship, then in
addition to whatever you're using, like if you want to
use birth control, or you have an IUD or whatever
is your primary mode of birth control, even if you've
had your tubes tied, if you're in a non monogamous relationship,
(29:46):
you need to use condoms to make sure that you
are not getting infected with sexually transmitted infections. Because here's
the deal. The ratio of males to females, and particularly
for black women, that ratio gets less and less favorable
as we get older. We know that, all right, So
(30:07):
you take out all the reasons why black men if
that is your preference, fall out of that equation. If
you are not in a monogamous relationship and you're in
the dating world, it is not unlikely that one functioning
male may be servicing a few others. And that is
why you need to make sure that at least you're
(30:29):
clear what type of relationship is this before you say,
all right, we can be condom free, and there are
ways to do it. But I want women to be
aware of that that you're still at risk for the
things that you would tell your teenage daughter about. Beware
of pregnancy, beware of sexually transmitted infections. HIV rates are
(30:51):
the highest in African American women in this country. So
we tend to think that that's not a thing anymore. No,
it's still a thing. If you had gonnarear chlamydia, we
know how to treat that. We forget about the other
things that are much more serious, herpies and HIV and
things that can be problematic for you.
Speaker 1 (31:11):
I'm curious, doctor Malone because you also mentioned that there's
a higher rate of increased urinary tract infections. Is there
a connection between that and then the increase in sis
in that ee?
Speaker 2 (31:21):
Well, you know what, think about this. When you are
a young person, your vagina is thick, it has the
ability to lubricate really well. As you get older, and
if you do not have estrogen on board, the vagina
gets thinner, it's more easily irritated, it's easier to be traumatized.
(31:42):
That's why sex is so painful because now those nerve
endings are closer to the skin than they were before
and you have no protection, so you're more susceptible to
STIs because again you don't have as healthy a vagina
as you had twenty years before. And the same thing
is true with urinary tract infections. You need a healthy
(32:04):
vaginal tissue. You need healthy urinary tissue, and when that
fends and it's easily irritated, it's so easy for bacteria
to get into your bladder. So all of that, you
think of it all together that the less healthy the tissue,
the more likely you are to be infected with bacteria
or with viruses.
Speaker 1 (32:24):
So that's malone. I'm also curious is there a concern
about the physical exertion that is connected to sex as
we get older. You mentioned like cardiovascular kinds of things,
So is there concerned around like the exertion of actual
sex being a concern as we get older?
Speaker 2 (32:39):
So what are you doing? I'm just no, I'm just saying,
y'all do I'm just trying to figure you know, regular
old people says, no, you fine, You fine? Okay. I
mean if you had to go do some acromatics, perhaps,
but no, if you are a healthy person, then there
is really nothing that you have unless we know that
you have some under lying severe heart disease. But no,
(33:02):
the amount of exertion for normal sexual activity, which actually
is good for you. Women and men who are sexually
active longer actually have better health span and lifespan. So no,
there's really not a whole lot to be worried about
unless you have serious other complications.
Speaker 1 (33:22):
So I would imagine that a part of your role
as obgyn also sometimes is a bit of therapy as well, right,
And so I wonder if you can talk a little
bit about some of the other stigmas are conversations you're
having with your patients around getting older and what it
means to feel sexy and even have interest in sex.
Speaker 2 (33:39):
The one thing that I loved about my job and
that I really may be missing in future relationships is
that I stayed in one place for thirty years and
I had a lot of the same patients for thirty years,
so I knew them, they knew me, and an obgyan
is the most intimate medical relationship you're ever going to
(34:03):
have with a doctor. So yes, on any given day,
I always kept a box of tissues just right there.
I would come in, I'd say, hey, how you doing,
and I go I'm fine, and I'm like, really, okay,
let me get my tissues here, and we would sit.
Because there are a lot of things that happen in
midlife in addition to perimenopause and menopause and all the
(34:27):
sort of trials and tribulations that that brings, It's an
emotionally fraught time of life. That is, when we are
generally dealing with aging parents. We still have children who
are adolescents and who are usually pains and the ads
at that point marriages may not be going well, so
there's a lot So yes, you have to know how
(34:48):
to be sensitive to the total person who is presenting
to you, not just I'm going to come in here
and do your pap smear and we're gone and all
of that. That You're mental health matters, how you are
moving about in the world, also affects your sexuality, how
you are feeling. You have to realize that there is
(35:10):
a very different relationship that you have to your libido
when you're fifty than when you're twenty. I mean, it
just is. And that doesn't mean there's anything wrong with you.
And it means that how you approach things and what
your expectations are are different. And I think that as
long as women understand that, and even after you understand
(35:31):
that it's different, if it's bothersome to you, to know
that there are again therapy that we can offer. Sometimes
it's a marital counselor sometimes it's sex therapy, sometimes it's
hormone therapy or any combination thereof about how to address it.
But know that it's different, it's not just you. And
(35:51):
I think that if we don't talk about menopause, we
don't talk about our sexual difficulties with our peers, because
we tend to think that everybody's having a great time
except me, And you have to be able to be
vulnerable with someone and to be able to explain, hey,
is this normal? What can I do to have that
(36:13):
kind of relationship? And what happens to a lot of
women in midlife, as I told you, is we start
experiencing a lot of these mental health issues like depression, anxiety.
One of the first things that a doctor wants to
do is put you on an SSRI or the antidepressants,
things like paxel zolof medications like that, and okay, yeah,
(36:35):
it might help a little bit, it might take the
edge off. But the thing that most women don't realize
is that they also have some sexual side effects. And
you've now taken a problem and you may have fixed
one thing and you've made another thing worse. So long
answer to a short question, but yes, how we deal
with ourselves sexually at fifties different. I think that we
(36:59):
also have to understand that this is a time when
many women are entering this phase of life and we
don't have partners. That's the reality. Okay, well, just because
you don't have a partner doesn't mean that you can't
be sexual. Sometimes that means you need to be sexual
with yourself understand what that means. We can all wish
for certain things, but at the very least know how
(37:22):
to take care of things for yourself. M h.
Speaker 1 (37:26):
More from our conversation after the break. You know, doctor Malone,
I'm sure you are aware of like the certain general's
conversations around loneliness and what an epidemic this has become
for us. Can you talk a little bit about loneliness
(37:47):
as it impacts women, especially in this age.
