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Menopausal Musings

Psychological aspects of menopause

Tammuz 5779 | July 2019
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It was a simple phone call, asking for money to fund the upkeep of the local mikvah, an annual phone call.  Of course, Hana made her usual donation.  She never could have anticipated her emotional reaction after hanging up.  She burst into tears at the realization that she had not visited the mikvah in a year, that her days of child-bearing had ended and she had officially entered menopause.  After a few minutes, she composed herself and pondered the meaning of this new stage in life.

Just as the beginning of menstruation marks a new phase in a young girl’s life with confusing and sometimes conflicting emotions, the end of menstruation elicits a spectrum of feelings.  Women’s reactions to the realization that they will no longer visit the mikvah every month range from relief to sadness.  To mark the milestone of mikvah completion, the Eden Center is compiling an educational booklet with recommendations for tekes ha’preida, a separation ceremony for the final mikvah visit.  The absence of a monthly period with its concomitant time of separation alters the tenor of a marriage.  Now a couple is always permitted to each other. There are no off times.  For women who welcomed niddah as a break from sexual relations, being permitted all the time may be stressful.  Others may embrace the possibility. Finally, the end of childbearing leaves many women in an existential crisis wondering about their purpose in life.  The Akedat Yitzchak’s description of the duality of Chava as both a mother and Isha, a woman of valor, with all the qualities to be a prophetess, reminds menopausal women that while they may no longer be able to bear children, they still retain their more compelling role as Isha capable of performing good deeds and profoundly impacting the world, independent of procreation.

Does the loss of fertility- the ability to become pregnant and fulfill the mitzvah of pru u’revu diminish mitzvat onah, the husband’s Biblical obligation to sexually gratify his wife?  Does Halakha value marital intimacy in the absence of procreation?  The answer is resoundingly yes. In his book, Rav Paalim, Rav Yosef Chaim of Bagdhad was asked whether a man who unknowingly married a woman no longer capable of having children was permitted to remain married to her.  Quoting Avodah Zara 5b which interprets G-d’s command to the Jewish people to resume marital relations after receiving the Torah as an obligation to enjoy conjugal rights and not just engage in them for procreation, Rav Yosef Chaim answers that the husband is clearly still obligated to perform mitzvat onah.  He also cites the Ari Z”L  who believed that marriage had a higher calling or purpose and chastised “pious” men who separate from their wives when they are no longer able to bear children. Thus, mitzvat onah prevails even when procreation is not possible, when a woman is pregnant, nursing, barren or menopausal.   Though the mitzvah persists in menopause, fulfilling this mitzvah may be challenging as couples age and develop sexual dysfunction.  For women after menopause, lack of estrogen can cause vaginal dryness, pain with intercourse, decreased libido or arousal, cervical atrophy and decreased elasticity of the vaginal wall. However, continuing sexual activity may prevent some of these changes.  The colloquial expression is, “use it or lose it”.  Erectile dysfunction common in older men can also interfere with mitzvat onah.  It is important to bear in mind that mitzvat onah is not limited to the act of sexual intercourse and includes any form of intimacy which brings pleasure to the woman.   A broad definition of how one may fulfill mitzvat onah is reflected in the decision of poskim to permit a virgin bride to immerse in the mikveh on Friday night even though it was customary (in some places) to defer intercourse for the first time until after Shabbat.  “All other forms of physical contact are a mitzvah,” writes the Shach.

Hana made a decision to embrace menopause with its many changes, and celebrate this new stage of life and marriage free of the pressure of becoming niddah every month.  She takes pride in her accomplishments as an Isha and cherishes her strong marriage that has withstood the test of time, her changing body, status and role in life.

Dr. Sharon Galper Grossman

a radiation oncologist and former faculty member of Harvard Medical School where she also obtained a Masters in Public Health. Her current interests are in Women’s Health and Halakha, specifically issues related to preventing women’s cancers. She has recently published “The Angelina Jolie Effect in Jewish Law: Prophylactic Mastectomy and Oophorectomy in BRCA Carriers” in the Rambam Medical Journal. “Resolving the Debate Over Human Papilloma Virus (HPV) Vaccination for Cancer Prevention in the Religious World” has been accepted for publication in Tradition.