Let's Talk About Sex*
*Sex troubles, that is. And while we’re at it, let’s break the silence on mental illness and drug abuse. Incontinence? Now there’s another taboo topic women are only beginning to discuss with their doctors. Open up. Don’t be embarrassed. Honest, you’ll feel better if you’re frank with your physician—and with other women—about such verboten subjects.
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Today, little more than a dozen years after the artist and model Matuschka exposed her mastectomy scar on the cover of the New York Times Magazine, pink ribbons have become ubiquitous.
There are Pink Ribbon parades, races, and golf tournaments. There are Pink Ribbon Tic Tacs and Pink Ribbon Shower Gel. It’s easy to forget that breast cancer was once mentioned only in a whisper.
In fact, just a generation ago, almost all women’s health issues—but particularly those involving the breasts and reproductive organs—were forbidden topics for conversation.
“Breast cancer, menstruation, menopause—even breastfeeding in public—were taboo,” recalls Nancy Raymond, MD, director of the University of Minnesota’s Deborah E. Powell Center for Women’s Health. As a result, many women felt confused and isolated when they developed health problems.
The women’s health movement that began in the late 1960s and early 1970s changed all that. “There’s much more emphasis now on empowering people to control their own health,” says Lynne Shuster, MD, director of the Women’s Health Clinic at the Mayo Clinic in Rochester.
Many women now talk openly—at least with family and friends—about heavy menstrual periods or annoying hot flashes or how best to prepare for a colonoscopy. And today, when a woman undergoes treatment for breast cancer, her friends are likely not only to talk to her about it, but also to provide her and her family with emotional support and plenty of hotdishes.
Yet some health topics remain off-limits, or at least uncomfortable, for women to discuss with their friends or physicians. No hotdish brigades, for example, are started for women who go into a medical institution to be treated for substance abuse or mental illness. Nor do women tend to discuss with their book group buddies their inability to have an orgasm or to control a leaky bladder.
Some of these latent health taboos have to do with society’s denial of aging. “It’s socially unacceptable to admit that you’re older,” says Raymond. Two unmentionable topics, sexual dysfunction and incontinence, she points out, are associated with getting old. But, truth be told, mental illness, substance abuse, sexual problems, and even incontinence affect young women as well as older ones.
If women talked more openly about these issues, they would know that. They would also learn that medical help is available. Ongoing research has led to new and more effective strategies for treating all of these conditions.
Women don’t need to whisper anymore.
Taboo Topic No. 1
When Beth, a 43-year-old former laboratory scientist, was hospitalized for bipolar disorder in 2000, she told only a handful of friends. She feared people would respond as her sister had, with a brisk, “Why don’t you just snap out of it?”
Three years later, when she was hospitalized a second time, Beth expanded the number of people she told, with mixed results. “I found I have many fair-weather friends, people who talk to me only when I’m stable,” she says. “They’re just too overwhelmed to be around me when I’m depressed.”
Although mental illness is no longer considered a sign of the devil (as it was in America’s Colonial days), it continues to carry a mark of shame. In the media, people with mental illness are usually portrayed as unstable and dangerous—yet research has shown that less than a fraction of violent episodes in the United States were committed by someone with mental illness and, in most of those cases, the perpetrator also had a substance-abuse problem.
Other popular (and equally inaccurate) media stereotypes of the mentally ill include the “rebellious free spirit,” the “violent seductress,” the “narcissistic parasite,” the “mad scientist,” the “sly manipulator,” and the “helpless and depressed female.”
No wonder people who cite television as their main source of information have the least tolerant attitudes toward people with mental illness. And no wonder women with mental illness are reluctant to discuss their condition.
The stigma surrounding mental illness discourages women from seeking treatment. Although women are often better at reaching out for help than men, as many as two-thirds of those with depressive disorders, for example, do not get the treatment they need.
The good news is that in recent years the public has gained more knowledge about depression, which affects about 12 million women in the United States annually. Many women are now quite candid about their struggles with depression, Raymond says.
Postpartum depression, a type of major depression that occurs in about 1 in 10 new mothers, has attracted significant attention from the media. In the past few years, actresses Brooke Shields and Courteney Cox, model Elle Macpherson, and singer Marie Osmond have all gone public with dramatic tales of overcoming this illness.
But the public remains less understanding and accepting of mental illnesses that involve psychosis, such as schizophrenia. In fact, studies have shown that attitudes toward these illnesses have actually worsened in recent years.
“There’s still a lot of stigma against people with psychotic illness who experience hallucinations and disturbances of perception of reality,” says Raymond. Women with such illnesses feel the social rejection acutely, and they express an overwhelming sense of loneliness and isolation.
“When I told one woman about my illness, her mouth dropped open and she didn’t talk to me again for months,” Beth recalls. Many people, including physicians, don’t know how to act around those with mental illnesses, she says, which is why she now works as a volunteer with a mental-health advocacy group, educating policymakers, physicians, and others about mental health issues.
Raymond suggests that women who are uncomfortable talking with their doctor about depression—or any health issue—bring a newspaper or magazine clipping about the topic to their next office visit.
“Use the article as an icebreaker,” she says. “Mention that you have similar concerns.”
Above all, adds Beth, make sure your doctor takes you seriously. If not, find one who will.
“I was sick and tired of the stigma attached to my illness,” Beth says, “and of not being taken seriously by the community and by my doctors.” Attitudes are changing, albeit slowly, she says. “I still get some cold stares when I bring up the topic,” she says, “but in general people are becoming much more open about it.”