Speaker 2 (37:50):
Yes, COVID made it all worse. I think we were
already becoming more isolated as we spend more time with
our devices, because you can retain yourself just looking at
a movie or I'm going to scroll through Instagram or TikTok,
forgetting the fact that even though that may be entertaining
in the short term, it's not sustaining when it comes
(38:13):
to our physical and mental well being. And there have
been numerous studies that have actually shown that people who
do best are people that have large social networks, be
it at your school, be it your colleagues, be it
your family. We really need each other because that's how
we're wired. We're wired for community, and if you want
(38:35):
to age well, then you need to make sure that
your network, your sisterhood is strong, because that's more important
even than having a spouse or a romantic partner, of
having that just network of sisterhoods and friends.
Speaker 1 (38:51):
You've mentioned a couple of times around you know, if
your doctor's not having these kinds of conversations, maybe it's
time to find another doctor. I wonder what kinds of
things can you suggest for people of how to vet
their healthcare professionals so that they are feeling comfortable that
they're able to take care of them in this next
phase of life.
Speaker 2 (39:08):
Oh oh, if only someone had written a book about that.
Oh oh, that would be me. Oh that would be me.
Thank you for that. No, When I wrote my book,
and it's called Grown Woman Talk for a reason, and
that is because it's not just about menopause. There is
clearly a component. There are two chapters on there about
(39:28):
perimenopause and menopause. But I organize the book with two
thoughts in mind. One that no one really talks to
you when you're over forty because so much of our
time has been spent around reproductive issues and we deal
with that. But also to give you heads up on
how medicine has changed. And I think a lot of
(39:51):
the assumptions that we make about what your relationship is
going to be like with your doctor, those are no
longer valid. And like I said, I'm very grateful for
the thirty years that I had with my patients. You're
not going to have thirty years with a doctor anymore.
There's a doctor shortage. The amount of FaceTime that you
get with a doctor is less and less and less.
(40:13):
So I wrote the book to say two things. One,
I give you an idea of the kinds of things
that are important. How do you pick a doctor, how
do you assemble a team? What's important about your history?
Your family history. So it's that you can show up
better for your doctor's appointment because you're not going to
get a lot of time. So if you've got five
to seven minutes, make sure that you've invested on the
(40:35):
front end and your homework and you are prepared. Very important.
And I think the other thing that we have got
to realize is that medicine has changed and we're not
going back. We are dealing with the fact that we're
going to have to incorporate more telehealth into our visits.
There's going to be a component of artificial intelligence that's
(40:56):
going to be part of how medical care is delivered.
And that's good news and bad news. Bad news. Okay, yeah,
it's not as personal as it once was, but the
good news is that that means that gives you more
of an opportunity to be able to direct your care.
So I would say, in an ideal world, yes, everyone
should be able to find a caring, culturally competent doctor
(41:20):
who takes your insurance, who sees you and hears you.
If you find that hold on tight. But for a
lot of people that's not going to be what's out there.
And it's not because doctors are really trying to do
a bad job. Doctors are being squeezed and pulled every
way possible. But I say don't give up the fight,
(41:44):
because if you have someone and you know that they're
not right for you, then move on. And if you
cannot find someone, even within that framework, then that's one
of the reasons why when I left my private practice
in addition to writing my book to give you that
guide and the navigational tool that you need to get
(42:04):
through this confusing system that we have. But I also
wanted to say I want every woman to have access
to at least the minimum care and access to hormone
therapy and to understand perimenopause and menopause. And that's why
I'm the chief medical Advisor at Alloy Women's Health, because
(42:25):
I want all women to be able to get information.
It shouldn't matter whether you live in Arkansas or you
live in New York City. There should be a standard
quality of care. And that's my job to make sure
that the information that we give you is science based,
that it is accurate. I'm not trying to sell you something.
(42:48):
Because here's the other thing. As we said, we're in
this sort of real inflection point now where we're trying
to decide how is this all going to shake out? Well,
there are a lot of people who have awaken to
the fact that women in midlife have money to spend,
and the same things that we've been complaining about forever,
we're still complaining about. But now everybody's got a potion
(43:11):
or a lotion or a pill or something for you
to buy. How do you know whether or not that works,
or whether or not they are just trying to profit
off your misery. You don't unless you have a trusted
source for that information. And if I had to say,
what is my goal? My goal is to be that
(43:32):
I do what I do because I feel passionately about it,
and I want to make sure the information is out there.
And if you're not getting it from your doctor, then
nowhere to go.
Speaker 1 (43:42):
Thank you so much for that, doctor Malone. I wonder
if you could share any affirmations that maybe you've shared
with patients before around entering menopause or continuing to stay
connected to sexuality and sexual viovence throughout their lives.
Speaker 2 (43:56):
I'd say two things. One, just in terms of how
to enter this process and what your expectation should be.
I think you should enter perimenopause and menopause with the
expectation that I'm going to feel good. I'm going to
be good, and I'm going to come out on the
other side of this thing, and I'm going to be
(44:16):
better than I started. That should be your goal, not
that I'm going to be worse. I tell people all
the time, I said, look, I'm sixty five years old.
I am much happier now than I was when I
was forty five. But to be able to be happier
and to be productive at sixty five means that you
have to enter this process and know what to do
(44:39):
and how to navigate it, because, let me say, it's liberating.
And I want to say to all the young women
out there who are entering this phase, just know that, yeah,
you can be good if you just knew what to
do and how to do it. And the other thing.
I would say, sexuality at sixty is not what it
was thirty, Okay, and that's what it is, But it
(45:03):
doesn't mean that it's over. And if there are things
that are getting in the way, like you don't feel well,
like you can't sleep, like you have vaginal dryness, like
you have painful sex, then go fix those things. Go
fix them. It's easy, and it involves hormones, not always
(45:24):
systemic hormones, even though that's helpful for women who have
hot flashes, but sometimes it's just vaginal estrogen for women
who have frequent urine air tract infections and painful sex.
So no, it ain't over till it's over. You know
when that time is. But don't let the things that
are fixable get in the way. That's all I say.
Speaker 1 (45:46):
Thank you so much, flackh alone. I know people will
want to stay connected with you. So where can we
find your website. Where can we grab a copy of
the book in any social media handles you'd like to share.
Speaker 2 (45:56):
You can get my book Grown Woman Talk any place
you get books, so you can get it on Amazon,
you get a Target, Walmart, in your local bookstore. You'd
be surprised at what's in my book because one thing
that I've found over the years is that people don't
like to be lectured to. They like to have a conversation.
