Antidepressants Blog

Sexual Diversity—Coming Out in Midlife

Just because people get married does not necessarily mean they are straight. Many people discover that they are lesbian, gay, bisexual, or transgender later in their adult lives. Others may also come to realize that their gender identities do not reflect the social norm.

Denying their sexual feelings can lead people to attempt to act and feel straight by dating, marrying, and having children. Sexual experiences during our teen years and early 20s don’t determine our sexual orientation. Reevaluating our sexual orientation or gender identities after a committed relationship with someone of the other gender, marriage, widowhood, or divorce can result in discovering a whole new world of sexuality, including our sexual orientation.

Many people whose sexual identities differ from social norms may be uncomfortable about themselves and their sexuality for many years and may lack the confidence to face their differences and actualize their desires until they develop the maturity that comes with midlife.

Divorce and Widowhood

Not all people who get married establish other committed relationships or live together for the rest of their lives. Some people end their relationships or marriages intentionally. Many do so legally with divorce. Others experience the death of a partner and become widowed. All these situations require a time of adaptation.

People who are divorced, leave relationships, or become widowed are usually accustomed to regular sexual expression. Suddenly, they find themselves without a sex partner. Often, women and men must renavigate their sexual journey.

Thirty-three percent of women and 40 percent of men who become divorced are between the ages of 35 and 54. Divorce and breaking up can be a response to stresses such as people growing differently from one another, midlife career and identity crises, discovery of sexual identity, and extramarital affairs.

Many people accept divorce as a positive alternative to an unhappy marriage. Others find divorce to be devastating to their emotional, social, and financial lives. Becoming the single, primary caretaker of children can be especially overwhelming.

Midlife widowhood is not uncommon. Because women have a longer life expectancy than men, there are generally more widows than widowers. A woman may feel like a fifth wheel when she socializes with couples that she and her partner knew. Finding single people of the same age may be difficult. But today, women and men who become single again in midlife are unwilling to resign themselves to a life without companionship and sexual activity.

Many people who marry again after divorce or widowhood have successful marriages. Their marriages are often based upon mutual interests, goals, and emotional compatibility. Divorced and widowed women and men who have sexual activity without being married again also express great satisfaction.

Dating and marriage after becoming single again in midlife can be difficult. Remember how anxiety-ridden we were about dating during adolescence? Dating in midlife makes a person a second-time beginner. Rules for dating and sexual relationships may have changed since we were teenagers. We may have to relearn them in the process of dating again. This may feel very clumsy at first.

Newly single men usually have less difficulty finding dating opportunities. They may date women their own age or women quite a bit younger. Although the same opportunities should be available to women, our social norms do not generally support dating between older women and younger men.

Our sexual journey does not end with parenthood or midlife. It changes pace and design as we become older adults.

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During childbirth, some women have a procedure called an episiotomy. An episiotomy is an incision through the skin and muscles in the perineum, the area between the vagina and the anus. This incision is made just before delivery and before the baby’s head comes out. It’s done to help prevent the baby from naturally tearing the skin and tissue in areas that would cause more complications.

Not every woman has an episiotomy. Some health care providers do not believe it is necessary, while others say that it helps a woman heal more quickly after labor. How rapidly a woman heals affects how soon she may have sex after childbirth.

In general, health care providers suggest waiting about four to six weeks before resuming sexual intercourse. This allows the body to heal and the uterus and vagina to return to their pre-pregnancy size. There is also a time after childbirth called the postpartum period, a time of both physical and psychological adjustment for a woman and everyone in her family. It is a time of intense emotional highs and lows. A father may soon become jealous of the closeness between a mother and newborn. A new mom might feel that she has to care closely for the baby and doesn’t want to be distracted by others. She may not be interested in sexual activity.

Breast-feeding is another way a mother forms a close bond with an infant. This is a very special relationship. Breast feeding has very practical benefits. It helps weight loss for the new mom and causes the body to release a hormone called oxytocin. Oxytocin causes contractions of the uterus during breast-feeding, which help the uterus return to its normal size. These contractions can be sexually pleasurable. Some women feel guilty over these sexual feelings, but they are perfectly normal and natural.

Sometimes in our sexually intimate relationships, we care for our partners as much as we care about ourselves. This is called mutuality. It means that we are willing to make sacrifices and compromises. Sometimes we may feel as though we are making sacrifices and compromises that are not appreciated by our partners. This can greatly affect the sex play and intimacy in a relationship.

It is always important to open communication about these issues—to discuss what we appreciate as well as what we expect. It helps to carefully evaluate the compromises and sacrifices we make and try to figure out what purpose they serve and what they may mean to the relationship over time.

Intimacy in a relationship can fluctuate. Each one of us has our ups and downs. The nature and quality of the intimacy in our relationships change with each up and each down. It is this emotional intimacy that makes our relationships in adulthood different from the ones we had as adolescents. It also makes possible a mutual sharing of sexual pleasure.

Mutuality is one of the aspects of romantic love. Romantic love is a combination of liking, sexual attraction, and intense emotional interaction between two people. There are two kinds of romantic love. Passionate love is a strong combination of feelings. It can sometimes be confusing because it can include tenderness, sexual desire, elation, pain, anxiety, relief, altruism, and jealousy all at once.

