What Happens to Sex in Midlife? A Look at the “Bedroom Gap” | Maria Sophocles | TED

翻译人员: Shirley Tu 校对人员: Yanyan Hong

So the other day,

所以前几天，

a woman walked into my office and exclaimed:

一位女士走进我的办公室， 惊呼：

"My vagina has betrayed me!"

“我的阴道背叛了我！”

(Laughter)

（笑声）

Not what most of us hear on a Monday morning before coffee,

不像是我们大多数人在周一早上 喝咖啡前会听到的话，

but welcome to my world as a gynecologist

欢迎来到我的世界， 作为一名妇科医生

and sexual medicine specialist.

和性医学专家。

You know, everybody thinks of menopause as hot flashes,

你知道，每个人都认为 更年期就是潮热，

but for over half of menopausal women,

但是对于一半以上的更年期女性而言，

it’s accompanied by sexual issues.

更年期伴随着性问题。

Things like loss of libido or painful intercourse,

诸如性欲丧失或性交疼痛，

even total destruction of a relationship.

甚至彻底摧毁一段关系。

It’s what I call the “bedroom gap,”

这就是我所说的 “房事差距”，

the difference in sexual expectations and capabilities

即性期望和性能力在

of men and women in midlife.

中年男性和女性之间的差异。

Now the bedroom gap is a combination of the genital effects of menopause

现在，房事差距是一个综合结果， 由更年期对生殖器官的影响

and deeply entrenched cultural and historical gender roles.

以及根深蒂固的文化和历史性别角色所致。

To understand how to close the bedroom gap

要了解如何缩小房事差距

and to get the sex we want,

并获得我们想要的性生活，

we have to examine its root causes.

我们必须研究其根本原因。

So let's start with some science.

那么，让我们先从科学原理开始。

In menopause, the ovaries make estrogen less consistently

在更年期，卵巢越来越少地分泌雌激素，

and eventually stop making it altogether.

最终完全停止。

And this loss of estrogen has two huge effects in the vagina.

这种雌激素的流失对阴道 产生了两个巨大的影响。

The first is on collagen.

第一个影响是胶原蛋白。

Less estrogen means less collagen is made,

雌激素越少，意味着 产生的胶原蛋白越少，

and the quality of that collagen deteriorates

并且胶原蛋白的质量会下降，

from strong and stretchy to brittle.

从强韧有弹性的，变成脆性的。

Ouch.

哎哟。

(Laughter)

（笑声）

The second effect of the loss of estrogen in the vagina is on blood vessels.

阴道内雌激素流失的第二个影响， 是对血管的影响。

We need blood vessels for lubrication.

我们需要血管来润滑。

When I'm examining a patient,

我检查病人的时候，

I can literally see if she's deficient in estrogen.

我真的能看出她是否缺乏雌激素。

The deterioration from thick,

从厚实的、隆起的、

ridgy, dark pink, elastic, moist tissue

深粉色的、有弹性的、潮湿的组织

to thin, dry, inelastic, pale pink,

变成薄的、干燥的、 没有弹性的、淡粉色的，

even yellowish white tissue.

甚至带点黄色的白色组织。

We also need blood vessels for arousal.

我们还需要血管来性唤起。

This is where you're supposed to wake up.

这是你应该醒来的地方。

(Laughter)

（笑声）

Now I'm excited.

现在我很兴奋。

(Laughter)

（笑声）

When we're aroused, fluid moves ...

当我们被性唤起时， 液体会流动……

Fluid moves from the blood vessels

液体从血管

through the vaginal wall to make lubrication.

流经阴道壁来进行润滑。

Without blood vessels, you’re not going to get wet

没有血管，你是不会湿的，

no matter how turned on you are.

无论你多么精力充沛。

(Laughter)

（笑声）

So where does this leave you?

那么这将给你带来什么呢？

Well, you feel dried up,

好吧，你会感到干燥，

you can't get wet,

你无法变湿，

your vagina seems to be on fire and --

你的阴道似乎着火了然后 ——

(Laughter)

（笑声）

Your partner perceives your discomfort,

你的伴侣察觉到你的不适，

then you feel bad,

然后你感到难过，

then your partner feels guilty,

然后你的伴侣感到内疚，

and then you feel as if you have wrecked the whole moment.

