Woman's Hour - Women and map reading, Faecal incontinence, Sexual desire and the menopause

Episode Date: October 15, 2019

The Queen’s speech yesterday contained mention of 26 new or returning Bills and more than a dozen areas where the government plans action. We look at how Boris Johnson’s legislative programme might address the concerns of women and the charge from critics that this is a pre-election manifesto. We had such a huge response to yesterday’s item on faecal incontinence that today we’ve invited on surgeon Mr Oliver Warren and specialist pelvic physiotherapist Sue Almond to respond to your comments and outline the various treatments available.Being bad at map reading is one of the many well-worn stereotypes about women. But is it true? The results of a massive global study of over 2.5 million people suggests it is, although not through any innate fault with women’s brains. Gillian Coughlan from the University of East Anglia talks about the science behind finding your way, while former Head of Publishing at the AA Helen Brocklehurst talks about the history of route-finding, women’s relationship with navigation, and her new British Road Map puzzle book.How often have you heard the comment, the menopause seems to have taken away my sex drive? It’s a topic that psychotherapist and sex therapist Louise Mazanti comes across frequently in her practice. We explore how it’s possible for the two – sex and the menopause - to co-exist happily together.Presenter: Jane Garvey Interviewed guest: Anne McElvoy Interviewed guest: Oliver Warren Interviewed guest: Sue Almond Interviewed guest: Gillian Coughlan Interviewed guest: Helen Brocklehurst Interviewed guest: Louise Mazanti Producer: Lucinda Montefiore

This BBC podcast is supported by ads outside the UK. I'm Natalia Melman-Petrozzella, and from the BBC, this is Extreme Peak Danger. The most beautiful mountain in the world. If you die on the mountain, you stay on the mountain. This is the story of what happened when 11 climbers died on one of the world's deadliest mountains, K2, and of the risks we'll take to feel truly alive. If I tell all the details, you won't believe it anymore. Extreme, peak danger. Listen wherever you get your podcasts.

BBC Sounds. Music, radio, podcasts. This is the Woman's Hour podcast. Hi, good morning. Thanks to everybody who emailed the programme after we talked about faecal incontinence yesterday. That's why, frankly, we're returning to the subject today because so many of you had further comments and questions. And this is typical, actually, from a listener who says,

finally, somebody's talking about this. I have felt alone with all this since January of 2018. There's nobody to talk to. The friends I've told haven't experienced it at all. And I feel all alone and heavily restricted

by my anxiety about it all. So we'll investigate further. We've got a colorectal surgeon with us and a physiotherapist as well, who are both experts, and they will hopefully give us more information. Keep your questions coming as well at BBC Women's Hour on Twitter and Instagram, or you can email the programme via our website. Also today, we'll look at sexual desire and the menopause.

Is it inevitable that your libido just decreases? And the old cliche that women can't read maps. Apparently, that might actually be true, or at least I've been a bit journalistic there. It's certainly true that men tend to be slightly more adept at reading maps. Why might that be? That's later in the programme today. Now, the Queen's speech yesterday variously described today as a message that will strike a chord with millions. That was the editorial in The Sun. On the other hand, Polly Toynbee in The Guardian said it was a sham of a speech.

Well, whatever you think of it, 26 new or returning bills were referenced and more than a dozen areas where the government plans action were discussed as well. The domestic abuse bill, which female MPs on both sides of the House supported returns, of course, many male MPs supported it too. And so too does the divorce bill, allowing so-called no-fault divorces. Well, we hope to talk to Anne McElvoy, who's at The Economist. But if we can't get hold of Anne as well, we'll focus on Katie Balls, who is here, Deputy Political Editor of The Spectator. Welcome, Katie. Good to see you again. So first of all, where do you stand on what it was yesterday? What was it all about, really?

Well, it's a very strange Queen's Speech because ultimately, we don't expect this to pass in the House of Commons. Well, it won't. It can't. Well, and barring some type of miracle where suddenly Labour MPs start voting for Conservative Queen's Speech is not going to. So ultimately, what was the point of this exercise? And I think from the Conservative and the government perspective, they thought, well, we're trapped in Parliament, we can't have a general election, let's just put forward what we would like to do in terms of a legislative agenda if we had a majority. And if voters like

what they see, perhaps they'll give us a majority when we eventually get to a general election. So I wouldn't expect to see much of what's in there happening in the next even couple of months. But if the Conservatives do return to government, that's when you will start to see these bills. Anne McElvoy can join us now. Anne, what do you think? Was the grand ceremonial tarnished yesterday in some way? I think the problem with the grand ceremonial was that it looked the way that all Queen's speeches looked. And certainly the Queen did her job, so to speak, of having to read out something that reflects the tone and aspiration of whatever the government of

the day is. But it was like a split screen in which the other side of the screen was blank. And that's what's going on in Brussels and in the European capitals in the run up to the European Council on Thursday. And at the moment, there's very little information coming out from that because they really are in the nitty gritty bit where they decide whether the Boris Johnson deal is worth taking seriously or not by the end of the week. So we had this slightly Potemkin Queen speech in which everything that would make it happen or not happen, as Katie has described, was happening somewhere else. Can we talk then about things that were at least referenced yesterday? Social care is hugely important, certainly to our audience, many of whom have a whole string of caring responsibilities. I think all that was said yesterday was my government will bring forward proposals to reform adult social care in England to ensure dignity in old age.