Passionate love often occurs at the beginning of a romantic relationship. As time passes, it usually quiets into companionate love. Companionate love is less emotionally intense than passionate love. It remains sexual but is moderated by friendly affection and a deeply emotional committed attachment.

As individuals, we are capable of feeling all kinds of love toward others. Sometimes love grows out of friendship. Other times love is found with a new person in our lives. Some people even fall in love at first sight!

There may be times when we think we are in love but we are not. We may be infatuated with someone. Infatuation is a strong sexual attraction to someone, based mainly on her or his resemblance to the ideal in our lovemap. Infatuation is common and healthy. It doesn’t take long for us to realize that we are infatuated and not in love. Infatuation often passes when we get to know the person and realize that we were attracted to surface qualities, not the substance of a person. An infatuation so strong that we can’t get it out of our heads is called limerance.

Jealousy is another emotion that is sometimes a part of our romantic relationships. Jealousy occurs when we believe that there is someone else who is receiving our partner’s affection. We all fear the loss of love at some time in our lives. The thought that a loved one might be looking for a new love interest can cause us to feel anxiety and anger. It can lower our self-esteem. Communication and honesty are the best cures for jealousy. We may also find it important to remember that we are all capable of caring for many different people during our lives.

A good, healthy, lasting relationship requires work from both partners. We can’t just sit back and think it will happen of its own accord. Communication and honesty are just two ingredients of healthy relationships, but they can go a long way. On the next page are some helpful hints that can strengthen relationships. They may seem simple, but it is often the easy things that we forget!

We are constantly making decisions when we are in relationships. These decisions include such issues as contraception, commitment, and living arrangements. As adults, we become more responsible for continuing to educate ourselves about our sexuality and sexual health. We can no longer depend on family and friends to do it for us.

We should know what contraceptive methods are best suited for our individual needs. We should know about sexually transmitted infections, including HIV/AIDS, and how to get tested. Young women should receive an annual pelvic exam, and young men should receive an annual physical. We should also try to understand what makes relationships healthy so that we can avoid abusive relationships. We should try to develop the communication and negotiation skills that are vital to maintaining healthy relationships.

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MYTHS ABOUT BIRTH CONTROL AND PREGNANCY

Positively valued stereotypes of femininity

According to the stereotypes of femininity, women are always supposed to be:

emotional

warm

able to devote themselves to others

gentle

helpful

kind

understanding

aware of others’ feelings

Positively valued stereotypes of masculinity

According to stereotypes of masculinity, men are always supposed to be:

able to perform under pressure

independent

dominant

active

competitive

decisive

self-confident

determined

Dangerous myths about birth control and pregnancy

Although nearly 75 percent of all teens have sexual intercourse before they graduate from high school, many believe myths that may lead to unintended pregnancy or sexually transmitted infection. To offset these misconceptions about birth control and pregnancy, young adolescents need to know the following:

• A woman can get pregnant even if:

- she is having vaginal bleeding

- she doesn’t have an orgasm

- she doesn’t have vaginal intercourse often

- she has vaginal intercourse standing up

- she urinates right after having vaginal intercourse

- she douches with Coke®, Sprite®, Fresca®, or anything else

- the man pulls his penis out of her vagina before he ejaculates

- she jumps up and down after vaginal intercourse

- she hasn’t had her first period yet

- she’s under 12 years old

- it’s her first time

• Plastic wrap wrapped around the penis is not an effective contraceptive.

• The Pill does not prevent sexually transmitted infections.

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Most of you would like to put your whole cancer experience completely behind you. You would like to say, “I had cancer, but it’s all over now. I am, or soon will be, as healthy as I was before I got sick. I can go back to my routine medical care.”

Can you really face your future by ignoring your history of cancer? Should you? Unless your doctors have given you a 100 percent guarantee that your cancer will never come back, you will have some concern about recurrent cancer. Depending on what treatment you received, your body will need to recuperate. And many treatments cause their own problems, in the short run or the long run.

Your health is not the same as it was before you developed cancer. Your knowledge about the vulnerability of your health is painfully changed. Believing that you are back to the way you were before cancer may save you immediate anxiety about possible future problems. But it would be at an enormous cost to you, emotionally and physically.

There are many reasons why you should continue learning about your cancer. In the short run, you can take steps to prevent or minimize problems, and thus maximize and speed your recovery. In the long run, knowledge allows you to take measures to help prevent future problems such as recurrent cancer (recurrence) or the development of a new type of cancer.

You have met the challenge of treatments. But your situation is like that of a marathon runner, whose efforts are not over at the end of the race. Successful runners are careful about their recovery. For days afterward they get extra fluids, nutrients, and rest. They know that it takes weeks to get their primed, but spent, bodies completely back to normal.

Given that an optimally conditioned runner has to make adjustments to recover from a race, imagine the needs of a competitive runner who sprains her ankle. She has to decide how to deal with her injury. She can ignore the injury and risk further injury while performing at less than peak performance. Or she can find out what to do to maximize and speed her recovery. This may mean slowing down or even stopping her training schedule for a while. If, after complete healing, some ankle weakness remains, she can act as if there were no problem, running in pain and risking recurrent injury. Or she can learn about modifications to make in her shoes, running style, training schedule, or running route that would allow continued, though changed, running.