然后你觉得自己好像毁了整个时刻。

I will never forget, a patient said to me once,

我永远不会忘记一位病人曾经对我说：

“Dr. Sophocles, when my partner and I have sex,

“索福克勒斯博士，当我和伴侣行房时，

we sing this Johnny Cash song."

我们会唱约翰尼·卡什 （Johnny Cash）的这首歌。”

(Laughter)

（笑声）

Oh, you know it?

哦，你知道这歌儿？

(Laughter)

（笑声）

"Ring of Fire."

“《火环》。”

(Laughter)

（笑声）

"We sing it, I sing it

“我们唱这首歌，我唱这首歌

because I have to sing and laugh,

是因为我必须唱和笑，

or else I would cry and it would spoil the moment for him."

否则我会哭， 然后会毁掉他的这一刻。”

For him.

为了他。

So while women are living in this ring of fire, mercy sex world,

因此，当女性生活在这个火环般的、 慈悲的性爱世界中时，

on the other side of the mattress --

在床垫的另一边——

(Laughter)

（笑声）

things are a little different.

情况略有不同。

See, for 25 years,

看，25年来，

men have had a relatively safe, reliable,

男性一直有相对安全、可靠、

available medical option for erectile dysfunction.

可用的勃起功能障碍医疗方案。

What was first invented to firm up a floppy penis

最早使疲软的阴茎硬起来的发明

has now become a global phenomenon

现在已风靡全球

to optimize male sexual performance.

旨在优化男性性能力。

Now, Viagra did not cause the bedroom gap, but I believe it has widened it.

现在，伟哥并没有引起房事差距， 但我相信它扩大了差距。

And by the way, it's not men's fault.

顺便说一句，这不是男人的错。

They are just availing themselves

他们只是在利用

of what gender-biased modern medicine has on offer.

带有性别偏好的现代医学所提供的服务。

True.

是的。

But while middle-aged men are benefiting from a rock hard,

然而，当中年男性正受益于一个坚如磐石的、

medically enhanced erection,

靠医学增强的勃起时，

their female partners are literally left hung out to dry.

他们的女性伴侣却被干巴巴地晾在一边， 字面意义上的。

(Laughter and applause)

（笑声和掌声）

So here's the good news, women do have options,

那么好消息来了， 女性是有选择的，

but they just don't seem to avail themselves of them.

但她们似乎没有利用这些选择。

Why?

为什么？

What's the hold up?

有什么阻碍？

Well, one problem may be

好吧，一个问题可能是，

that many doctors don't feel comfortable talking to female patients

许多医生不愿与女性患者谈论

about menopause and sexual issues

更年期和性问题，

because they feel they were never properly trained.

因为医生们觉得自己 从未接受过适当的培训。

And I think this is true.

而且我认为的确如此。

Our medical system is woefully outdated.

我们的医疗系统已经严重过时了。

In fact, one study showed

实际上，一项研究表明

that two-thirds of medical training programs in the US

美国三分之二的医学培训项目中

have just one lecture on menopause, one.

仅有一个关于更年期的讲座，一个。

Which may explain why doctors are uncomfortable

这也许可以解释为什么医生不愿谈及此事，

and why 75 percent of women

以及为什么75%的女性

who go to doctors to seek care for menopausal problems

为了治疗更年期问题去看医生，

come away empty-handed.

却空手而归。

This has to change.

这种情况必须改变。

Because every one of us is going to go through menopause

因为我们每个人都将经历更年期，

and experience the loss of estrogen.

并体会到雌激素的流失。

And there are a lot of us right now.

而且还有很多人正在经历。

Globally, there are 1.1 billion women right now

全球目前有11亿女性

who’ve reached menopause and post-menopause.

已经进入更年期和绝经期。

And almost half of them are suffering from sexual issues

而且其中将近一半的人 都在忍受性问题的困扰，

largely quietly,

大多数是悄无声息地，

and it's probably underreported.

而情况还可能被低估了。

I know because for 28 years

我知道是因为28年来

I have listened to your stories

我一直在听你们的故事，

on five continents,

来自五大洲，

and I can tell you that the bedroom gap

我可以告诉你，房事差距

cuts across race, ethnicity,

横贯所有种族、族裔、

economics, education and geography.

经济阶层、教育背景和地理差异。

It is universal and ubiquitous.

它是普遍的、无处不在的。

It's also lasting a lot longer.