Katie, we seem to have heard this all before. Yes, and we've been waiting for a social care green paper for several years now. When Theresa May came to number 10, she outlined something that would be coming soon. Well, several years on, it hasn't. And when Boris Johnson entered number 10 he gave that speech outside he said that it was something he was going to fix now speaking to various figures in government you know why have you left this out in terms of not putting forward what you would like to do in terms of legislation I think there is a sense that there will be details but

potentially in the Tory manifesto now the last time the Tories tried that and we had what came to be known as the dementia tax. Well, it went down really, really badly. And I think this is partly why you're seeing this reluctance from the Conservative Party to put too much forward. I think that the solution to social care will be unpopular in many ways, because it's going to have to be drastic. Whoever puts it forward. So I think whoever puts it forward. And there was this hope to get a cross-party agreement, but we've seen over the years with the death tax and then the dementia tax

that there's just too much temptation on both sides to politically attack your opponent on something like this and all come together. So I don't hold out much hope for a quick solution here. And do you get frustrated by this? Because it's such an important issue. I seem to have been saying that for, well, I have been saying it for over a decade. Don't we need some big, towering political or non-political figure to get this by the scruff of the neck and do something? If you're frustrated, I was policy editor for five years when this got started and I've moved

on to my next job and it's still not sorted. So yes, there is great frustration about it. It's always difficult. If you're going to do health and social care reform in a meaningful way, there are going to be winners and losers. And that's inevitable, however you cut it. And one of the things that's happened is majorities have got tighter. Governments are much less willing to take that risk. And they saw what happened to Theresa May when she put it forward in the manifesto and the way that her proposals fell could then be seen to be particularly bad for a certain group of people. Nonetheless, something does need to happen. And I think Matt Hancock, as the health secretary, is pushing in a direction, but he doesn't want the details to start being picked apart. Now, they want it for a conservative manifesto. They

want health to be at the heart of their general election offer, partly because it's traditional Labour territory, but also a mixture of technological advances and the fact that the front line is so stretched. One of the reasons social care has probably got worse, or there are two reasons, one is cuts to local council budgets. But the other one is people are showing up in A&E because they have nowhere else to go when things go wrong, particularly in old age. So for that reason alone, the efficiency argument says you have to do something. Can we mention, too, no fault divorce, which is another old favourite, seems to have been something that has been discussed for many, many years. Is that going to be something that genuinely happens, Katie? I think the fact they put in the Queen's speech, picking up from Theresa May means that this is

something that would be pushed forward if the Conservatives had a majority. It's also a question on that, is there cross party support? If you look at a few of those bills, I suppose the less contentious ones, I would put no default divorces in there, along with the domestic abuse bill. So I think there is a chance that if this parliament drags out and you don't have a general election this side of the new year, you could see an attempt to hold votes on these things. Right. And actually, you think they genuinely might come into law even without a majority government in charge? I think potentially those areas where you might see opposition MPs finding that they can support these things, particularly domestic abuse. But if you looked at the debates around that, there's a sense that on these issues, I think they're less party political. Well, what do you think about that, Anne? Here's an opportunity. It's odd and I think regrettable that we're in the territory between Parliament and the executive, as we call it, the government.

We're actually saying, oh, they can actually just about manage to put through a bill possibly on no-fault divorce and on domestic abuse. I mean, they should be areas where if you have broadly consensual approach to that and a socially liberal Conservative Party, which I still think you do have on those kind of issues under Boris Johnson and Labour is being reasonable and with Lib Dem support and others. The problem is that they are issues in which you can hope to get agreement, but there are not very many of them. And the public may rightly say wherever it stands on Parliament, on the government, Brexit, prorogation in these matters, This is a very small amount of what Parliament should be dealing with. It's really doing things that should almost be no-brainers. It's the more difficult fare that is blocked at the moment.

This message on crime and law and order, Priti Patel, who's the Home Secretary, has talked about the UK being a soft touch on foreign criminals for too long. Who is that designed to appeal to, Katie? Well, I think overall, there's a sense that on crime, in number 10, that you can't really actually be too tough on crime, particularly in an election. Well, you can never be too tough. I think that they think crime is the one area where Westminster is out of touch with the rest

of the country. They think the country is more right-wing on crime than the Westminster consensus. And I think that's partly why Priti Patel is Home Secretary, someone who is, even within the Conservative Party, seen as very right-wing. And it edges into that. But I think in terms of who they're looking at, their pitch on crime, which is toughening sentences, in terms of the type of events and also foreign criminals, there is a sense that a crime rising. A, the Tories were losing their reputation as a party of law and order and they wanted to get that back. But two, it's no longer just big cities that experience crime.

