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

譯者: Lilian Chiu 審譯者: 麗玲 辛

So the other day,

有一天，

a woman walked into my office and exclaimed:

一名女子走進我的辦公室，叫嚷著：

"My vagina has betrayed me!"

「我的陰道背叛了我！」

(Laughter)

（笑聲）

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

不是大部分人在星期一早晨 喝咖啡之前會聽到的話，但，

but welcome to my world as a gynecologist

歡迎來到我的世界，我是 婦科醫生和性醫學專家。

and sexual medicine specialist.

You know, everybody thinks of menopause as hot flashes,

大家都認為更年期就是熱潮紅，但，

but for over half of menopausal women,

對超過一半以上的更年期女性來說，

it’s accompanied by sexual issues.

還會伴隨著性問題，比如，

Things like loss of libido or painful intercourse,

失去性慾，

疼痛的性交，甚至 兩人的關係完全毀掉。

even total destruction of a relationship.

It’s what I call the “bedroom gap,”

這就是我所謂的「臥室落差」，

the difference in sexual expectations and capabilities

是中年男性和女性在性期望

of men and women in midlife.

和能力上的差距。

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

臥室落差結合了

更年期對生殖器的影響

and deeply entrenched cultural and historical gender roles.

及根深蒂固的文化和歷史性別角色。

To understand how to close the bedroom gap

要了解如何消除臥室落差 並得到我們想要的性愛，

and to get the sex we want,

we have to examine its root causes.

我們必須探究其根本原因。

So let's start with some science.

因此，咱們從一些科學知識開始。

In menopause, the ovaries make estrogen less consistently

在更年期，

卵巢不會再一直製造雌激素，

and eventually stop making it altogether.

最終會完全停止製造。

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

失去雌激素對陰道 有兩個重大的影響。

The first is on collagen.

第一個是對膠原蛋白的影響。

Less estrogen means less collagen is made,

雌激素減少，表示 製造出來的膠原蛋白變少，

and the quality of that collagen deteriorates

且那些膠原蛋白的品質會變差，

from strong and stretchy to brittle.

從強韌且有彈性變成很脆弱。

Ouch.

哎喲。

(Laughter)

（笑聲）

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

失去雌激素對陰道的 第二個影響和血管有關。

We need blood vessels for lubrication.

我們需要血管來潤滑。

When I'm examining a patient,

當我檢查病人時，

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

我真的可以看出

她是否缺乏雌激素。

The deterioration from thick,

從退化可以看出：

從有皺褶、有彈性、 濕潤的深粉紅厚組織，

ridgy, dark pink, elastic, moist tissue

to thin, dry, inelastic, pale pink,

退化成又薄又乾燥、

沒有彈性、淡粉紅， 甚至黃白色的組織。

even yellowish white tissue.

We also need blood vessels for arousal.

我們也需要血管來引起性慾。

This is where you're supposed to wake up.

各位聽到這裡應該要醒來了。

(Laughter)

（笑聲）

Now I'm excited.

現在我很興奮。

(Laughter)

（笑聲）

When we're aroused, fluid moves ...

當我們的性慾被引起時， 液體會移動……

Fluid moves from the blood vessels

液體會移動，從血管，

through the vaginal wall to make lubrication.

穿過陰道壁，

提供潤滑。

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

若沒有血管，

無論你有多激情，你都不會濕。

no matter how turned on you are.

(Laughter)

（笑聲）

So where does this leave you?

那麼這會讓你怎麼樣？

Well, you feel dried up,

嗯，你會覺得很乾燥，

you can't get wet,

你濕不了，

your vagina seems to be on fire and --

你的陰道好像在燃燒一樣，而——

(Laughter)

（笑聲）

Your partner perceives your discomfort,

你的伴侶感受到你的不適，

then you feel bad,

然後你感覺不好， 你的伴侶感到罪惡，

then your partner feels guilty,

然後你會覺得 你把這個時刻全搞砸了。

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

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

我永遠忘不了， 有位病人曾經對我說：

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

「索佛克雷斯醫生，

當我和我的伴侶做愛時，

we sing this Johnny Cash song."