并且它还将持续更长的时间。

See, women are outliving men by five to six years,

看，女性的寿命普遍比男性长五到六年，

and they're spending more than a third of their lives after menopause.

而她们会在更年期后 度过三分之一以上的生命。

So there are more postmenopausal women who are single, widowed, divorced.

因此，有更多的绝经后女性是处于 单身、丧偶、离异状态的。

Some of them want to be intimate.

她们中的一些人想保持亲密关系。

They go online,

她们上网，

they swipe left, they swipe right,

向左滑，向右滑，

they start dating, they start having sex.

她们开始约会，开始发生关系。

And this is great.

这很棒。

But between the issues inherent in the bedroom gap,

但是，房事差距是固有的问题，

Viagra widening that gap,

而伟哥又加大了这种差距，

and the complexities of online dating,

再加上在线约会的复杂性，

it's no wonder you feel your vagina has betrayed you.

怪不得你会觉得你的阴道背叛了你。

But it's not your vagina's fault.

但这不是你阴道的错。

No.

不是。

What has betrayed you

背叛你的

is not only the biology of aging

不仅仅是生物学上的衰老，

but history

还有历史，

and culture.

还有文化，

And gender roles etched in sexual stone over millennia.

以及几千年以来，镌刻在性的石碑上的 性别角色。

Sexual dogma that decrees

性教条规定

that a woman's role in the bedroom is to please,

女性在卧室中的角色是取悦

to serve.

和服务，

To not impede the sexual pleasure that a man is entitled to.

是不要妨碍男人享受应有的性快感。

Now, we’re not going to change a millennia of sexual scripting in a TED Talk.

现在，我们不是要在一个TED演讲中 改写数千年以来的性别剧本。

But I can offer you this.

但我可以为你提供这个。

Since we know that deficiency of estrogen

既然我们知道缺乏雌激素

makes the vagina dry and unpleasant,

会使阴道干燥不适，

then maybe one solution to closing the bedroom gap

那么缩小房事差距的一种解决方案

might be to replace that vaginal estrogen.

可能是更换阴道雌激素。

Uh-oh, I see the look on your face.

啊哦，我看见你脸上的表情了。

(Laughter)

（笑声）

I know what you're thinking.

我知道你在想什么。

You're thinking, "Estrogen?

你在想，“雌激素？

What about the cancer risk?"

那么癌症风险呢？”

Well, I get it.

行，我懂了。

We have to address this collective fear of estrogen and cancer.

我们必须解决这种 对雌激素和患癌的集体恐惧。

That fear stems from the Women's Health Initiative,

这种恐惧源于女性健康倡议，

the media storm that surrounded the release

以及20年前围绕该数据发布的

of that data 20 years ago.

的媒体风暴。

That study examined the risks of oral estrogen

该研究调查了口服雌激素

and cancer, among other things,

和癌症等的风险，

not vaginal estrogen.

而非阴道雌激素。

So here's the key point.

所以关键在这儿。

Estrogen behaves differently

雌激素的表现

depending on where and how it's used.

因使用部位和方式而异。

Check it out.

看看吧。

Vaginal estrogen works genitally, locally and has positive effects.

阴道雌激素作用在生殖器局部， 并产生积极作用。

Systemic estrogen can have positive or potentially negative effects

全身性雌激素可能产生正面 或潜在的负面作用，

depending on the target tissue.

具体取决于靶组织。

Vaginal estrogen has been out since 1946

阴道雌激素自 1946 年问世

and studied extensively

就拥有了广泛的研究，

and has never been shown to cause breast or other cancer.

从未显示会导致乳腺癌或其他癌症。

But we, the big we,

但是我们大部分人，

have made vaginal and systemic estrogen falsely equivalent.

却把阴道雌激素和 全身雌激素错误地划上了等号。

We have thrown the baby out with the bathwater.

我们把孩子和洗澡水一起倒掉了。

Our fear does not discriminate.

我们的恐惧不分青红皂白。

And now far too many women don't use estrogen at all.

而且，现在有太多的女性 根本不使用雌激素。

So where does this leave us?

那么这会给我们带来什么呢？

Well, the thing is,

好吧，问题是，

we have a right to comfortable sex.

我们有权享受舒适的性。

And a right to pleasurable sex.