And if you are a family member, a mother, a father, and you know someone affected by that, you suddenly want a much tougher approach. So I think that's what they're aiming for. Yeah, I mean, some would say they've got a bit of a cheek, bearing in mind they've been in charge for quite some time now, Anne, and the criminal justice system is, to put it mildly, creaky. The criminal justice system has been creaky for a number of years,

in fairness, and the challenges to it do change over time. Violent crime is rising in many places. Drug-related crime is rising. A lot of other crime is sort of falling down, falling off, I should say, because it's easier to protect yourself against sort of crime against property or against your car than it was. So it's a mixed picture. But I think violent crime has come back to haunt the government. I would say I don't think it's quite fair to say they've got a bit of a cheek because violent crime spikes are often to do with other sociological trends and demographics and the way that demographics bunch around certain areas or

urban areas and towns. And governments just have to be nimble and they have to be able to deal with it. So you come down to whether you want to take the pretty Patel line that you're out of touch and that you should really go into whacking up sentences and that would satisfy that demand, or whether you think that your whole criminal justice system needs to respond more to that kind of specific challenge. But a lot of liberals on crime aren't going to like what they see either way. Can we talk about Brexit briefly, if that's possible? Oh, let's.

Because it's Boris Johnson who's Prime Minister, is there, has he, more of a chance of getting a withdrawal agreement this week than his predecessor? Quick one, Katie. He has more of a chance. He's a better placed salesman in terms of winning over Brexiteers than Theresa May ever was, partly because he voted leave. But it's still a very limited landing space. Anne.

It's certainly, he couldn't do any worse at it than Theresa May did in the end. But it is still a way to go. His big advantage is the clock has run down. So everybody is beginning to say, you know what, let's see if we could get this off the table. If not this week, then very soon. Anne McElvoy, Katie Ball, it's good to talk to you both. Thank you very much. Now, I've already said that so many people wanted to email the programme.

We've had comments, too, on our Instagram feed and on Twitter just talking about faecal incontinence which was a subject on Women's Hour yesterday. So we have gathered Oliver Warren who's a colorectal surgeon and Sue Armand who's a specialist pelvic physiotherapist and they are here just to comment really and to talk through some of your emails. It does seem actually horrifyingly Sue Sue, that very little has changed because we've had emails from women in their 70s and women in their 30s, both talking about very similar problems. Why is that still going on? Indeed, and it's something I see in my clinic most days, actually, women and girls from age 16 to in their 80s so often they've got the problem they're perhaps slightly ashamed it's restricting their lifestyle so much they speak to friends or they may not speak to anyone

they may hide it from their family and then they'll in desperation go to their GP who perhaps says particularly after childbirth oh it's part of childbirth or it's part of the ageing process, of course your muscles are weaker down there. And so they often have great difficulty in getting referred for further, onward referral for help. Oliver, you're a surgeon. That's right, yeah. And it was interesting, I was reading some of these,

they're very sad, some of the emails we've had. One woman just said, I'm ashamed that all this is on my medical records shame is so it's so closely linked to all this isn't it actually yeah it is and that's um that's a real problem for us because we need people to come and talk to us about this um it's incredibly common all these problems are both faecal incontinence and other difficulties with pooing and opening our bowels and so on. And of course, because everybody suffers in silence, they think they're the only person. So people are quite happy at dinner parties and things to say, oh, I'm having my shoulder done or my knee's been playing up. But they don't all sit around and say, do you know what?

Since I gave birth a year or two ago, I'm having real problems with my bottom and it's leaking and I can't control it. And yet it's just as common. I'm just going to read some emails to you both and you can just comment at the end. This older lady says, I gave birth to my only son in 1976. I'm 69 now.

I had an episiotomy in stitches but only began to suffer faecal problems about 15 years ago. I don't suffer urgency but I habitually leak during exercise and I keep pooing my pants. This also began to occur during sex and for the last 20 years I haven't had a sexual relationship.

That's very sad and I wonder, you mentioned to me earlier when we were talking, Oliver, that although you might have problems after birth, you were likely to get worse problems during the menopause and that seems to have happened to this lady. Yeah, so it's kind of like a two-hit process. We know that a number of women sadly suffer an injury that what we call an occult sphincter injury at the time of delivery. And there's a lot of work going on at the moment to try and raise awareness around that and to try and help midwives, obstetricians and general practitioners to try and pick these injuries up a bit earlier because

they're often missed. But what then happens is patients just about cope until they go through the menopause and then when you go through the menopause all your muscles become weaker as a result of hormonal changes and that second hit of your pelvic floor muscles weakening means that something that you might just about been a coping with up until now you now can't cope with but everything feels like it's so long-standing it feels like it's not the right time to go and talk about it. And so people don't come forward. But also, I wouldn't have known that. I wouldn't have known that if I had a problem after childbirth, it would likely get worse during my 50s. I just wouldn't have known that. And I'm not sure how many women do know. I don't think very many people know at all, because we've really

struggled to talk about it. So for example, we know that at least 10% of women after vaginal delivery suffer with an element of flatulence incontinence. So not being able to control your wind, your farts, if you don't mind me using that language. And nobody talks about that. And it's not mentioned in things like the six week health check with GPs. So urinary incontinence is on the syllabus for general practitioners. Fecal incontinence isn't on the syllabus for general practitioners. Another, can I just, sorry, I've got so many,

