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Marimer Pérez, gynecologist: ‘There are issues that I thought about treating with my psychologist that menopause solved for me’

In a conversation with EL PAÍS, she about the high points of menopause, the role and attitude of men in today’s infertility problems and the need for women to change ‘I’m not that bad’ to ‘I’m just fine’

Doctora Marimer Perez
Doctor Marimer Pérez.D. R.

One of the indisputable benefits of social media is that it has become a showcase for health professionals whose posts seek to educate and raise awareness, while making empathy a weapon (almost) as powerful as medicine itself. Thanks to the digital universe, we’ve met doctors who, with their didactic online presence, manage to bring healing a little closer, thanks to profiles full of advice and explanations in which information and parasocial intimacy go hand in hand. The well-regarded Marimer Pérez, gynecologist and obstetrician, is a great example of this wave of doctors 3.0. In addition to the knowledge she’s accumulated over a 24-year career, plus the confidence, realness and humane treatment she offers to patients, Pérez’s success can be credited to her personable communication, sense of humor and, of course, her immense sense of empathy. Founder of WoMer, a Barcelona integral health center born out of sisterhood, she is a popular communicator when it comes to menopause, a process that she herself has been going through during the past two years.

An expert in communicating through Instagram about when it’s like to live in the middle of menopause, when Pérez is asked by a reporter to talk about her symptoms, she flatly refuses. “Let’s put a new twist on the subject: I don’t want to talk about hot flashes or things you read about in other places … So much negative messaging! When’s the euthanasia?” she asks, with her characteristic humor. We talked to her to rethink our perceptions of menopause and to get to know its lighter side. We covered these topics, plus common male misunderstandings when it comes to her work… But we’re getting ahead of ourselves. Let’s begin.

Question. You speak openly about your menopause on social media. Why does it continue to be such an embarrassing topic for so many women?

Answer. I don’t know what’s up with us. People are surprised by the fact that I’m not ashamed to say that I’m going through menopause, because they think that men won’t find me attractive. “Doctor, think about it: men won’t see you in the same way,” they tell me with the utmost affection, allowing me to see how they think that menopause says everything you need to know about us. Many women write to me saying that it embarrasses them to tell people, and it’s important that they speak openly about it so that the male sector understands us. The problem is that this subject has never really been put on the table, certain symptoms that our partners should understand have never been talked about, it makes it seem like menopause doesn’t affect them. However, menopause is not just a women’s issue: it’s everyone’s issue. Along with the fear and shame, you’ve got to add the societal conviction that “we will get over it.” This is not how it works: we do not have to suffer, endure or limit our care to just fanning ourselves. It seems that this suffering is part of being a woman: we are continually Joan of Arc, and it seems that we have to be, in all the stages we go through.

Q. Have you noticed a change in women’s attitudes during their first gynecological appointment?

A. Teenagers are much wiser than we are. I have been in this profession for 24 years, and I’m seeing that they have a very clear eco-conscious and speak openly about contraception, STDs… It seems significant to me that with maturity, we have not lost our embarrassment. Nowadays, younger women approach sex in a way that makes you fall out of your chair. They have de-romanticized it, they have sex for pleasure and are clear on the issues. The word shame does not exist for them.

Q. So what you’re saying is, we’re not leaving behind fear and shame with the passage of time?

A. I find the most shame in older women. It is not uncommon for me to meet patients in my office who ask me how they are going to explain to their husband that it hurts to have sex because of menopause. The reality is, it’s just like telling your spouse that you are taking insulin because you’re diabetic. It’s a physiological process: the less estrogen you have, the more vaginal dryness. If you explain the physiological process well, men will have to understand. It’s important that the male sector understands that it’s tough living without estrogen. We are going to live a third of our lives without the principal hormone that factors into all of our life’s processes, which tells you that this cannot be a subject that embarrasses us. Women will have to talk about menopause all the time, and they’ll have to give us a medal of honor, because it’s not easy and we do it with dignity.