我們會唱這首強尼‧凱許的歌。」

(Laughter)

（笑聲）

哦，你們知道這首歌？

Oh, you know it?

(Laughter)

（笑聲）

"Ring of Fire."

「環繞的火。」

(Laughter)

（笑聲）

"We sing it, I sing it

「我們會唱它，我會唱它，因為，

because I have to sing and laugh,

我必須唱歌和大笑，

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

不然我就會哭，破壞他的這一刻。」

For him.

他的。

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

當女性生活在這個 環繞的火、憐憫式性愛的世界，

on the other side of the mattress --

在床墊的另一邊——

(Laughter)

（笑聲）

things are a little different.

狀況則有點不同。

See, for 25 years,

要知道，二十五年來，

men have had a relatively safe, reliable,

男性可以取得相對安全、可靠的

available medical option for erectile dysfunction.

醫療選擇，來治療勃起功能障礙。

What was first invented to firm up a floppy penis

最初為了強化軟趴趴的 陰莖而發明的東西

has now become a global phenomenon

現在已成變成了一種全球現象，

to optimize male sexual performance.

優化男性性表現的現象。

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

威而剛並不是臥室落差的成因， 但我相信它擴大了這種落差。

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

順道一提，這不是男人的錯。

They are just availing themselves

他們只是利用了有性別偏見的 現代醫學所提供的東西。

of what gender-biased modern medicine has on offer.

真的。

True.

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

但是，當中年男性受惠於透過 醫療方法強化的硬梆梆勃起，

medically enhanced erection,

他們的女性伴侶卻 卻被晾在一旁，乾瞪眼。

their female partners are literally left hung out to dry.

(Laughter and applause)

（笑聲和掌聲）

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

有個好消息：

女性確實有選擇，但她們 似乎沒有利用這些選擇。

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

Why?

為什麼？為什麼不去用？

What's the hold up?

Well, one problem may be

嗯，其中一個問題可能是

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

許多醫生

無法自在地和女病人 談論更年期和性問題，

about menopause and sexual issues

because they feel they were never properly trained.

因為他們覺得自己 從未接受過適當的培訓。

And I think this is true.

我認為這是真的。很不幸， 我們的醫療系統很過時。

Our medical system is woefully outdated.

In fact, one study showed

事實上，有一項研究指出，

that two-thirds of medical training programs in the US

美國的醫療培訓計畫有三分之二

have just one lecture on menopause, one.

都只有一課和更年期有關，一課。

這可能可以解釋

Which may explain why doctors are uncomfortable

為什麼醫生會覺得不自在， 以及為什麼 75% 的女性

and why 75 percent of women

who go to doctors to seek care for menopausal problems

去找醫生尋求治療更年期問題

come away empty-handed.

都會空手而回。

This has to change.

這點必須改變。

Because every one of us is going to go through menopause

因為我們每個人都會經歷更年期，

and experience the loss of estrogen.

並經歷雌激素的喪失。

And there are a lot of us right now.

而現在我們這樣的人很多。

Globally, there are 1.1 billion women right now

全球，現在有十一億名女性

who’ve reached menopause and post-menopause.

已經到達更年期和更年期後。

And almost half of them are suffering from sexual issues

這些人當中有近一半都為 性問題所苦，多半默默承受，

largely quietly,

and it's probably underreported.

且這數字可能還低報了。

I know because for 28 years

我知道，因為二十八年來，

I have listened to your stories

我都在傾聽你們的故事，

on five continents,

來自五大洲的你們，

and I can tell you that the bedroom gap

我可以告訴各位，臥室落差

cuts across race, ethnicity,

跨越種族、人種、

economics, education and geography.

經濟狀況、教育程度，和地理所在。

It is universal and ubiquitous.

它很普遍，無處不在。

It's also lasting a lot longer.