I just want to get as many people's stories in really. Another listener says, I've been suffering from problems for over 20 years. My first birth, my son was a forceps delivery after an episiotomy. And I was warned that I might have nerve damage, which I think I do. I've asked several GPs about this but they said nothing could be done beyond pelvic floor

exercises which I do regularly. I'm also prescribed vaginal oestrogen. This does at least reduce the frequency of UTIs. What do you think about that Sue? Yes this is a common scenario that I have with patients that come to me. Very often they've seen their GP, they've gone away and tried their best with pelvic floor exercises without really knowing quite why they're doing it except to get a bit stronger down there. They've been told, oh, just pull up those muscles or they've gone on the net to try and teach themselves. A large percentage of them, I find, there's more than one cause. You talk to some of them and they've got long-term constipation from a child, from school. We see schools where children

are not allowed to go out and use the bathroom except at lunchtime. And a lot of this becomes a habitual thing. As we've spoken about, it goes on and the brain starts to think that this is a normal state of affairs um so we do we do see it all the time this is another lady now 78 she says i had my first baby in 72 he was delivered after two days in labor by a junior doctor years later after horrible experiences of desperation to find a loo and hideous, embarrassing accidents, I plucked up the courage to go to the doctor. I was told it was IBS and I got some tablets. I was eventually sent for tests, which showed what I already was too well aware of, that I had very little sensitivity in the rectal area at all.

I suppose my nerves had been damaged. I still seek out the loos everywhere I go and I dread long journeys. Thank you for talking about faecal incontinence, says another listener. I am unable to empty my bowels without manual manipulation and experience urgency that dominates outings and I suffered for 10 years. I don't think any man would put up with that. I know that GPs and consultants are not treating this postpartum problem seriously and they're not offering help. Please, how can I find someone who would help me? Oliver? that I hear quite frequently in clinic, particularly around the requirement to manually manipulate the back of the vagina to help open bowels often after pregnancy.

The problem with faecal incontinence is that it ties into lots of other problems and it's a multi-speciality problem. So what we need is patients to be referred to specialised units that have both gynaecology, urology and colorectal services, all of whom are interested in pelvic floor and are interested in helping women and also men. And that comes on to the sort of second point. I know I'm on Women's Hour and speaking as a man,

so I'm probably on slightly dodgy ground, but it is also a problem that affects men. And men are even worse, I would say, at coming forward and talking about faecal incontinence, talking about leakage. And there are men who need help as well. We have to get better at creating clear pathways into these services and flagging these patients up from primary care as needing specialised units that look after them. But this lady who's had a tough time for a decade, she doesn't, she shouldn't give up and assume this is what she's supposed to accept for the rest of her life. No, not at all. There's a lot of treatments, many of which don't require operations and surgeons and need people more like Sue with their expertise around physiotherapy, biofeedback, pelvic floor specialist nurses, all of whom can make a huge difference to patients' lives. But then there are also a group of patients, of women and occasionally men,

who would benefit from certain interventions such as nerve stimulation, sphincter repairs and things like that, done by very specialised surgeons in units that are recognised nationally for doing this work. This is one for you, Sue, from a listener who says, I've just heard your discussions about post-birth pelvic problems. I wish to recommend the pelvic floor clinic at Guy's and St Thomas' Hospital. I'm 66 and I've suffered for many years.

About five years ago, I asked my doctor for a referral. They are amazing and have helped me so much. So that's good. But is she very fortunate to have that clinic relatively close to her or are they everywhere? Or should they be everywhere? There are specialist clinics in most large cities, but I would say that every NHS trust in the country

will have an established physiotherapy pelvic team who are used to seeing this kind of condition. That can be accessed quite simply via the GP, not taking no for an answer, maybe seeing one of the other partners and say, I want to see a pelvic physiotherapist. There may be a waiting list. Those referrals do require a referral from a GP.

If the patient has got private medical insurance or is willing to pay, they can phone their local private hospital and see a specialist physio there, and we don't require a referral for that. It's important, isn't it, to keep in mind doctors have seen everything. I remember worrying about various things. Okay, my hemorrhoids are not going to the doctor. And then you realise, do you know what, love, they've seen it all before. I say to my ladies and gents, they come through the door,

they often sit down and they can hardly speak. They're embarrassed they're in tears i'm sure oliver sees this and i say you've done the hardest thing you've walked through the door but thank you for coming that's true sue and i'm sure you i can tell from the way you conduct yourself you're a lovely person to meet but if your gp isn't encouraging when you have plucked up the courage to see your gp then that can be difficult. Go on, Oliver. Yeah, well, I think we often ask, how can GPs help? We should also be asking, how can we help GPs? So I was sent some data last night when I knew I was going to come on and talk about this from Julie Cornish down in Cardiff, who's done a huge amount of work in this area, looking at a

survey of GPs. A huge number of GPs have never had any training on faecal incontinence. It's not part of their syllabus. A huge number of them really want to learn and know more about it. And they have to cover a huge amount of different subjects and topics. So there's a bit about us trying to help primary care physicians and midwives who are seeing these patients often post-delivery to signpost and flag how they can get in. And I'd also like to flag, if I may, MASIC. I don't know if some of your listeners have mentioned MASIC. We put a link to their website on our website yesterday. Incredible work in this area.

