Why Talking About Menopause Has Been Taboo for Too Long

By Ranjith Ramasamy, University of Miami

Contrary to myths circulating on social media, COVID-19 vaccines do not cause erectile dysfunction and male infertility.

What is true: SARS-CoV-2, the virus that causes COVID-19, poses a risk for both disorders.

Until now, little research has been done on how the virus or the vaccines affect the male reproductive system. But recent investigations by physicians and researchers here at the University of Miami have shed new light on these questions.

The team, which includes me, has discovered potentially far-reaching implications for men of all ages – including younger and middle-aged men who want to have children.

What the team found

I am the director of the Reproductive Urology Program at the University of Miami’s Miller School of Medicine. My colleagues and I analyzed the autopsy tissues of the testicles of six men who died of COVID-19 infection.

The result: COVID-19 virus appeared in the tissues of one of the men; decreased numbers of sperm appeared in three.

Another patient – this one survived COVID-19 – had a testis biopsy about three months after his initial COVID-19 infection cleared up. The biopsy showed the coronavirus was still in his testicles.

Our team also discovered that COVID-19 affects the penis. An analysis of penile tissue from two men receiving penile implants showed the virus was present seven to nine months after their COVID-19 diagnosis. Both men had developed severe erectile dysfunction, probably because the infection caused reduced blood supply to the penis.

Notably, one of the men had only mild COVID-19 symptoms. The other had been hospitalized. This suggests that even those with a relatively light case of the virus can experience severe erectile dysfunction after recovery.

These findings are not entirely surprising. After all, scientists know other viruses invade the testicles and affect sperm production and fertility.

One example: Investigators studying testes tissues from six patients who died from the 2006 SARS-CoV virus found all of them had widespread cell destruction, with few to no sperm.

It is also known that mumps and Zika viruses can enter the testicles and cause inflammation. Up to 20% of men infected with these viruses will have impaired sperm production.

A new study on vaccine safety

In America, not talking about menopause is a cultural norm that Dr. Mary Jane Minkin is at odds with. Minkin, a leading women’s health expert, clinical professor at Yale University School of Medicine’s Department of Obstetrics, Gynecology, and Reproductive Sciences and member of HealthyWomen’s Women’s Health Advisory Council, is the host of the podcast “menopause: unmuted.”

“There are a lot of barriers to talking about menopause,” Minkin said, pointing out factors contributing to its taboo nature: There is a reluctance to talk about sexual problems and many don’t look positively upon aging.

“You couldn’t call a vagina a vagina on TV until very recently!” Minkin said, adding, “The other issue with menopause is that we go through menopause as we get older, we’re not supposed to get old, because getting old is [considered] a bad thing.”

But Minkin, the second woman to finish Yale’s OB-GYN residency program in 1979, says women need to talk about menopause.

That’s the guiding principle behind “menopause: unmuted,” a podcast sponsored by Pfizer and released last summer. In 20- to 25-minute episodes, women share their often funny, sometimes sad, but always forthright menopause experiences, with Minkin offering her thoughts and explanations along the way.

In a recent conversation with HealthyWomen, Minkin discusses the podcast, its future and the importance of talking about menopause.

The interview has been edited for length and clarity.

HealthyWomen: Tell us the origin story for “menopause: unmuted.”

Dr. Mary Jane Minkin: “Menopause: unmuted” grew out of this broader concept of how to have better conversations with patients. How do we as healthcare professionals learn to communicate better? And how can we help patients communicate better so that they get their points across?

The idea became, “Let’s get the words of women themselves out there to describe what they’re going through. Because there’s not one universal experience of going through menopause.”

We launched in the United States first, and we’ve expanded the series to other countries like Canada and Denmark.

Women in different cultures experience menopause differently, and it’s interesting to hear how other countries talk about menopause.

For example, in Kathie’s story, she’s from Uganda, where age is revered. She talks about her aunties, whom she looked up to. And menopause was something that’s discussed and celebrated. You’re getting older, you’re getting smarter. That’s good. So her experience is different than somebody who goes through menopause thinking, “I’m old.”

HW: In the first season, Susan’s story — having emotional symptoms before physical ones — her desire to have a “pack” of people to talk to and her decision to share her menopause story despite people worrying that she was “exposing” herself, really resonated.

Dr. Mary Jane Minkin: Susan is a career woman and menopause just sort of hit her over the head. We are hoping that women can see from her experience that this is something they can identify with. She is in no doubt that talking helps.

HW: You said “menopause: unmuted” is part of a larger project sponsored by Pfizer, what other work has been done on this topic?

Dr. Mary Jane Minkin: As part of the larger project we had some health literacy experts work directly with women to develop a descriptive guide for women on how to talk about menopause as well as a glossary of terms. After development, the experts then did some research and found women had better knowledge about menopause after reading the guide.

Pfizer’s next goal is to get the guide out to women’s groups to help women communicate with their providers. The problem is — and why I’m delighted to be part of this — the knowledge out there is terrible. Women aren’t educated on the topic of menopause and, to get me on my high horse, neither are clinicians. Eighty percent of OB-GYN residency programs in the United States had no formal menopause curriculum as of 2013. It’s a little bit better now, but not dramatically so.

HW: Why is it important for women to discuss menopause?

Dr. Mary Jane Minkin: Basically, people are not wanting to talk about menopause because it’s a reflection of getting older. Also, we like people to be able to say this isn’t so bad. But I just want people talking. If they can talk about menopause and question what’s going on and how to find relief of symptoms, they may do better.

HW: Could you expand on places that respect aging and how that’s different for women?

Dr. Mary Jane Minkin: I think, in many societies, people tend to respect age and wisdom. If you look at Asian and African societies where elders are considered good, noble folks –– where age is revered — menopausal symptoms are less bothersome. Meaning hot flashes, night sweats and mood changes are less pronounced.

HW: Aside from women going through menopause, are you hoping to reach anyone else with “menopause:unmuted”?

Dr. Mary Jane Minkin: What’s really interesting to me is there’s interest in the podcast among men, which I think is fabulous because, if you can have understanding from a partner, that’s terrific. So I think the inadvertent beneficiaries are guys.

The other group is young women. You may have a 36-year-old coming in and they don’t have a neon sign on their foreheads saying, ”
I’m perimenopausal.” So, it’s up to you to listen and piece it all together for her.

HW: Is there anything else you’d like to highlight?

Dr. Mary Jane Minkin: It’s been a privilege to participate in this project. I think it’s going to help a lot of people.

I should also mention, if somebody is feeling lousy and not getting answers, they can find a menopause expert near them through the North American Menopause Society’s online tool at
menopause.org.

Season 3 of menopause: unmuted will tell stories of menopause from a different perspective.


What is it like to be the partner, family member, friend of a woman experiencing menopause?

Interested in being a voice on the next season of menopause: unmuted?

If you would like to share your story and are interested in finding out more, please visit http://bit.ly/menopauseunmuted3.

Seasons 1 and 2 are available to listen via www.menopauseunmuted.com.

This resource was created with support from Pfizer.

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