它也持續得更長久。

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

女性的壽命比男性多五到六年，

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

女性過了更年期，還有 超過三分之一的人生要過。

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

許多更年期後的女性 是單身、寡婦、離婚的。

Some of them want to be intimate.

當中有些人想要親密感。

她們會上網，

They go online,

they swipe left, they swipe right,

她們向左滑，向右滑，

they start dating, they start having sex.

她們開始約會， 她們開始做愛，這很棒。

And this is great.

But between the issues inherent in the bedroom gap,

但是，

有臥室落差中存在的問題，

威而剛又擴大了這落距，

Viagra widening that gap,

and the complexities of online dating,

再加上線上約會的複雜性，

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

也難怪你會覺得你的陰道背叛了你。

But it's not your vagina's fault.

但這不是你的陰道的錯。

No.

不是。

What has betrayed you

背叛你的

is not only the biology of aging

不僅是老化的生物學，

but history

還有歷史

and culture.

和文化，

And gender roles etched in sexual stone over millennia.

以及數千年來刻在 石板上的性別角色。

Sexual dogma that decrees

性別教條裁定

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

女性在臥室中的角色是去取悅、

to serve.

去服侍，

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

不要阻礙到男人才有權享受的性愉悅。

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

我們不可能靠一場 TED 演講 就改變數千年的性別劇本。

But I can offer you this.

但我可以提供給各位這個：

Since we know that deficiency of estrogen

既然我們知道

缺乏雌激素會讓陰道乾燥

makes the vagina dry and unpleasant,

且讓人不愉快，

then maybe one solution to closing the bedroom gap

那麼，消除臥室落差的 一個解決方案可能是

might be to replace that vaginal estrogen.

替補陰道雌激素。

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

喔喔，我看到各位臉上的表情了。

(Laughter)

（笑聲）

I know what you're thinking.

我知道你們在想什麼。

You're thinking, "Estrogen?

你們在想：「雌激素？

What about the cancer risk?"

那癌症風險呢？」

Well, I get it.

嗯，我懂。

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

我們必須處理這種對雌激素 和癌症的集體恐懼。

That fear stems from the Women's Health Initiative,

這種恐懼源於婦女健康關懷研究，

the media storm that surrounded the release

二十年前那些資料釋出時 圍繞這個事件的媒體風暴。

of that data 20 years ago.

That study examined the risks of oral estrogen

該研究探究的風險包括口服雌激素、

and cancer, among other things,

癌症，及其他的，沒有陰道雌激素。

not vaginal estrogen.

So here's the key point.

所以，重點如下。

Estrogen behaves differently

雌激素會因為使用它的部位

depending on where and how it's used.

和方式不同而有不同的反應。

看看這個。

Check it out.

Vaginal estrogen works genitally, locally and has positive effects.

陰道雌激素在生殖器官局部 起作用，具有正面的效果。

Systemic estrogen can have positive or potentially negative effects

全身性雌激素具有正面 或可能負面的效果，

depending on the target tissue.

取決於目標組織。

Vaginal estrogen has been out since 1946

陰道雌激素在 1946 年就被發現，

and studied extensively

自此被廣泛地研究，

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

從未發現它會導致乳癌 或其他癌症的證據。

But we, the big we,

但我們，廣義的我們，

have made vaginal and systemic estrogen falsely equivalent.

已經誤把陰道雌激素 和全身性雌激素畫上等號。

We have thrown the baby out with the bathwater.

我們已把嬰兒和洗澡水一起倒掉了， 我們的恐懼沒有差別對待。

Our fear does not discriminate.

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

現在太多女性根本不使用雌激素了。

So where does this leave us?

那我們現在的處境 是什麼？嗯，重點是，

Well, the thing is,

we have a right to comfortable sex.

我們有舒適性愛的權利，

And a right to pleasurable sex.

以及愉悅性愛的權利。

(Applause)

（掌聲）

Yeah.