还有权享受愉快的性。

(Applause)

（掌声）

Yeah.

没错。

(Cheers and applause)

（欢呼和掌声）

So the thing is,

问题是，

we talked about vaginal and systemic estrogen,

我们谈到了阴道雌激素 和全身雌激素，

and there are even other medications we can use, vaginal and oral,

甚至还有其他药物 包括阴道雌激素和口服雌激素，

that will help us

可以帮助我们

to close our bedroom gap.

缩小房事差距

The other avenue to close the bedroom gap is advocacy.

缩小房事差距的另一个途径是宣传。

How can you close your bedroom gap

如何缩小房事差距

so that you can enjoy sex?

以便你享受性生活？

Or better yet, how can you never have one happen in the first place?

或者更好的是，一开始你如何 杜绝这样的事发生呢？

I’m talking to you, millennials and Gen Zers.

我在对你们喊话， 千禧一代和Z世代们。

Well, one, get educated.

好吧，第一，接受教育。

Read credible sources.

阅读可靠的来源。

Find clinicians invested in sexual health.

寻找致力于性健康的临床医生。

Two,

第二，

talk about it to each other,

和对方谈谈，

to your clinicians, to your partners.

和你的临床医生谈， 和你伴侣谈。

Talk without shame or blame and get specific.

不要羞耻，也不要责备， 谈论得具体一点。

What hurts?

哪里痛？

What feels good?

哪里感觉不错？

Get sexually creative.

发挥性创造力。

And don't do anything that doesn't feel good.

而且不要做任何感觉不好的事。

(Applause)

（掌声）

And number three, reframe sexual and genital health

第三，将性健康和生殖器健康

as a lifelong maintenance project.

重新构建为一项终身维护项目。

And don't think that just because you can't get wet

不要想着 那只是因为你无法变湿

or you have wimpy orgasms

或者你疲软的高潮

that that can't be fixed.

根本得不到修复。

Because, here's the deal,

因为，情况是这样的，

which you already heard in this talk.

你已经在这次演讲中听到了，

We have a right to comfortable sex

我们有权享受舒适的性，

and a right to pleasurable sex.

有权享受愉快的性。

So let's move

因此，让我们向前推动

the sexual equality needle forward.

性别平等的进程。

Let's start with young people,

让我们从年轻人开始，

young men and women.

从年轻男女开始。

It is time

是时候

for sex ed to progress beyond getting a condom on a banana.

让性教育比给香蕉戴避孕套 更进一步了。

(Cheers and applause)

（欢呼和掌声）

It is time for sex ed to prioritize

是时候让性教育优先考虑

equal sexual pleasure for men and women.

男女之间平等的性快感了。

So they learn it right from the beginning

让他们在开始发生关系时

when they're starting to have sex.

就认识到这一点。

And it is time to revamp medical education

是时候改进医学教育

to keep up with the demographic explosion of menopausal women.

以跟上更年期女性人口的爆发性增长了。

So that doctors have the tools

让医生拥有所需的工具

and the information they need to provide to women

和信息，可以提供给女性

so they don't leave empty-handed.

使她们不会空手而归。

And it is far past time

而且性快感的概念

for the concept of sexual pleasure to be gender-neutral.

早就该不分性别了。

Because it's never too early to start.

因为任何时候开始都不嫌早。

It's never too late to improve equal sexual pleasure for men and women.

改善男女平等的性快感 还为时不晚。

And let's face it,

让我们面对现实吧，

sexual health is part of long-term human health.

性健康是人类长期健康的一部分。

We know that staying sexually active reduces blood pressure,

我们知道保持性活跃会降低血压，

improves cardiovascular health,

改善心血管健康，

decreases stress and depression and anxiety

减轻压力、抑郁和焦虑，

and is linked to longevity.

并与寿命息息相关。

And we, women,

而我们，女性，

we must emancipate ourselves

我们应该解放自己，

from the rigid roles of sex for procreation

从“性是为了生育或男性的快感” 这样僵化的性别角色中

or male pleasure.

解脱出来。

My big hope

我最大的希望是，

is that in closing the bedroom gap,

在缩小房事差距的过程中，

we take one small sexual step

我们在性事上的一小步，

towards gender equality for all of us.

是实现所有人性别平等的一大步。

Thank you.

谢谢。

(Cheers and applause)

（欢呼和掌声）