(46:17):
And that's the tone of my book. It's conversational. I
think there's a little bit of humor there. There's even
a playlist, so you can go to Grown Woman Talk
Book on Apple Music or Spotify, and I have some
music in there that anytime as subject gets too hard,
you can just step away, go listen to some music,
and come back later. But it's really a book to
(46:37):
be shared. Certain chapters will speak to you at different
points in your life. I think the earlier you read them,
the more proactive you're able to be. So that's how
you can deal with my book. And then as far
as following me, we are out there on myalloy dot com,
which is the telehealth company that I'm the medical advisor for.
(47:01):
You can follow me on Instagram at s Malone, MD,
and I just put fun stuff beautiful.
Speaker 1 (47:08):
We will be sure to include all of that information
in our show notes. Thank you so much for spending
some time with us today, Doctor Malone. I appreciate it.
Speaker 2 (47:15):
Thank you for having me, Doctor Joy.
Speaker 1 (47:20):
I'm so glad Doctor Malone was able to join me
for this conversation. To learn more about her and the
work she's doing, or to grab a copy of her book,
you should have visited the show notes at Therapy for
Blackgirls dot com slash Session three seventy six, and don't
forget to text two of your girls right now and
tell them to check out the episode. If you're looking
for a therapist in your area, visit our therapist directory
(47:41):
at Therapy for Blackgirls dot com slash directory. And if
you want to continue digging into this topic or just
be in community with other sisters, come on over and
join us in the Sister Circle. It's our cozy corner
of the Internet designed just for black women. You can
join us at community dot Therapy for Blackgirls dot com.
This episode was produced by A. Least Ellis and Zaria Taylor.
(48:01):
Editing was done by Dennison Bradford. Thank y'all so much
for joining me again this week. I look forward to
continuing this conversation with you all real soon. Take good care.
Speaker 3 (48:15):
What's
Welcome to the Therapy for Black Girls Podcast, a weekly
conversation about mental health, personal development, and all the small
decisions we can make to become the best possible versions
of ourselves. I'm your host, doctor joy Hard and Bradford,
a licensed psychologist in Atlanta, Georgia. For more information or
(00:32):
to find a therapist in your area, visit our website
at Therapy for Blackgirls dot com. While I hope you
love listening to and learning from the podcast, it is
not meant to be a substitute for a relationship with
a licensed mental health professional. Hey, y'all, thanks so much
(00:57):
for joining me for Session three seventy six of the
Therapy for Black Girls Podcast. We'll get right into our
conversation after a word from our sponsors.
Speaker 2 (01:05):
Hi. I'm doctor Sharon Malone and I'm on the Therapy
for Black Girls Podcast. I'm in session today unpacking how
our sex lives change as we age.
Speaker 1 (01:24):
And yet another episode themed to our twenty twenty four
Sex Positive September celebrations, our annual campaign centering the importance
of black women's pleasure, agency and sexual liberation. We're discussing
the ways in which our sex lives change and evolve
as we get older. While the symptoms women experience during
menopause and perimenopause can cause our sex lives to shift
in some challenging ways, that doesn't mean you still can't
(01:47):
embrace sexual vibrancy no matter the age. Joining me for
today's conversation is the New York Times bestselling author of
Grown Women Talk, Doctor Sharon Malone. Doctor Malone is a
nationally known expert in women's health, serving as the chief
Medical Advisor at Alloy Women's Health, a telehealth company that
focuses on women over forty. Doctor Malone and I chatted
(02:08):
about all things menopause and sex, including how to combat
some of the various symptoms that can make the idea
of having sex less than appealing. We also discussed the
importance of continued obgy in visits even as you reach
the end of your reproductive years, plus all the reasons
why grown womanhood is something to look forward to, not
to fear. If something resonates with you while enjoying our conversation,
(02:30):
please share with us on social media using the hashtag
TVG in Session, or join us over in the Sister
Circle To talk more about the episode. You can join
us at Community dot Therapy for Blackgirls dot Com. Here's
our conversation. Thank you so much for joining me today,
doctor Malone.
Speaker 2 (02:49):
Thank you for having me.
Speaker 1 (02:50):
Yes, we had a chance to chat briefly. We met
earlier this year at the Accelerator conference in Florida. I
didn't get a chance to hear you talk, so I'm
excited to chat with you today.
Speaker 2 (03:00):
Well, I've got lots to say. So you're in love,
So I wonder.
Speaker 1 (03:05):
If you could start by telling us a little bit
about what sparked your interest in women's health.
Speaker 2 (03:10):
You know what, I have been in women's health for
so long I can't even remember the beginning of it.
But I'm an obgyn. I had been in private practice
for almost thirty years and had been in residency for
four years before that. But even before becoming a doctor,
I am the youngest of eight children, and I am
(03:31):
the last of five girls in a row. So my
entire upbringing has been very, let's just say, woman centric,
and I think that my family history really as I've
watched my older brothers and sisters, in particularly my mother,
who passed away at the young age now of fifty seven,
(03:53):
I grew up understanding that there was really something that
was getting in the way of our health and how
we were able to survive or thrive. And my job
was to make sure that the kinds of things and
the care that my mother got, which I think was
really insufficient, didn't get replicated in the next generation. So
(04:13):
that's really the core of why I got involved in
women's health, and I have never looked back. It has
been really the joy of my life.
Speaker 1 (04:21):
I love that. And not only are you focused on
women's health, but you have a particular specialty in working
with women over the age of forty. So tell me
more about that, Niche.
Speaker 2 (04:30):
As I told you, I started practicing. Oh my god,
it's hard to believe you'd have to apply the COVID discount.
When you realize it's like, oh yeah, you got to
add those four years onto anything else you've been doing.
But I started practicing back in nineteen ninety two, and
when I joined my practice, I inherited the practice of
(04:51):
two much older physicians. So from the moment I started,
I had patients of all ages. So usually as a
young physician, you start out and you start out with
young patients and then you all grow up and get
older together. But on day one I had eighty year olds,
I had fifty year olds, and I had eighteen year olds.
So being involved in menopause and perimenopausal care has always
(05:14):
been a part of my practice in obgyn. It's not
just the delivering baby's part, it's what happens to women
after they're done with their reproductive years. And I think
that today that art has really been lost because we
don't talk as much about women's health over forty what
(05:35):
happens when you're done, And I think most of us
think of going to the obgyn for a couple of reasons.
You go for your pap smear, you go to make
sure you get contraception, and you get through a pregnancy.
And then once women get done with their childbearing, they
tend to fall off and they don't follow up as much.