Your cancer and treatment caused changes in your body that can take days, weeks, months, or even years to disappear. Some changes may be permanent. Like the runner, you will feel better and heal faster if you learn about the changes in your body and the ways to help yourself recover.

Many survivors who have completed treatment struggle with a sense of vulnerability and an urgent desire to do something to help protect their renewed health. Learning what you can do to stay healthy will allow you to regain a sense of control and will maximize your chance of staying healthy.

After cancer, you may feel bombarded by information about what causes, cures, or prevents cancer. Newspapers and magazines, books, and well-meaning friends and family offer frightening, exciting, confusing, and often contradictory messages. Knowledge can help you sort out useful facts from inaccurate or misleading stories.

Each year brings advances in the diagnosis and treatment of cancer. In the future, new options for screening, follow-up, and preventive measures for your type of cancer may be offered to you. Staying informed about your medical situation after cancer will make it easier for you to appreciate the benefits of these developments.

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Here I would like to speak out loud and clear: I advocate compulsory periodic medical examinations for everyone.

Already there is the compulsory X-ray examination for tuberculosis. At schools, doctors and dentists give our children regular ‘physicals.’ We accept the fact that our community water and milk supply and the food we eat should be subject to inspection. We take it for granted that our children should be vaccinated against polio. We agree that individuals have a social obligation not to transmit illnesses to others. Nurses and individuals in certain other professions and jobs are examined regularly.

It seems obvious to me that this practice should be extended. Why not include everybody, in these days when we come into close contact with total strangers every day in trains, stores, movies, swimming pools, and so on? In addition to the examinations and tests for communicable diseases, optional examinations for other potential killers and disablers should become a national habit. These would include tests for diabetes, cancer, heart and kidney diseases, and other illnesses, according to the age or condition of the individual being examined. Naturally, I realize that this programme will not be introduced today or even tomorrow. I hope some of you will help to speed its realization.

When people come to accept such examinations and tests as a part of their regular lives, diseases can be prevented or cured without arousing alarm.

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Most of the harm done by campaigns against the killing and disabling diseases stems from the fact that such campaigns are conducted over relatively short periods of time. Organizations that do excellent work every day of the year are limited to a week or so in which to educate the public and publicize their work. Whether they wish to or not, they must in a sense compete with other valuable organizations. If they want to put across their message, they must use advertising methods and publicity techniques similar to those intended to sell a commercial product.

This situation would be greatly improved if these organizations could obtain the money they need without having to engage in intensive fund-raising campaigns—for example, by increased donations from individuals and foundations and by aid from the Government. It would also help if the campaigns placed even more emphasis on the fact that the health hazards they are publicizing can be cured or controlled if they are detected early enough. As an example, this positive approach to the dangers of childbirth has done a great deal to eliminate fear and anxiety in prospective mothers.

But most important of all, health education should be a continuous process, so that organizations would not have to crowd their warnings and recommendations into a single intensive week.

Health education should begin in childhood. Some elementary schools train young children in many of the essentials of health and hygiene. Some high schools continue this excellent work, teaching first aid, human biology, and the prevention of disease. How about your school? By working through parent-teacher associations or by organizing interesting after-school programmes, parents can see to it that their children’s health education is not neglected.

This education should not end when young people leave school. Churches, adult education centres, clubs, trade unions, and other organizations should keep health on their agenda, working out ways of interesting their members by means of lectures, exhibits, and so on, and of bringing these projects to the entire community.

The public health department in your community can be of great assistance. Many of us tend to overlook this valuable agency. The effectiveness of your local health department depends to a great extent on the interest of the local citizenry. Public health departments and health inspectors have learnt how to get excellent results without resorting to scare techniques.

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I am by no means opposed to health campaigns. On the contrary, I feel that they and the voluntary or governmental agencies sponsoring them do wonderful work. They alert and educate the public. They raise money to carry out vital research and to assist the victims of various diseases. They deserve great credit for helping to eliminate or control many illnesses that once took a toll of disability and death.

It is impossible even to estimate the number of lives that have been saved and the amount of suffering that has been prevented by the efforts of national health campaigns. The endless, tireless—and unpublicized— work of our local public health departments protects us against typhoid fever, dysentery, undulant fever, and other milk-, water-, and food-borne diseases. Public health agencies have all but eliminated malaria, smallpox, and yellow fever.

Not so very long ago, a man who was even suspected of having leprosy might be stoned to death, and people who had touched him were apt to consider suicide. We know now that the danger of catching leprosy by touching a leper is, practically speaking, non-existent.

Having eliminated the ignorance responsible for such panics, must we now pay for our knowledge by becoming a nation of chronic hypochondriacs?

My answer is No. We can have the tremendous advantages that come with enlightenment and at the same time avoid the danger of being frightened into becoming hypochondriacs by (1) continuous health education; (2) routine periodic medical examinations; and (3) a sensible attitude towards the calculated risk in health

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