I had a look at their website, MASIC, and it's excellent actually. Yeah, really brilliant stuff. M-A-S-I-C from memory. Yeah, you can find it. Diet. A number of people have asked whether diet helps, how you can change your diet. What would you say, Oliver? Yes, it does, but it's also quite individual. So there's no one correct diet, but certainly our bowels and our bowel habit and our stool consistency makes a big difference to the way our bowels work. It's much harder to remain continent to liquid, soft stool than it is to a slightly more well-formed, harder poo. And so for each individual person, they're going to have to see what works for them. But yes, manipulating your diet will have an impact on the consistency

of poo that you pass. And this listener asks, well, actually, she says, I have had a rectocele. This is something that we talked about yesterday. Can you briefly define what that is, Oliver? Yeah, so a rectocele is where the anterior wall of the rectum bulges forward into the posterior wall of the vagina. And this can have varying effects. In some women, it has absolutely no symptoms whatsoever. And in other women, it causes all sorts of problems. It's a common finding, particularly in women after delivery. And in each individual case, you'd need assessment by an expert as to whether or not repairing it would help.

Well, this listener asks, she's 31, she says, my female doctor, whom I trusted implicitly, asked when I went to her about this, asked if I had a good sex life and if I thought it was something I could live without. I responded that I couldn't. And she inferred that should I have surgery to repair it, I may well lose some sensitivity. Now, that's a question I don't know for either of you. Could surgery affect your sex life negatively? Any idea? Yes. I mean, surgery on the vagina or on the anus and rectum can definitely negatively impact on your sexual satisfaction and performance and can cause all sorts of problems.

It doesn't mean it always will. I suppose that's part of a very important consent discussion between any surgeon and their patient so it's something certainly to ask about if you're going to have surgery at any point on the bottom at all or on the vagina is to ask about that because sometimes surgeons won't be feel able to be as forthcoming as probably they ought to be talking to a 31 year old lady but yes it can it won't always but it can just very quickly can i ask about potty stores which a number of people have recommended but i'm so i'm not sure that you think you this is a device where you helps you to squat in the right position it's the way we've evolved

um into an upright posture we no longer squat to poo we sit on a very nice westernized toilet in an upright position which is not a good position for opening the bowel and allowing the poo to basically come right has to come around a bend to exit right but surely you don't need to bind you could just use a couple of yeah um i actually as part of the treatment we give a lot of lifestyle advice if it's a young mum or a mum with a toddler i say at home you've probably got one of these little stools that your little boy climbs on to wash his hands you train him use that get get it or get a good thick book and put your feet on that or if you're out and about shopping um you can just simply cross one leg over the other so at least you're flexing up one side of your pelvis

and alter your posture on the toilet and it works wonders thank you both so much and if you think it doesn't matter believe me it does i'm just going to end with this email who says i'm listening to your program with tears rolling down my face i'm 64 had my first baby at 23 i've had 40 years of suffering ever since with the inability to poo normally thank you for airing this difficult subject and encouraging women not to be embarrassed about seeking help um nobody in my family realizes i have a problem um to that woman i hope this has given you at least the strength you do not need to be anonymously suffering like that so not even your own family know about it um thank you sue thank you very much oliver for talking to us this morning.

This is Woman's Hour and a little later in this programme, and it's not entirely unconnected. Obviously, there are inevitably links. We're talking about a loss of libido at the menopause. I mean, if this is something that affects you or you think it's something that you should expect at the time of the menopause, you can let us know what you think about that.

I promise I can keep all your comments anonymous, obviously on email. That is a lot easier. Twitter, you can't really stay anonymous for long, but email would do it, I think. So bbc.co.uk slash womanshour. So we mentioned a couple of weeks ago, it was an interesting conversation this, Caroline Criado-Perez and Professor Gina Rippon were on, talking about taking sex differences into account in science and society. Both have written very significant books about this.

It is a cliché that women have different map-reading abilities to men. In other words, to be honest, women are thought not to be quite as good as men are in terms of navigation. You might well have missed the Global Determinants of Navigation Ability Study, which came out a while ago and did appear to reveal that indeed it's true, men are better at navigating than women. Gillian Coughlin is from the University of East Anglia. She is doing research on navigation and Alzheimer's. Gillian, good morning to you. Good morning. Hello. Thank you for having me here.

Great pleasure to have you. And Helen Brocklehurst is the former head of publishing at the AA and the author of the British Roadmap Puzzle Book, which with Christmas fast approaching is absolutely ideal. Welcome to you, Helen. So, Gillian, first of all, were you surprised by that headline finding from that enormous study? Because it actually involved millions of people, didn't it? Yes, absolutely. So I guess for a bit of background, the study was largely based on this people-powered gaming app called Sea Hero Quest. And basically, this gaming app was made freely available to download on the Apple and Android Play Store in 2015. And the idea behind this was it was a way for scientists to collect data on basically inter-individual differences in navigation ability. And so one of the primary findings of that study then was basically that men and women appear to differ in terms of their navigation ability. And there's definitely some evidence to suggest that men are, you know, they're outperforming women, basically.