And I think that there are a couple of reasons
(05:57):
for that. One, you think you don't need to go
because why do I need to do that now I'm
done with my children. But there's also a lack of
guidance that really happens for women after they're forty. It
seems as if the things that were interesting about you
are no longer And I think that nothing could be
farther from the truth. So if you have a doctor
(06:18):
who is really not speaking to you about what that
means to age and to age healthfully, then you need
to really reassess whether or not that particular doctor is
right for you, because this is the most important time
of your life. This is where what you do and
how you do it really really matters.
Speaker 1 (06:37):
Can you say more about that doctor, Malone? Because I
think you're right there's a lot of focus on those
child rearing child age years, but when you are starting
mini hall then later there isn't as much conversation. So
what makes that such a critical point in a woman's life.
Speaker 2 (06:52):
Well, because you don't think about it, but we are
going to spend anywhere from a third to half of
our lives in our post reproductive years. You're going to
spend more time there. And as we couple that with aging,
that is when you can get away with murder until
you're forty. You can not care of your gil self,
(07:13):
not get enough sleep, not do all the things you're
supposed to do, and really function relatively well. But when
you get to be over forty, that's when you really
start to pay the price for some of these behaviors,
and that's when it matters. It matters how you take
care of yourself. It matters what kind of guidance you get,
because I think most of us want to do better.
(07:36):
Who wants to feel bad? No one, But I think
what happens to us as we age, particularly as women,
we accept that feeling bad is part of just growing old.
I don't think that we envision another way to age,
and particularly when we come from families where we have
(07:58):
seen what aging looks like, and for most of us,
particularly in black families, it's usually not good. We are
dealing with chronic illnesses. By the time you look at
your parents, it's high blood pressure, it's diabetes, it's dialysis,
it's strokes, it's all of those things that we think
are inevitable. But leading up to that, those real, honest
(08:20):
to God productive years that you have between say forty
and sixty sixty five before you sit down to retire,
those are the years when you should be at your
peak functioning. So I don't want any woman to go
into perimenopause and menopause one unaware of the kinds of
(08:41):
things that you will encounter. That's number one and two.
If you do encounter these things. I want you to
know that, yes, it's normal, but suffering is not normal.
And that is where we have got to get out
of that mindset that as you enter perimenopause and menopause,
suffering is just the latest in the continuum of things
(09:04):
that women suffer from, starting from the moment we get
our periods, and we just sort of take that as normal.
And I'm here to say, no, no, no, let's not
do that. Let's understand that this is the time when
we really can have a lot more control over our
lives and how we age.
Speaker 1 (09:23):
Thank you so much for that. So we've had a
couple of conversations here on the podcast about menopause and
that whole process. But for those who maybe haven't listened
or haven't heard you explain it, can you say a
little bit about what signals to us that we are
entering a period of perimenopause.
Speaker 2 (09:37):
In menopause, Yes, perimenopause is a word that a lot
of women hadn't even heard of before let's say four
or five years. It didn't really enter the lexicon. We
kind of knew what menopause was, but we thought that
menopause was something that happened to old ladies. It's like,
oh yeah, menopause. You know you're fifty sixty when that happens,
and not really the tran transition, which is what perimenopause is.
(10:03):
It is that time between your peak reproductive years, which
usually they start at puberty and probably peaks in about
your early to mid thirties. So perimenopause is that period
between your peak reproductive years and the end of your
reproductive years, which is what really marks the beginning of menopause.
(10:23):
So menopause is easy because we know what that looks
like and what it means. Menopause means the age at
which you've had your last period, and it's confirmed when
you've gone twelve months and you haven't had another period,
but in that perimenopausal phase, which for most women can
last anywhere from four to seven years, but for African
(10:46):
American women that transition can take ten years. So let's
do a little simple math. If I tell you the
average age of menopause, which means the aged which you've
had your last period, is fifty one, that means for
Black back women, the average age of starting that process
can be as early as your early forties or in
(11:07):
some women even their mid thirties. Because the one thing
that we do know about how the lived experience of
being a black woman in this country affects us and
it affects all of our aspects of our health, but
it actually shows itself in perimenopause as well. We tend
to enter that phase earlier, it tends to last longer,
(11:29):
and the symptoms that we normally associate with menopause, like
hot flashes and night sweats and mood swings, those symptoms
tend to be more severe for African American women. Now
did anybody tell you that? Did anyone mention, Oh, by
the way, not only is this going to happen for
you earlier, but it's going to last longer, and it's
(11:49):
going to be more debilitating. And we've all seen someone
they've got their fan out, you know, they're fan in
their sweating. There are clearly not having an enjoyable moment,
but they don't know what to do about it. Whenever
I see that, I want to go and tap them
on the shoulder and say, girl, this can go on
for a very very long time. And not only that,
(12:13):
but we know what to do about it because hot
flashes and I want to say this again and again
throughout this conversation. Hot flashes are not benign. They're not
just annoying, and they are, but they are sometimes harbingers
of things that can affect your long term health, such
as it increases your risk for cardiovascular disease, increases your
(12:38):
risk for sleep disturbance, which of course creates fatigue and
stress and lack of performance on the job, you get
brain fog, on and on. But I think the big
things increases your risk for type two diabetes and increases
your risk for Alzheimer's. So there are a thousand and
one reasons why if you are bothered by the hot flashes,
(13:02):
you at least deserve a conversation with your doctor about
how to treat them and what the hot flashes mean.
Because it gets back to what I was saying, is
that we expect to suffer and we think of perimenopause
and menopause and all the symptoms that we have, and
actually they're over thirty four. Symptoms of menopause is not
(13:25):
just the hot flash, but we don't realize it because
just because you're not having hot flashes does not mean
you are not in perimenopause. You're still imperimenopause, even if
you never have a hot flash. But all of these
things brain fog, changes in libido, dry itchy skin, loss
of hair. I mean, that's a big problem for women
(13:47):
who are transitioning. I say, hair loss where you want
it and hair growth where you don't. There is also
the aging of your skin. And a lot of women
have libido and vaginal dryness, irritation, and urinary symptoms as
a result of this. So it's a lot. It's a lot.
And because we don't really know that these things have
(14:12):
easy remedies. And the easy remedy for it is since
it's a hormonal issue, you know, what's happening to you
in perimenopause is not that your hormones are gone. Well,
they're not gone, they're just erratic. And that's why. Also
one of the symptoms that women get during perimenopause is
very irregular periods. Your periods may come too soon, they
(14:36):
may last too long, it may be too heavy. Women
will come in and said, I've been bleeding for three weeks.
