Arguing that medical authorities have claimed a privileged and pow­erful position in constructing the predominant discourse of sexuality, Sue Sherwin (1992) challenges feminists to critically address biomedical ethics and excise prevailing practices that result in women’s oppression. She points out that “physicians have been socially authorized to advise on sex­ual matters, although most of them have little training in the multidimen­sional aspects and varieties of human sexuality (and virtually no lessons on the politics of such studies). Many simply pass on their personal views about sexual matters under the guise of ‘scientific experts’” (p. 216).

In contrast, feminist visions of holistic health care, if widely imple­mented, would revolutionize traditional constructions of medical care and the doctor-patient relationship. The nurse-practitioner model, for instance, values the consultant role rather than the patriarchal model of unques­tioned authority and power over the diseased body part of the patient. In this model, the full context of women’s lives—nutrition, exercise, work, relationships, stressors, personality strengths and weaknesses, and even spir­ituality—is assessed. This fuller picture, which takes much longer to form than the typical physician’s office visit, allows for a collaborative relation­ship, better exchange of information, and more informed decision making for women.

Feminist notions of women’s sexuality must counteract and correct the assumptions pervading the biologically based, partner-oriented, hetero­sexist, and patriarchal models that continue to dominate sex research. As Naomi McCormick (1994) points out, a feminist alternative should view sexuality as a whole mind and whole body experience. It is more than physiology (frequencies of orgasms, strength of vaginal contractions, and amount of lubrication). Relational dynamics and subjective meanings and motivations to understand female sexuality should be a central part of this picture. The power relationships that exist must similarly be addressed. Women must be free to explore, free to have pleasure, and free to be diverse. They must be free of the tyranny of traditional sex-role expecta­tions that limit good sex to the young, the attractive, the healthy, and the middle and upper classes while obscuring a transforming vision of mascu­linity and femininity in the second half of the life cycle (Allgeier, 1983). Cross-cultural analyses have found that there are two universal aspects to sexuality: pleasure and self-disclosure (Reiss, 1986). Mid-life women (and men) can enjoy both; yet our concern about performance and technique leaves room for neither (Rubin, 1982).

Datan and Rodeheaver (1983) distinguish between the generative love of young adults that is about the task of procreation and nurture of children and the existential love of mid-life and old age that recognizes the finitude of life and cherishes the present moment. “The supreme tri­umph of our humanity over our biology is that we do not only make babies, we also make love… [yet] we have not yet awakened to the potential for existential love between old women and old men, just as we are not yet prepared to recognize the pleasures of sexuality as natural to the life span, particularly to the postparental period” (pp. 286-287).

Conventional sexual scripts shortchange both men and women, cre­ating pressures that contradict internal needs, particularly in the mandate that good sex equals intercourse equals orgasm. As McCormick states, “A feminist vision of sexual salvation would redefine lovemaking to include behaviors other than genital contact and orgasm” (p. 187). We must rec­ognize that sexual intercourse is not necessarily a woman’s favorite erotic activity. We must offer women at all stages of development more alterna­tives than those implied in the simplistic cultural messages to “Just Say No” before marriage and “Never Say No” after.

The “change” that is not addressed in current literatures is the change from sexual object to sexual being that mid-life women frequently report (e. g., Rountree, 1993). Holistic conceptualizations of women’s sexuality at mid-life will value all the biological cycles, offering rituals and support for each. One nurse-practitioner questioned the extensive and long-term use of hormone replacement therapy, not necessarily because of its questionable safety, but because it potentially induces a developmental arrest (Kelsea, 1991). That is, the natural order is for women to become hormonally more like men as they age, and for men to become hormonally more like women. By preventing this natural order, are we preventing women from achieving certain psychological and spiritual benefits that are the reward of “the other side of menopause?”

Certainly, many women report that they are more assertive, autono­mous, and authentic after the menopausal transition. Many view this as a time of blossoming spirituality, creativity, expressiveness, and passion. Many reflect, reorder, reevaluate, and reinvest, ultimately transforming and reconstituting the meaning of their lives. Words such as exploration, play, humor, and joy pepper the language of many mid-life women (Rountree, 1993). Ironically, at the very time that older adults begin to experience the physiological effects of aging, they also experience increased levels of sensuality and psychological integration (Allgeier, 1983). If sexuality were viewed as more than equipment malfunction, enriched sexuality and sexual expression would be the norm rather than the exception. In any case, we cannot know for sure until we disentangle from our pervasive cultural ste­reotypes of femininity, not a small struggle even for those with the courage, vision, and psychosocial resources to rebel. For these pioneers, a rich tap­estry of sexual expression and involvement is available. For others, perhaps the greatest loss is not physiological functioning or the loss of a partner, but the loss of social acceptance of aging persons as sexual beings (Genevay, 1982).