And presumably this differed across countries and ethnicities and age groups? Yes. So nationality, you know, age and as we're talking about gender, they do affect basically your navigation ability. But across all the countries and across all age groups, we were finding this gender effect. So between men and women of, say, between 20 and to 30, you see this gender effect. And you also see it in older men and women as well. And then, you know, it's very consistent across countries.

So the gender effect itself seems to be a very kind of stable finding. But the richer the country, So the gender effect itself seems to be a very kind of stable finding. But the richer the country, the less likely there was a yawning gap between the biological sex differences. Yes, absolutely. So that's correct. So what they found basically in the study is that GDP, so I guess, you know, the more wealth the country has in terms of the gross domestic product, the smaller the gender effects. So there's less differences between men and women. And there's also another measure which that as that gender gap goes up and there's more inequality between the sexes the gender effect on spatial navigation gets greater as well so you're seeing bigger differences in men and women with men outperforming women

in terms of navigation. Right, Helen are you a little disappointed by this because you're obviously a map lover you've been in absolutely embedded in the world of maps for your professional life. Yes, I am disappointed by that. But I think it can also be explained because I think culturally women tend to do a lot less map reading. And that's, I think, what you're saying about the effect of the GDP and the difference there is that in countries where you might be doing less navigation, those skills, that sort of spatial intelligence won't be trained in the same way in your brain. So the lack of practice could make for weaker spatial intelligence. When does it all start? Because we're all born with the same capacity to navigate shortly. I think probably that for younger children growing up now, particularly those who do orienteering and those sorts of skills, there will be a less discernible gap.

But I think traditionally boys have gone out and they've done more cycling and probably more navigational. Yeah, which I guess feminists would say boys have felt safer to do so, which is, well, depressing, isn't it, actually? Yes, and also I think if you look at drivers, now the gap between number of male and female drivers in Britain is narrowing. Is there still a gap, though? There is still a gap. It's something like 17.1 million men and 16.5 million women.

And I think that as the population ages, that distinction between being a non-driver is higher with the older population. Rebecca on Twitter makes a point. I'm afraid I can relate to this. As long as the map's facing the same way as the direction of travel, she says. How long have we used maps, Helen? Seriously. Well, I think we've used maps for a very, very long time. The earliest maps are probably made by the Romans who were the first big road builders in Britain.

And the early history of mapping was really very connected to the military because it was about sort of conquest or defence of territory. As time goes on, you see in the 17th century, the need for developing the postal service was kind of the motive to create better roads and better communications. And then it's really in the 20th century with the arrival of the motor car that mapping becomes essential for people to find their way around. And yet, of course, if the man traditionally drives the car, then the woman might be in charge of looking at the map. Traditionally in charge of giving the directions. Yeah, because men don't ask for directions. Let's make a sweeping generalisation. But actually, men are less likely to ask for directions.

The reason I like map is because I'm actually very bad at remembering directions. So if somebody gives me directions, my memory for that routing is really poor. I can unusually remember the first couple. Right, but that's you. It's nothing to do with your biological sex, is it? I don't think so. But I think that, again, that is something that could be trained. Yeah, it's all about the training, isn't it, Julian? It has to be. Yeah, so I definitely agree that practice effects are definitely a very strong, maybe, explanation for the gender effect we see.

And it's simply that men seem to be engaging in activities that stimulate, you know, their navigation skill more. And therefore, when we go to measure navigation, they perform better, basically. And there is data in the Sea Hero Quest game that does suggest that. So, you know, independent of GDP or anything, Nordic countries do perform better on spatial navigation. So they outperform all other countries in the world. And that is, you know, explained basically because Nordic countries, they put a strong emphasis on orienteering. And orienteering is something that's taught from a very young age among these people so they're getting to

stimulate the navigation system from a very young age, making them basically better navigators so that's a good example of a practice effect. Thank you very much, Gillian Cotland from the University of East Anglia and Helen Brocklehurst who was the Head of Publishing at the AA. I guess when, well, not when, if civilization crumbles, then we will all need

to be able to read a map. So it's actually not something we can dismiss. Sorry, I went a bit dystopian there. It's possibly because I'm about to talk about the potential loss of libido connected to the menopause. Let's bring in our guest, the psychotherapist and sex therapist, Louise Meazzanti. Welcome, Louise. Thank you very much. Good to have you on the program. So it is one of those things that is regarded by some as an inevitability. Yes.

Is it, though? Do we all lose libido as we go through the menopause or just get older? No, not at all. Some women actually gain libido during menopause. Why might that happen? See, this is because many women grew up with a cultural conditioning of you should not have sex. If you have sex, you'll get pregnant. And during menopause, you lose the ability to get pregnant. So it's a fear that goes away.