All of these things are indicators that your hormones are
just out of whack. They're too high one day, too
low the next, and everything in between. And for women
who are complaining when they go to their doctor and
(14:56):
they'll say, well, doctor, I have hot flashes, or I'm
gaining weight, or any of the other thirty four symptoms
that you may have. A lot of times the doctor
that you see does not recognize it as such, because
all they're thinking about as well, are you getting your
period or is your period regular? And if you answer yes,
then it would not be uncommon for you to get
(15:19):
an answer like, well, it can't be menopause. It's like no,
but it's menopause adjacent this thing called perimenopause. And so
after you've gone through this entire transition, which like I said,
can take as long as ten years, then what happens
are you over it? Well, a lot of women will
(15:39):
continue to have symptoms even after they've had their last period.
So this notion that it is something to be endured
or something that you will get over, I want to
sort of disabuse everyone of that notion. Because menopause process
is complete, you will continue to have the us of
(16:00):
that lack of estrogen and you will be that way
for the rest of your life. So for anybody who says, oh,
I didn't have menopause or I'm over it now. No,
you may be over your hot flashes, but you are
not over all the other signs and symptoms and health
issues that are associated with menopause.
Speaker 1 (16:20):
Got it, so, doctor Malone, how often are people coming
to you to talk about So you gave some symptoms
around vaginal dryness, changes in libido, which is of course
what we want to spend more time talking about today.
How often are patients coming to you talking to you
about those symptoms in particular?
Speaker 2 (16:36):
Well, you know whether they bring it up or not.
Eighty percent of women will experience either vaginal dryness, painful sex,
itchy dry vulva, or urinary symptoms as in frequent urinary
tract infections or urinary frequency and urgency. And that has
even a separate name for itself. It's called the genital
(16:58):
urinary Syndrome of menopause. Now that's a mouthful, so we
just say GSM. That means that the lack of estrogen
will affect your genital system. It affects your urinary system
and even your external genitalia. So I told you eighty
percent of women will experience, in some form of fashion
some combination of those symptoms well, a lot of women
(17:22):
are embarrassed. You may not bring it up, and you
look at what is advertised on TV, and you'll understand
how common the problem is. And remember how many incontinence
products there are advertised every time you look around, gotta go,
gotta go, and here's some new underwear that you can
put on because you're leaking. But no one really talks about, Okay,
(17:46):
why and better still, if that many women are having
these problems, what are we doing about it? And again
it gets back to the same thing that we're talking about.
What undergirds all of this is at menopause, the lack
of estrogen. So when you're having painful sex, when you
are having dry, itchy volvas, it is the lack of
(18:10):
estrogen because all of that tissue is estrogen sensitive. And
as a matter of fact, when you are just using
lubricants or creams or gels or that kind of stuff
to treat the symptoms, you're doing just that. You're just
treating the symptoms. You are not addressing the root cause.
And for most women, the simple solution is you can
(18:33):
use topical or local estrogen, which means just an estrogen
cream or tablet or a ring just in the vagina.
And this is even for women who either choose not
to take hormone replacement therapy after menopause or have reasons
why they should not take. But at a minimum, every
(18:54):
woman should have these issues addressed. And if you don't
bring it up to your doctor, it's not uncommon that
doctors won't ask because we've got so many other things
to talk about. And I have to give my colleagues
a little bit of a break here, not my gyn colleagues,
because they should be asking. But you're internist or you're cardiologists,
(19:15):
they're never going to ask you about whether or not
you have painful sex, or whether or not your vagina's dry.
But your gynecologists should, which is why I get back
to you can't stop going to the gynecologists just because
you're done having your kids, because there are other things
that come up in midlife that do need to be addressed,
(19:36):
and a lot of times your gynecologist is the most
appropriate person to bring that up with. HM.
Speaker 1 (19:42):
You know, doctor Malone, as you're talking about some of
these other thirty four symptoms of menopause, you're sharing, like
the mechanics that may make sex painful or difficult. But
some of the other things that you're mentioning, like hair
laws or weight gain like also play into I think
some of the mental health components that may be connected
to sexual activity. Can you speak to that a little absolutely?
(20:03):
I mean, think about none of these things happens in isolation,
and one thing affects the other. And the thing that
I didn't mention of those thirty four symptoms, the other
thing that really picks up in perimenopause is really a
lot of either depression, anxiety, irritability. I mean, they really
peak in midlife as you are making this transition. So imagine,
(20:28):
let's just start with the hot flesh, because everybody understands it,
all right, you have a hot flash. Now you've got
night sweats, you didn't get a good night's sleep, You're fatigued,
you're irritable, you got brain fog. And you go through
this day after day, month after month. You're not feeling
your best self. You're certainly not going to exercise because
(20:51):
you're tired, and you're gonna make bad choices. You don't
feel well. So we self medicate with things, some people
with alcohol, some people with food, some people with drugs,
whatever it is. We are constantly trying to get to
a point where we say, I just need to feel better. Now,
is that any recipe for anybody who wants to be
very sexual? When you think about it, it's like.
Speaker 2 (21:13):
I'm mad, I'm hot, I'm tired, And at the end
of the day, after you've gone through all of that,
then somebody says, oh, yeah, wouldn't this be a great idea?
Probably not, okay. I mean, a tired woman is not
going to be at her peak sexual best. And that's
why you can't just say I'm just going to take
(21:36):
care of the weight gain issue. Okay, well that's fine,
but what about all the other stuff? Because they all
play into each other, and they feed into each other,
and it really creates a really negative doomsday loop for
women in terms of how we feel. And as I said,
this is something that if there's a message there, and
there are a lot of messages I want to get
(21:57):
out there. But the good news is that we are
really trying to show women a different path forward and
to get you out of the mindset that old. I'm
old and creaky. I'm sixty five years old. I mean,
Kamala Harris is almost sixty. Michelle Obama, all of these
(22:18):
women who are out there that are saying, no, this
can and should be the best time of your life.
It should be something to look forward to, not something
to dread. And whether or not this part of your
life is good or bad is really going to be
dependent upon how we navigate it, and a lot of
(22:39):
times most of us just don't know how. And it's
not your fault. This is the kind of thing that
we don't talk enough amongst ourselves, and we don't talk
enough intergenerationally because I think for many of our mothers,
they didn't really know that there was an option, and
for many of them there really was. That's not an option.