是的。

(Cheers and applause)

（歡呼和掌聲）

So the thing is,

所以，重點是，

我們談過了陰道和全身性雌激素，

we talked about vaginal and systemic estrogen,

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

甚至我們還可以使用其他的 藥物，陰道藥物和口服藥物，

that will help us

來協助我們

to close our bedroom gap.

消除我們的臥室落差。

消除臥室落差的另一招是倡導。

The other avenue to close the bedroom gap is advocacy.

How can you close your bedroom gap

你能如何消除你的臥室落差，

so that you can enjoy sex?

讓你可以享受性愛？

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

或者更好的是，你要如何 打從一開始就避免臥室落差？

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

千禧世代和 Z 世代， 我是在跟你們說。

Well, one, get educated.

嗯，第一，接受教育。 閱讀可信賴來源的資訊。

Read credible sources.

Find clinicians invested in sexual health.

找到有花心力在 性健康上的臨床醫生。

Two,

第二，

talk about it to each other,

彼此談談它，

to your clinicians, to your partners.

和你的臨床醫生、和你的伴侶談談。

Talk without shame or blame and get specific.

談的時候別帶著羞辱感 或責怪，且要具體。

What hurts?

怎樣會痛？怎樣會有好的感覺？

What feels good?

Get sexually creative.

在性方面發揮創意。

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

感覺不好的就不要做。

(Applause)

（掌聲）

And number three, reframe sexual and genital health

第三，重新定義

性健康和生殖器健康 為終身維護計畫。

as a lifelong maintenance project.

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

且不要覺得因為

or you have wimpy orgasms

你濕不了或你的高潮很弱， 就不可能補救。

that that can't be fixed.

Because, here's the deal,

因為，

狀況是這樣的，

which you already heard in this talk.

各位在這場演說中已經聽到了：

We have a right to comfortable sex

我們有舒適性愛的權利，

and a right to pleasurable sex.

和愉悅性愛的權利。

So let's move

所以，讓我們一起來

the sexual equality needle forward.

推動性平等。

Let's start with young people,

讓我們從年輕人著手，

young men and women.

年輕男女。

It is time

是時候了，

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

性教育該要進步了，不能再 只是在香蕉上套上保險套了。

(Cheers and applause)

（歡呼和掌聲）

It is time for sex ed to prioritize

性教育應該要優先推動

equal sexual pleasure for men and women.

男性和女性擁有平等的性愉悅。

So they learn it right from the beginning

讓年輕人從最初開始做愛時 就要學到這些。

when they're starting to have sex.

And it is time to revamp medical education

現在也該改造醫學教育了，

to keep up with the demographic explosion of menopausal women.

要配合目前的人口背景： 更年期婦女爆增。

So that doctors have the tools

讓醫生能擁有

and the information they need to provide to women

他們能提供給女性的工具和資訊， 女性才不會空手而回。

so they don't leave empty-handed.

And it is far past time

還有一件早該做的事：

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

讓性愉悅的觀念變成是不分性別的。

Because it's never too early to start.

因為開始永遠不嫌太早。

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

改善男女平等的性愉悅， 永遠不嫌太晚。

And let's face it,

咱們面對現實吧，

sexual health is part of long-term human health.

性健康是人類長遠健康的一部分。

We know that staying sexually active reduces blood pressure,

我們知道保持性活躍可以降低血壓、

improves cardiovascular health,

改善心血管健康、

decreases stress and depression and anxiety

減少壓力、憂鬱，和焦慮，

and is linked to longevity.

還與長壽有關。

And we, women,

而我們女性，

we must emancipate ourselves

我們必須讓我們自己擺脫

from the rigid roles of sex for procreation

死板角色的束縛，

別再停留在為了繁殖 或男性愉悅而做愛。

or male pleasure.

My big hope

我的宏大希望

is that in closing the bedroom gap,

是透過消除臥室落差，

we take one small sexual step

讓我們能踏出性的一小步，

towards gender equality for all of us.

朝向所有人的性別平等邁進。

Thank you.

謝謝。

(Cheers and applause)

（歡呼和掌聲）