So many women feel the relief and actually feel a deeper sense of internal permission to have sex. It's like the old conditioning falls away. And that can actually decrease libido and her interest in having sex feeling more free. Right. So it doesn't need, we certainly don't accept it as a given. Absolutely not. Right. Having said that, there are various symptoms of the menopause. Vaginal dryness is one. General achy, tiredness doesn't help either. We can't dismiss the menopause, can we? No, we can't dismiss it. There is a physiological change that happens in the body, absolutely. But we can do two things with it. We can go along with the cultural conditioning of

when you get to menopause, it's kind of over. Or we can have our own experience of our own body and have some knowledge about what is actually going on. And for example, with vaginal dryness, it's a matter of a woman takes just longer to lubricate. It's not like it's over. But that means that we have to define our perception of what sex is. Is sex just the script that we've been living most of our lives, that most people sadly do, that sex is about penetration until one,

usually the man, has an orgasm. That's sex. Well, that's heterosexual sex. We can't assume, obviously, we know not everybody is straight. So does it differ in gay relationships? I think it's kind of the same, that we're still rolling out a script of this is how sex is, this is what works. And especially in long-term relationships, we get used to this is how sex works for us. This is our script. This is our recipe. And we don't want to change it or we're not inclined to change it. We're not inclined to change it because there's also a big cultural expectation about it and all the performance of this is what sex is supposed to look like.

And we hit menopause. And what happens is that we actually, our body is sending us a signal. It's not working as it's used to. But it's also a signal of, okay, what else is there? What is sex really for me? How can we expand the sexual experience? How can we experience sexual energy in a different way? So we're not just rolling out the script?

We're losing the script and we have to really work out what is sex now? What are the much more pleasurable and deeper and longer experiences? Fantastic in theory, but you need a partner who is cooperative and understands what you're going through up to a point. How likely is that? That very much depends on your ability to communicate and the trust that you have with each other and in the relationship. But men go through their own kind of menopause too. Many men also, their identity changes.

That happens both for men and women. And that means they are redefining their masculinity. So that happens within a couple. So it's an opportunity for both to kind of renegotiate who are we now? What is sex for us now? What is more? Can we talk about Viagra? Because we know it's now been available over the counter for over a year.

I don't know, in terms of the people you see, is it a factor? Is it something people talk about? Because yes, I actually was reading about it last night. It does not enhance desire in men. It merely enables an erection effectively. So that can cause complication, can't it? It can be wonderfully functional, but equally some women might feel that it's too much. Viagra is sadly mostly just masking an underlying problem. So it allows the man to have a more sustainable erection, but it doesn't take away that there is a message behind the lack of erection. And that impacts both men and women, because if we mask something, we don't get to the root of what is really going on,

which is for both men and women. Very often that when we start getting into the 50s, we're done with performing. We get into actually, we get into a more empowered place in ourselves. We don't care as much. That means we don't want to play the script. So our body is telling us, I'm not going to play the script anymore. I'm going to be more truthful to what is it actually that I want. And there we discover, wow, I've been playing out this kind of sexual game,

both for men and women, for my whole life. And I've missed out on what is my body really telling me. But just for the benefit of our male audience, and indeed our listeners who have male partners, if you can't get an erection, it might just be, not that there are underlying conditions, but just that you are 65 or 70 rather than 23. There's some truth in it, but it's also a myth.

It's a myth. If you can't get an erection, usually there is an underlying issue. Either it's physiological, you need to get checked with your GP. Is it indicating that there's some other conditions going on? Or is it that you're actually realizing, well, the way that my sex life has been working is not exciting for me anymore. We have to rediscover what is sex. It's also a sign that there just isn't polarity. There isn't something that's exciting that is showing up as a sexual issue, but it's a deeper issue of am I allowing myself to explore and keep engaged, vital in my life?

Am I still engaging my erotic energy? Engaging my erotic energy. I mean, I'm not laughing, except there will be listeners who are thinking, you know, I've got so many things to do. My list of stuff I need to tackle is ever growing. And this lady is telling me to engage my erotic energy. Cou i need to tackle is ever growing and this lady is telling me to engage my erotic energy um couples need to communicate don't they um and this is one of the toughest things of all to talk about yeah yeah there's a lot of taboo around sex of course and and it's also because it's vulnerable because this is our about our performance am i good enough am i

attractive enough am i sexy enough all these things that i have to say all that self-doubt and anxiety doesn't it gets much worse around the time of the menopause women look at themselves and just think oh hopeless yeah absolutely that that plays a big role and that's why it's also so important to rediscover who am i now so i i can't just pull out the the the card i used to be that I used to be attracted by. I perceived myself in that way. But also to say, yeah, it's a journey into who am I now? What feels good in my body instead of what looks good? That was the sex therapist and psychotherapist Louise Mazzanti.

We've got some emails on that, actually. But I'll go to them first of all. I am 50, says this anonymous listener, and in the midst of perimenopause. And I've never felt more sexual. I now know how my body works. And I was going to ask for what I need. I feel confident and happy with myself. Unfortunately, oh, I was just enjoying that.

And then we get to, unfortunately, my husband decided we should be celibate about 15 years ago. When my libido awoke some years later, I met somebody else. We are currently starting the painful process of separating from our marriages to be together. I've been having this affair now for eight years and the sex remains amazing and as frequent as we can manage. I hope it carries on until I'm very old. It's a joy. There we go. That single email took us on a real rollercoaster of emotions, didn't it? But basically, fingers crossed, all going well, although I appreciate that getting out of the marriages isn't going to be easy.