(23:01):
So you know, that kind of acceptance of not being
your best self is something we've got to get out
of the mindset of. And so that's why if I
sound passionate about this, it's because I am. Because I
really want every woman to make the decision that's right
for you. And I think for all of these thirty
(23:22):
four symptoms of menopause that we talked about, the most
effective treatment for the symptoms of menopause is hormone therapy.
You know who gets that message least of all Black women,
but that's my job. Make sure you know when to
access what is important. What are the things that you
(23:46):
think are the reasons why you can't take unless knock
down those myths one at a time.
Speaker 1 (23:51):
More from our conversation after the break, but first, a
quick snippet of what's coming next week on TVG My.
Speaker 3 (23:58):
Mom's sister was and is a journalist. Her name is
Soladette O'Brien, and she traveled to cover Hurricane Katrina, and
she was there for months on end, at times living
out of cars, to cover the story, to put other
people's voices out on a national platform. And I don't
(24:19):
think I would have had the words for this at
the time, but I do remember getting the impression or
just having the feeling that, Wow, it is so amazing
that when there is a problem, there are people who
run toward it instead of running away from it, and
that at a time when so many people were trying
to figure out how to leave this city, I had
a loved one, an aunt, who was there actually recording
(24:42):
and documenting and showing people every day why they couldn't
look away from what was happening there.
Speaker 1 (25:00):
So, doctor Malone, can you talk about why black women
are not getting prescribed it as much. Is it just
good old fashioned racism or is there something else going on?
Speaker 2 (25:09):
Oh? Yeah, two things can be true. Okay, And let
me tell you there was actually a study that came
out twenty two years ago, the Women's Health Initiative, which
put this out there in the universe that estrogen causes
cancer and it doesn't have any benefit in long term help.
That study came out twenty two years ago. Well, I
(25:31):
had been practicing for ten years before that study came out,
and so I had a very different experience. And remember
I told you I had been treating women with menopause
since the first day I started, and so we were
taught something very different in terms of how to prescribe
hormone therapy what it was for. We were taught that
(25:51):
not only did it relieve the symptoms it does it
did then still does, but it also decreased the risk
of cardiovascular disease. And that was the big push about
why we were really advocating that women take it, because
more women die from heart disease every year, anywhere from
two to seven times more women die of heart disease
(26:12):
than die of breast cancer. So if you had something
that was going to decrease your risk of cardiovascular disease. Yay,
everybody should take it, right, But that study that came
out twenty two years cast doubt on that assertion that
it decreased the risk of cardiovascular disease. But it did
more than that. It cast doubt on that, and it
(26:34):
also throughout there. Oh yeah, and by the way, it
increases your risk of breast cancer. Now, neither of those
turned out to be true, and there was argument about
it from the very beginning. But you know how it is,
bad news travels fast and it's sticky. Even though we
in medicine and even in academic circles have been refuting
(26:57):
that for twenty two years, ever really made it out
into the universe. Everybody remembers when you get indicted. Nobody
remembers when you got to quit it. And that's the
hormone story. So we have an entire generation of doctors
that don't know how to prescribe and still will tell
you that to this day, Oh no, you can't have
(27:19):
hormones because your mother had breast cancer. That kind of problem.
So that is true for all women, okay, all women.
And here's where the racism piece comes. In if it's
true for all women, then it's twice as bad when
it comes to Black women. And that is culturally educationally,
(27:39):
both on the part of physicians and on the part
of women. It sort of creates that perfect storm for
the people suffering the most getting the least. And that
is the story of just about any condition that you're
talking about when we're talking about African American women.
Speaker 1 (27:56):
Got it. So, when the chances of getting pregnant are
less likely, right, typically in perimenopause menopause age, I think
a lot of women say like, oh, I don't need
kind OFMS, I don't need other protections, but we know
that the rate of STIs are also higher in older populations.
Can you talk a little bit about the continue need
for protection.
Speaker 2 (28:16):
Yes, okay, there are two kinds of protection, and perimenopausal
women need both because remember I told you that that
period of time between your peak reproductive years and no reproduction. Okay,
well that's a long span in between, and decreased fertility
does not mean no fertility. So even when you are
in perimenopause, you still should be using some reliable birth control.
(28:40):
And if you don't believe it, well, yours truly I
am that child that my mother was probably wishing for
menopause and she got me instead. My mother was almost
forty five when I was born. And it's funny because
now the family stories make sense to me because as
I was growing up, and I told you, I'm eight
of eight and the next sibling to me is seven
(29:01):
years older than me, and so the family stories I
always heard were, oh, we didn't even know your mother
was pregnant, And I was like, she probably didn't know
either until it was too You know, here, I am
so to all my perimenopausal ladies, it's decreased fertility, not
no fertility. So if you need reliable birth control, use that. Now,
(29:24):
if you have a male partner, and you and that
male partner are not in a monogamous relationship, then in
addition to whatever you're using, like if you want to
use birth control, or you have an IUD or whatever
is your primary mode of birth control, even if you've
had your tubes tied, if you're in a non monogamous relationship,
(29:46):
you need to use condoms to make sure that you
are not getting infected with sexually transmitted infections. Because here's
the deal. The ratio of males to females, and particularly
for black women, that ratio gets less and less favorable
as we get older. We know that, all right, So
(30:07):
you take out all the reasons why black men if
that is your preference, fall out of that equation. If
you are not in a monogamous relationship and you're in
the dating world, it is not unlikely that one functioning
male may be servicing a few others. And that is
why you need to make sure that at least you're
(30:29):
clear what type of relationship is this before you say,
all right, we can be condom free, and there are
ways to do it. But I want women to be
aware of that that you're still at risk for the
things that you would tell your teenage daughter about. Beware
of pregnancy, beware of sexually transmitted infections. HIV rates are
(30:51):
the highest in African American women in this country. So
we tend to think that that's not a thing anymore. No,
it's still a thing. If you had gonnarear chlamydia, we
know how to treat that. We forget about the other
things that are much more serious, herpies and HIV and
things that can be problematic for you.
Speaker 1 (31:11):
I'm curious, doctor Malone because you also mentioned that there's
a higher rate of increased urinary tract infections. Is there
a connection between that and then the increase in sis
in that ee?
Speaker 2 (31:21):
Well, you know what, think about this. When you are
a young person, your vagina is thick, it has the
ability to lubricate really well. As you get older, and
if you do not have estrogen on board, the vagina
gets thinner, it's more easily irritated, it's easier to be traumatized.
