From the clitoris to menopause, the uncovering and recovering of pleasure

I’d like to start talking about perimenopause by first talking about the clitoris.

I don’t mean ‘just’ the little sticky-out bit that’s been the target of countless lame jokes if not the attentions of well-meaning men. I mean the entire internal pleasure-dome structure of it that dominates the female sex organs.

A structure that was only ‘discovered’ in 2009.

Now, I need to be clear here. The world had the opportunity to discover it when physicians poked about and described it in Ancient Greece and Rome and then in the 1500s and the 1600s and then again in the 1800s and then when, in 1901, the esteemed Grey’s Anatomy included this piece of female physiology in its pages. Until 1948 that is, when the updated edition simply erased it altogether.

Bloop. Gone.

This shouldn’t come as a surprise. For the bulk of its history, the medical establishment has paid little attention to the ‘sexual’ part of women’s sexual and reproductive rights, caring only for the former in as much as it’s qualified by the latter.

We only ‘discovered’ the clitoris in 2009 because in the mid-1990s, urologist Helen O’Connell got curious and ran MRIs to map its full anatomy – including its 15 000 nerve endings – and then published seminal papers on the topic in 1998 and 2005.

And the wider world only got to know about this because in 2009 two French researchers, Odile Buisson and Pierre Foldès, produced the world’s first 3D pics of the internal structure of the clitoris.

Still, it took a while for the news to trickle out.

I was working as a sex and relationships writer and yet I only heard about it at the end of 2011 and it was only from 2013 that the global news cycle found it and only in 2016 that entire companies and art forms had emerged to spread the gospel of the clitoris.

So, what has this got to do with menopause?

My work in the broad area of sex and relationships happened in parallel to producing a vast body of work as a health writer. Over the course of about 16 years, I became aware of the increasing focus on women’s health and voices not just in the SRH research but in wider medical research and in the media.

I imagine this happened as more women stepped into positions of power and authority in medical research and media or were ‘allowed’ by the establishments they found themselves in – whether universities or publishing houses – to follow their areas of interest, and those areas of interest meant looking at the world from the woman’s point of view.

Hence this slow but important move away from viewing the female body as more than just a baby-making factory or receptacle for the mighty penis, hence the research into and data-backed validation that women’s pain is not considered as important as a man’s in the medical field, hence the step away from pharmacology viewing women as ‘little men’…

I loved watching this shift happen. I loved being, in some small way in the SRH space, part of this shift here in South Africa. But the churn and general ignorance wore me down and I put all of this to bed when I closed off The Dot Spot and said sayonara to health writing.

And then perimenopause hit and I discovered that what happens after a woman’s baby-making years is as equally ignored or overlooked by the greater medical establishment. Worse, perimenopause and menopause are so wrapped in bad comms that most women know less about what to expect than what they did their period when they were teens.

And I was one of those women.

You see when perimenopause came a’calling, I didn’t know it was moving in. Sure, my night-time thermoregulation was going to shit, I was getting a second belly no matter how much I cut out of my diet or exercised, my muscles and joints were aching all the time, my capacity to care was diminishing just as bursts of clean, pure rage attached to nothing were increasing, and my sleep was slowly dribbling away along with my ability to think straight, form words from my mouth, or feel any joy, but hey, wasn’t this just ‘middle-age’?

After all, I’d been told menopause was hot flashes and no period, so if I was still getting my period and had no hot flashes then it was just … well … this ‘middle-age’ nonsense, right?

(And even if it was the menopause, then hurrah, nudge nudge wink wink, all that not caring, isn’t it fun to start experiencing the world as a man does?)

Of course, the mention of hormone replacement therapy (HRT) (also referred to as menopausal hormone therapy or MHT), would come up occasionally with one of my friends but I’d shy away from it. I’d heard that there was a study that said it was dangerous and caused blood clots and breast cancer and lord knows I did not want that, no sirree, I’ll use supplements and tweak my diet. Make sure my ‘sleep hygiene’ is perfect…

Nothing worked.

By the time I was bumping along with two hours’ sleep a night, feeling like there was a dense film between me and the outside world, convinced I was suffering from fibromyalgia and walking around like a full-body arthritis sufferer, I was almost ready to do anything. But not quite HRT. That was dangerous right?

And then one morning my lip muscles couldn’t form the word I was trying to say and I got properly scared.*

Luckily, at about that time, I found peri/menopause Instagram – and my life changed.

I followed Dr Mary Claire, Dr Louise Newson and Dr Vonda Wright** and through them I learned a few major things:

• Parts of the study that put the fear of God into everyone about HRT was flawed and the comms around it deeply flawed. After it came out, it effectively made the only real treatment for menopause suffering go Bloop. Gone.