From Rachel, my libido has completely and radically increased to a height not unlike my younger self in my 20s. I am very much more sexually and physically confident as a more mature woman. I think this has got a lot to do with cleaning up my lifestyle and my diet. Menopause does not have to mean the loss of desire. I'm also a lesbian,

so perhaps I have less cultural noise going on about a dry vagina being the end of my life. I think that's an interesting point, isn't it? That's probably very significant there. An anonymous listener says, after a very normal and healthy sex life, my menopause came like a thief in the night when I was around 51 and stole my sense of sexual desire completely away. I had no inclination, no desire and no sense of frustration either. I became asexual, I guess. That was 13 years ago, and I'm now in an established relationship

without any sexual relationship. Is this uncommon, she asks. Well, Anonymous, I suspect not as uncommon as you might think, but let us know. People can always email us on the strength of anything they've heard, whether it's on the programme or on the podcast. Another listener says, I've never had a very strong libido, but I've nevertheless enjoyed sex.

However, since the menopause, I seem to have no desire whatsoever. My husband, although understanding, finds my lack of libido a great disappointment and a rejection. We've always been close, but our relationship is now strained, and I feel he's somewhat resentful. Another listener, I have to say that before I went through the menopause at 51, I thought about sex practically all the time, and it seemed to interfere with everything. I've since experienced this loss of libido, but for me, frankly, it has been a positive.

I'm able to concentrate my energies into work more, and more creative pursuits as well. I still do have a very enjoyable sex life with my husband, but I'm not thinking about it constantly anymore when I'm in meetings and I'm at last able to follow proceedings. I wish I knew who that was. Do they work here? Have I been in meetings with them? Is she in the cabinet or he? Who knows? i hope they're not making decisions that impact or have made decisions that impacted on the rest of us right we'll never know will we uh matt reading elissa says boys are encouraged from an early age to be spatially aware to engage with the environment let alone drive and read maps so when women come to drive they are less experienced

already it isn't just safety it's what's enabled and encouraged. Thank you, Alyssa. Good point. Now, back to the subject of faecal incontinence, which, as I say, was something that we repeated the whole. Well, we didn't repeat the conversation. We went on in the conversation today precisely because of the reaction to yesterday. A listener says here, I agree wholeheartedly that this issue is one of the last taboos in our society.

We need to talk about it so women know it can happen and what to do and how they can get help if it does. I only got help by going private, which saddens me as it's not a route open to all. I'm professional and well-educated, but I had no idea what happened to me could happen. I'm sitting here crying, says another listener, as I hear the experiences of women echoing my own. I've never had a child, but I do have a problem with faecal incontinence.

It started with the menopause and has pretty much put an end to my sex life. For me, one of the worst issues is that my anus becomes very irritated and painful. I'm reduced to trying manually to make sure everything is empty before I go anywhere. I've got to take wipes with me everywhere I go as well. I'm so sorry. The number of women living these lives, which are just not in any way satisfactory. It's really saddening. Another listener says, I had a forceps delivery and an episiotomy 50 years ago. Now, in those days, we didn't know about pelvic floors or exercises.

About 10 years ago, I was diagnosed with an erectocele and had a successful repair. But what they didn't mention is that penetrative sex isn't only excruciatingly painful, but impossible after this op. Well, in my case it is anyway. My husband and I still have a good sex life, but it can be rather frustrating. And I think we'll end with this one. I visited an incontinence clinic following a GP referral several years ago,

and I filled in a 16-page document including food, exercise and drink intake, only to be told that I didn't meet the criteria. I could have wept. However, I bought my own nappy pants and products to protect the bed. I'm a happily married woman in her 50s and I've now been housebound for several years as a consequence of this. My husband tries to be patient with me, but I understand his frustration. and I've now been housebound for several years as a consequence of this. My husband tries to be patient with me, but I understand his frustration. It's so sad to have to end on that email because that, to me, is the most graphic illustration of the impact this can have on a life.

You've got a woman my age who is housebound because of this. It's just not on to that anonymous listener. I hope you hear this. And I hope somehow you get the strength to get some help because that is just no way to live, is it? I'm really sorry for you. Right. Thanks to everybody who did contact us on this one. We really do value the fact that you are willing to do it. And I'm really proud of the relationship we have with the audience that enables you to feel that you can so please do keep doing that Jenny is here with the podcast tomorrow hello I just wanted to tell you about my new podcast it's called classical fix and it's basically me Clemmie Burton Hill each week talking to a massive music fan I mix them a classical

playlist they have a listen they come in and we just see where the conversation goes. If you'd like to give classical music a go but you haven't got a clue where to start, this is where you start. To subscribe, go to BBC Sounds and search for Classical Fix. Now then, as you were. I'm Sarah Treleaven and for over a year I've been working on one of the most complex stories I've ever covered. There was somebody out there who was faking pregnancies. I started, like, warning everybody. Every doula that I know. It was fake.

No pregnancy. And the deeper I dig, the more questions I unearth. How long has she been doing this? What does she have to gain from this? From CBC and the BBC World Service, The Con, Caitlin's Baby. It's a long story. Settle in. Available now.