(31:42):
That's why sex is so painful because now those nerve
endings are closer to the skin than they were before
and you have no protection, so you're more susceptible to
STIs because again you don't have as healthy a vagina
as you had twenty years before. And the same thing
is true with urinary tract infections. You need a healthy
(32:04):
vaginal tissue. You need healthy urinary tissue, and when that
fends and it's easily irritated, it's so easy for bacteria
to get into your bladder. So all of that, you
think of it all together that the less healthy the tissue,
the more likely you are to be infected with bacteria
or with viruses.
Speaker 1 (32:24):
So that's malone. I'm also curious is there a concern
about the physical exertion that is connected to sex as
we get older. You mentioned like cardiovascular kinds of things,
So is there concerned around like the exertion of actual
sex being a concern as we get older?
Speaker 2 (32:39):
So what are you doing? I'm just no, I'm just saying,
y'all do I'm just trying to figure you know, regular
old people says, no, you fine, You fine? Okay. I
mean if you had to go do some acromatics, perhaps,
but no, if you are a healthy person, then there
is really nothing that you have unless we know that
you have some under lying severe heart disease. But no,
(33:02):
the amount of exertion for normal sexual activity, which actually
is good for you. Women and men who are sexually
active longer actually have better health span and lifespan. So no,
there's really not a whole lot to be worried about
unless you have serious other complications.
Speaker 1 (33:22):
So I would imagine that a part of your role
as obgyn also sometimes is a bit of therapy as well, right,
And so I wonder if you can talk a little
bit about some of the other stigmas are conversations you're
having with your patients around getting older and what it
means to feel sexy and even have interest in sex.
Speaker 2 (33:39):
The one thing that I loved about my job and
that I really may be missing in future relationships is
that I stayed in one place for thirty years and
I had a lot of the same patients for thirty years,
so I knew them, they knew me, and an obgyan
is the most intimate medical relationship you're ever going to
(34:03):
have with a doctor. So yes, on any given day,
I always kept a box of tissues just right there.
I would come in, I'd say, hey, how you doing,
and I go I'm fine, and I'm like, really, okay,
let me get my tissues here, and we would sit.
Because there are a lot of things that happen in
midlife in addition to perimenopause and menopause and all the
(34:27):
sort of trials and tribulations that that brings, It's an
emotionally fraught time of life. That is, when we are
generally dealing with aging parents. We still have children who
are adolescents and who are usually pains and the ads
at that point marriages may not be going well, so
there's a lot So yes, you have to know how
(34:48):
to be sensitive to the total person who is presenting
to you, not just I'm going to come in here
and do your pap smear and we're gone and all
of that. That You're mental health matters, how you are
moving about in the world, also affects your sexuality, how
you are feeling. You have to realize that there is
(35:10):
a very different relationship that you have to your libido
when you're fifty than when you're twenty. I mean, it
just is. And that doesn't mean there's anything wrong with you.
And it means that how you approach things and what
your expectations are are different. And I think that as
long as women understand that, and even after you understand
(35:31):
that it's different, if it's bothersome to you, to know
that there are again therapy that we can offer. Sometimes
it's a marital counselor sometimes it's sex therapy, sometimes it's
hormone therapy or any combination thereof about how to address it.
But know that it's different, it's not just you. And
(35:51):
I think that if we don't talk about menopause, we
don't talk about our sexual difficulties with our peers, because
we tend to think that everybody's having a great time
except me, And you have to be able to be
vulnerable with someone and to be able to explain, hey,
is this normal? What can I do to have that
(36:13):
kind of relationship? And what happens to a lot of
women in midlife, as I told you, is we start
experiencing a lot of these mental health issues like depression, anxiety.
One of the first things that a doctor wants to
do is put you on an SSRI or the antidepressants,
things like paxel zolof medications like that, and okay, yeah,
(36:35):
it might help a little bit, it might take the
edge off. But the thing that most women don't realize
is that they also have some sexual side effects. And
you've now taken a problem and you may have fixed
one thing and you've made another thing worse. So long
answer to a short question, but yes, how we deal
with ourselves sexually at fifties different. I think that we
(36:59):
also have to understand that this is a time when
many women are entering this phase of life and we
don't have partners. That's the reality. Okay, well, just because
you don't have a partner doesn't mean that you can't
be sexual. Sometimes that means you need to be sexual
with yourself understand what that means. We can all wish
for certain things, but at the very least know how
(37:22):
to take care of things for yourself. M h.
Speaker 1 (37:26):
More from our conversation after the break. You know, doctor Malone,
I'm sure you are aware of like the certain general's
conversations around loneliness and what an epidemic this has become
for us. Can you talk a little bit about loneliness
(37:47):
as it impacts women, especially in this age.
Speaker 2 (37:50):
Yes, COVID made it all worse. I think we were
already becoming more isolated as we spend more time with
our devices, because you can retain yourself just looking at
a movie or I'm going to scroll through Instagram or TikTok,
forgetting the fact that even though that may be entertaining
in the short term, it's not sustaining when it comes
(38:13):
to our physical and mental well being. And there have
been numerous studies that have actually shown that people who
do best are people that have large social networks, be
it at your school, be it your colleagues, be it
your family. We really need each other because that's how
we're wired. We're wired for community, and if you want
(38:35):
to age well, then you need to make sure that
your network, your sisterhood is strong, because that's more important
even than having a spouse or a romantic partner, of
having that just network of sisterhoods and friends.
Speaker 1 (38:51):
You've mentioned a couple of times around you know, if
your doctor's not having these kinds of conversations, maybe it's
time to find another doctor. I wonder what kinds of
things can you suggest for people of how to vet
their healthcare professionals so that they are feeling comfortable that
they're able to take care of them in this next
phase of life.
Speaker 2 (39:08):
Oh oh, if only someone had written a book about that.
Oh oh, that would be me. Oh that would be me.
Thank you for that. No, When I wrote my book,
and it's called Grown Woman Talk for a reason, and
that is because it's not just about menopause. There is
clearly a component. There are two chapters on there about
(39:28):
perimenopause and menopause. But I organize the book with two
thoughts in mind. One that no one really talks to
you when you're over forty because so much of our
time has been spent around reproductive issues and we deal
with that. But also to give you heads up on
how medicine has changed. And I think a lot of
(39:51):
the assumptions that we make about what your relationship is
going to be like with your doctor, those are no
longer valid. And like I said, I'm very grateful for
the thirty years that I had with my patients. You're
not going to have thirty years with a doctor anymore.
There's a doctor shortage. The amount of FaceTime that you
get with a doctor is less and less and less.