• The patriarchal system that already expects women to ‘just deal with it’ when it comes to pain was neatly in place then to deal with the fall-out of millions of women dumping their life-saving HRT. There were psyche meds and heart meds and pain meds and uppers and downers and supplements galore. Women were told what they’re always told: ‘Just deal with it’ because it’s just a natural part of aging (a line bandied about by supplement and diet influencers and doctors alike) …

• One of my favourite lines from Dr Mary Claire was something like ‘breaking your arm is also natural, so is a heart attack … no one expects those conditions to go unmedicated’ (this is only loosely quoted; you’ll find the full reel on her insta).

• Bioidentical hormones basically just put the hormones your body can no longer produce into your body. And your body needs it. Bad. Think of it like a supplement. If you lack vit d you take a supplement; if you lack estrogen, you take a supplement. It's nothing more nefarious than that. It's not 'big pharma' trying to make money either. It's cheaper than all those other meds and supplements you will need to take to manage the symptoms. Honestly, I am saving so much money just using the patch.

• Estrogen is essential for the healthy functioning of almost every part of your body, from your muscles and heart to your brain, bones, eyes, sexual function and more. You might not experience any symptoms – lucky you – but that doesn’t mean your body isn’t being affected from the lack of this essential hormone…

• HRT doesn’t mean you won’t have to make lifestyle adjustments, including changing your diet and how you move.

• But no supplement or dietary changes will ‘balance your hormones’ when there are no hormones to balance.

• And finally, there is no reason to suffer. You don’t have to endure perimenopause or make an uphill battle of it. Suffering is not a sign of how magical a crone you’re becoming; it’s not necessary for wisdom; it doesn’t make you more connected to ‘womanhood’.

So, read up on the symptoms – there are many – and if you’re between 40 and 50 (or younger frankly; if you are noticing weird changes in your body, mood, mind, and emotional make-up pay attention, early perimenopause is a thing, as is menopause induced by medical interventions or disease), find yourself a GP, gynae or endocrinologist specialising in menopause and get on that HRT (and make those lifestyle changes! It’s just going to make aging easier if you’re healthier and stronger).

And find someone else if they say any of the following shit to you and they’re brushing you off:

• This only happens in your 50s.

• You still have your period so it can’t be perimenopause.

• Every woman should consider HRT dangerous and take it with caution.

• Wait until your period has stopped for six months.

• Wait until you can’t live with the symptoms anymore.

• Are you having hot flashes? No? Then you’re not in perimenopause.

Follow menopause doctors and activists on Instagram. Find people who you relate to. The menopause doctors I follow on insta are like me: white cis women with white cis women perspective. You can and must search for menopause experts that you relate to whatever your gender or race. Learn a fuck ton. Tell other women and men who care for the women in their life.

What I’ve loved the most about this awakening, frankly, other than getting my life back, has been watching these women – these doctors, researchers, activists – be loud and powerful voices for women’s mental and physical health.

I love being in this moment where we watch the tide of medical practice perspective turn to not only include the female body, but to include it as its own imperative, not as a ‘little man’; where we start seeing women and their experiences taken seriously at every part of their physical expression, not just when they’re eligible for making babies.

Moreover, I’ve loved coming full circle on pleasure.

Much like the clitoris, the reality and influence of perimenopause and menopause is much more than the hot-flash tip of the endocrine iceberg. Much like the clitoris, it’s all about pleasure. Because living pain free, I see now, is pleasure. Not having your sexual function disrupted by a lack of estrogen is pleasure. Getting your brain, your life, your sleep, your functioning body back, is pleasure. Much like the clitoris, the time for ignoring menopause is done.

And once again, I’m here to be one very small part of spreading the word. Hope it helps.

t

---

* Don’t worry, it wasn’t a stroke; it’s a super rare symptom of the perimenopause. And there are so many, many symptoms. Apart from the lip thing, my weirdest was feeling these prickly and burning sensations all over my skin. Interestingly, fibromyalgia – something not fully understood and whose origins can’t be pinpointed – typically starts with women aged 40 and up … weird that.

** There are so many other amazing doctors working in this space; Dr Mary Claire is just especially great and making the circle bigger, so if you start with her you’ll get a lot of good leads. 

---

Some reads

Regarding the history of the clitoris and the erasure of female anatomy:
Vice: A brief history of medical books erasing women’s genitalia
The Conversation: The clitoris, a brief history
Helen O’Connell: Her Wiki page

Some information about the clitoris
Healthline: Your clitoris is like an iceberg

Menopause doctors to follow
Dr Mary Claire, Dr Louise Newson and Dr Vonda Wright are a good place to start. I won’t bother listing extensive info about menopause here, the experts do an infinitely better job than I ever could. Just go listen to them and find other medical professionals and activists you like.

A list of symptoms
The Menopause Charity

---

Photo by Mary Borysova on Unsplash