Q. What are the positive aspects of menopause?

A. I’ve been going through menopause for two years and I’m not at all in the worst phase of my life. On top of that, on a mental level, there are things that have benefited me. I am more mature and having more androgens has given me a mentality with which I can easily set boundaries. I used to be a fleuma [lazy person, in Catalan]; everything affected me, and now… much less. There are issues that I thought about treating with my psychologist that menopause solved for me. Things start to matter much less. The best part is that you don’t have to do a mental exercise to think this way and face things with this attitude: you’re simply in that mood.

Q. Are the sexual problems associated with menopause typically addressed?

A. I think that the sexuality problem is easy to understand: estrogen raises sexual desire, so if you have less, it’s logical that you’re not going to be chasing after your partner. It’s necessary to have nurturing, one-on-one conversations, and explain to your partner that they don’t need to get overwhelmed, but that initiating relationships is complicated for you right now for these reasons. If you use testosterone as the example, it will be even clearer: if they have less testosterone, they have a hard time getting an erection, right? That’s why couples have to work on it, and look for spaces of intimacy. You have to make it clear to the other person that it is not about there being a lack of attraction. You are not going to stop having orgasms, but you will still have to pay more attention to foreplay. I think we have to start being more permissive with ourselves. We have to understand ourselves and take advantage of the good that can come from menopause. When you understand what is happening to you and talk about it openly with your friends, you see that we’re all going through the same stuff. I’ve heard that thing about, “They’re going to give me the Oscar for Best Actress, because if you could see how I get when he’s after me and how I make him think I’m so excited…” I see 12 to 14 Oscar winners every year in my practice.

Q. Is a female gynecologist more empathetic than a male gynecologist, or is there really no difference?

A. The profession has become more female. I have a male gynecologist, but for dealing with menopause, I think I would recommend a female gynecologist. Empathy does not depend on one’s gender, but there are certain subjects, like menopause or adolescence, for which I think a female gynecologist will be more empathetic. During menopause, it seems to me that you’re immediately empathizing with the patient.

Q. Do you have hope for the male birth control pill?

A. I have little hope for anything that depends on men. Now that we’ve finally gotten the HPV vaccine for women and children, it is mind-boggling the percentage of mothers who have sons who they do not vaccinate. “They have HPV,” they say. It is a culturally ingrained issue. I have no hope, like when a man sees that his wife has had three Cesarean sections and she doesn’t want to be a mother again, and when you ask him to get a vasectomy, he’ll refuse. In that case, I would recommend that the patient find an empathetic urologist and make an appointment for her husband. Vasectomy rates are very low, because men believe that it affects their virility.

Q. Tell us some classic stories that you’ve encountered in your practice when men accompany their partners.

A. Let’s imagine that a woman just gave birth, she wants to breast-feed and she doesn’t want to take hormones… I find out that he doesn’t want to use condoms. In 90% of cases, you have to implant an IUD. Given that men are vectors, carriers of everything, they don’t get it. Since we have so few reliable methods for screening HPV, you can’t scare them with the data. Then there’s the issue of male infertility. You can’t imagine how many semen analyses turn up negative results these days, but we keep on blaming the woman when there are infertility issues.

Q. Speaking of infertility, there’s more and more assisted reproduction clinics…

A. We’re doing something wrong. To begin with, we’ve pushed back the age at which we’re having kids: now it’s normal to have your first even at 38. We’re just sneaking in under wire. I think that we are doing the right thing by spreading the word that fertility is not eternal. This is true: there are less and less taboos around cryopreservation. Given the pace of life that we are leading, and the idea that we have to be the best mother and the best businesswoman, it is impossible to raise your child giving it all the attention that it requires, and to properly fulfill all the professional duties we’ve set for ourselves. That pressure is having repercussions on reproduction, and that’s why semen has the quality that it does these days. That mega-executive man who has a frenetic pace of living, who doesn’t sit down to eat, who comes into contact with dire environmental factors and who has the lifestyle he does, will see the effects on his semen. Nonetheless, ask him for a semen analysis, and look at the face he gives you. You have to explain to him how he may have altered semen. I always hit them with that in my consultations.

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