(40:13):
So I wrote the book to say two things. One,
I give you an idea of the kinds of things
that are important. How do you pick a doctor, how
do you assemble a team? What's important about your history?
Your family history. So it's that you can show up
better for your doctor's appointment because you're not going to
get a lot of time. So if you've got five
to seven minutes, make sure that you've invested on the
(40:35):
front end and your homework and you are prepared. Very important.
And I think the other thing that we have got
to realize is that medicine has changed and we're not
going back. We are dealing with the fact that we're
going to have to incorporate more telehealth into our visits.
There's going to be a component of artificial intelligence that's
(40:56):
going to be part of how medical care is delivered.
And that's good news and bad news. Bad news. Okay, yeah,
it's not as personal as it once was, but the
good news is that that means that gives you more
of an opportunity to be able to direct your care.
So I would say, in an ideal world, yes, everyone
should be able to find a caring, culturally competent doctor
(41:20):
who takes your insurance, who sees you and hears you.
If you find that hold on tight. But for a
lot of people that's not going to be what's out there.
And it's not because doctors are really trying to do
a bad job. Doctors are being squeezed and pulled every
way possible. But I say don't give up the fight,
(41:44):
because if you have someone and you know that they're
not right for you, then move on. And if you
cannot find someone, even within that framework, then that's one
of the reasons why when I left my private practice
in addition to writing my book to give you that
guide and the navigational tool that you need to get
(42:04):
through this confusing system that we have. But I also
wanted to say I want every woman to have access
to at least the minimum care and access to hormone
therapy and to understand perimenopause and menopause. And that's why
I'm the chief medical Advisor at Alloy Women's Health, because
(42:25):
I want all women to be able to get information.
It shouldn't matter whether you live in Arkansas or you
live in New York City. There should be a standard
quality of care. And that's my job to make sure
that the information that we give you is science based,
that it is accurate. I'm not trying to sell you something.
(42:48):
Because here's the other thing. As we said, we're in
this sort of real inflection point now where we're trying
to decide how is this all going to shake out? Well,
there are a lot of people who have awaken to
the fact that women in midlife have money to spend,
and the same things that we've been complaining about forever,
we're still complaining about. But now everybody's got a potion
(43:11):
or a lotion or a pill or something for you
to buy. How do you know whether or not that works,
or whether or not they are just trying to profit
off your misery. You don't unless you have a trusted
source for that information. And if I had to say,
what is my goal? My goal is to be that
(43:32):
I do what I do because I feel passionately about it,
and I want to make sure the information is out there.
And if you're not getting it from your doctor, then
nowhere to go.
Speaker 1 (43:42):
Thank you so much for that, doctor Malone. I wonder
if you could share any affirmations that maybe you've shared
with patients before around entering menopause or continuing to stay
connected to sexuality and sexual viovence throughout their lives.
Speaker 2 (43:56):
I'd say two things. One, just in terms of how
to enter this process and what your expectation should be.
I think you should enter perimenopause and menopause with the
expectation that I'm going to feel good. I'm going to
be good, and I'm going to come out on the
other side of this thing, and I'm going to be
(44:16):
better than I started. That should be your goal, not
that I'm going to be worse. I tell people all
the time, I said, look, I'm sixty five years old.
I am much happier now than I was when I
was forty five. But to be able to be happier
and to be productive at sixty five means that you
have to enter this process and know what to do
(44:39):
and how to navigate it, because, let me say, it's liberating.
And I want to say to all the young women
out there who are entering this phase, just know that, yeah,
you can be good if you just knew what to
do and how to do it. And the other thing.
I would say, sexuality at sixty is not what it
was thirty, Okay, and that's what it is, But it
(45:03):
doesn't mean that it's over. And if there are things
that are getting in the way, like you don't feel well,
like you can't sleep, like you have vaginal dryness, like
you have painful sex, then go fix those things. Go
fix them. It's easy, and it involves hormones, not always
(45:24):
systemic hormones, even though that's helpful for women who have
hot flashes, but sometimes it's just vaginal estrogen for women
who have frequent urine air tract infections and painful sex.
So no, it ain't over till it's over. You know
when that time is. But don't let the things that
are fixable get in the way. That's all I say.
Speaker 1 (45:46):
Thank you so much, flackh alone. I know people will
want to stay connected with you. So where can we
find your website. Where can we grab a copy of
the book in any social media handles you'd like to share.
Speaker 2 (45:56):
You can get my book Grown Woman Talk any place
you get books, so you can get it on Amazon,
you get a Target, Walmart, in your local bookstore. You'd
be surprised at what's in my book because one thing
that I've found over the years is that people don't
like to be lectured to. They like to have a conversation.
(46:17):
And that's the tone of my book. It's conversational. I
think there's a little bit of humor there. There's even
a playlist, so you can go to Grown Woman Talk
Book on Apple Music or Spotify, and I have some
music in there that anytime as subject gets too hard,
you can just step away, go listen to some music,
and come back later. But it's really a book to
(46:37):
be shared. Certain chapters will speak to you at different
points in your life. I think the earlier you read them,
the more proactive you're able to be. So that's how
you can deal with my book. And then as far
as following me, we are out there on myalloy dot com,
which is the telehealth company that I'm the medical advisor for.
(47:01):
You can follow me on Instagram at s Malone, MD,
and I just put fun stuff beautiful.
Speaker 1 (47:08):
We will be sure to include all of that information
in our show notes. Thank you so much for spending
some time with us today, Doctor Malone. I appreciate it.
Speaker 2 (47:15):
Thank you for having me, Doctor Joy.
Speaker 1 (47:20):
I'm so glad Doctor Malone was able to join me
for this conversation. To learn more about her and the
work she's doing, or to grab a copy of her book,
you should have visited the show notes at Therapy for
Blackgirls dot com slash Session three seventy six, and don't
forget to text two of your girls right now and
tell them to check out the episode. If you're looking
for a therapist in your area, visit our therapist directory
(47:41):
at Therapy for Blackgirls dot com slash directory. And if
you want to continue digging into this topic or just
be in community with other sisters, come on over and
join us in the Sister Circle. It's our cozy corner
of the Internet designed just for black women. You can
join us at community dot Therapy for Blackgirls dot com.
This episode was produced by A. Least Ellis and Zaria Taylor.
(48:01):
Editing was done by Dennison Bradford. Thank y'all so much
for joining me again this week. I look forward to
continuing this conversation with you all real soon. Take good care.
Speaker 3 (48:15):
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