Therefore, social constructions that have medicalized and patholo- gized sexuality and aging must be deconstructed. When sexuality at men­opause becomes a medical problem in need of a medical solution, women lose control. Although benefitting some individual women, universal and routine medical intervention has iatrogenic consequences for women as a group.

Certainly, viewing mid-life and older women as sexual actors would disturb social and economic arrangements. As it is, lucrative industries surrounding HRT, penile implants, and traditional sex therapy benefit from propagating the myth of the coital imperative. Because sexual dysfunction diagnoses reflect stereotypically male sexual values (Rosen & Beck, 1988; Tiefer, 1995), a new interpretation of sexuality at mid-life carries the po­tential of disrupting current power relationships between men and women. Additionally, all patriarchal institutions that embody the ideology of “hetero-reality” benefit from constructions that serve to define all aspects of women’s lives in relation to male priorities and needs (Raymond, 1986). Sexual autonomy, considered a male entitlement, if extended to women would strain the traditional patriarchal bargain (Nathanson, 1991).

In contrast, rare studies of women’s subjective reports of their sexual experiences paint quite a different picture than the predominant diagnostic framework. Women most often list concerns such as an inability to relax, disinterest or being turned off, too little foreplay and too little afterplay, and annoyance at the partner for choosing inconvenient times to initiate lovemaking (McCormick, 1994). Reconstructing definitions of sexual dys­function in terms of feminist values would radically depart from the current equipment failure and desire disorder diagnostics. The overriding goal of feminist sex research, political activity, and therapy must be empowerment. Models of pathology that conceptualize solutions as matters of individual change are too limiting. What is needed are new ideas, theories, and meth­ods that value female sexual well-being as defined by women themselves. We must empower women with (a) self-esteem uncontingent on the cul­tural requisites of youth and narrowly defined beauty, (b) values that laud the accumulation of experience in loving rather than devaluing the phys­ical changes that accompany such experience; and (c) encouragement to initiate sexual relationships that they find personally rewarding and mean­ingful and based on internal needs rather than external pressures (Genevay, 1982).

CONCLUSION

The current medicalization of menopause and of sexuality sustains social arrangements that are detrimental to women. It establishes a con­ceptual and explanatory framework based on biology and disguises the larger social and political nature of women’s lives. Focus on the flawed and deficient individual as a basis for understanding implies that the issues and solutions are solely personal. The message is that women need to change who they are, or at least to disguise who they are in order to better please a larger society and to sustain their own happiness. Although this message reflects a received wisdom that is comfortable to most of society, it is costly to women. Women who may feel justified in speaking and acting on their acquired experience and wisdom are instead exhorted to spend their energy disguising their age. Because sexual activity in American society is believed to be so central to personal identity, older women (or any women for that matter) who do not attract the validation of a male sexual partner are seen as less than whole. It is hard to resist this view, and many older women themselves may feel diminished self-worth.

Messages about menopause and the lives of older women tend to reflect basic themes whereby power arrangements are camouflaged as bi­

ology, passivity is advanced in place of agency, and women are marginalized as Other. These themes are present in the discourse about menopause and women’s sexuality in general. A general message is that the facts of women’s sexuality are fundamentally biological and even evolutionary. Since these facts are thought to be objective and universal, there are no politics to any of this. Thus politics, power, status, authority over resources, viable choice, and access to alternatives are tacitly removed from the discussion.

A second theme is the notion of the body, and, in association, one’s self-identity, as a passive attractant begins early and is carried throughout the life span; it is operational in various forms for much more than meno­pause. This theme is based on denying agency to women and is partly why feminists hold that women of all walks of life, ethnicities, and ages share certain common bonds. The determination of self-worth on the basis of being an object pleasing to men does not begin with menopause. A con­sequence of this that will be revisited in other chapters is that women do not truly own their sexuality. A third theme is that women are Other. As such, women are unknown, problematic, perhaps dangerous, and certainly deficient. In the realm of women’s sexuality, arrangements are established whereby women’s sexuality can be controlled and channeled in the service of a man’s experience. Many of these arrangements are internalized by women themselves.

Feminist answers to these problems will involve resistance to received wisdom and the current social constructions of women’s sexuality. Resis­tance means creating a dialogue that occurs outside as well as within nor­mative bounds. Asking questions and giving voice are tactics that can validate women’s experience and promote agency for women. Society will not thank women for engaging in such dialogue, nor will society make it easy.