MEDICAL NEWS A BIMONTHLY SCIENTIFIC JOURNAL PUBLISHED BY POZNAN UNIVERSITY OF MEDICAL SCIENCES POLAND NOWINY LEKARSKIE

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1 MEDICAL NEWS A BIMONTHLY SCIENTIFIC JOURNAL PUBLISHED BY POZNAN UNIVERSITY OF MEDICAL SCIENCES POLAND NOWINY LEKARSKIE DWUMIESIĘCZNIK NAUKOWY UNIWERSYTETU MEDYCZNEGO IM. KAROLA MARCINKOWSKIEGO W POZNANIU Founded in Rok założenia (82) ISSN Indexed in / Indeksowane w: Polska Bibliografia Lekarska, MNiSW, Index Copernicus, Google Scholar Full texts on line / Pełne teksty prac: /

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3 Medical News 2013, 82, 6, PIOTR KORDEL 1, MAŁGORZATA KORALEWSKA-KORDEL 2 PARENTAL TESTING IN THE FORENSIC MEDICINE INSTITUTE OF POZNAN UNIVERSITY OF MEDICAL SCIENCES USTALANIE OJCOSTWA W ZAKŁADZIE MEDYCYNY SĄDOWEJ UNIWERSYTETU MEDYCZNEGO W POZNANIU W LATACH Laboratory of History of Public Health and Social and Health Policy, Chair of Social Sciences Poznan University of Medical Sciences, Poland Head: prof. Michał Musielak 2 Department and Institute of Forensic Medicine, Poznan University of Medical Sciences, Poland Head: Czesław Żaba, MD, PhD Abstract Introduction. Stating or denying the identity between the biological and legal parentage has been a problem for centuries. Not until the latter half of 20th century, thanks to advances in medical sciences, this problem couldn t be solved. The classic serological analysis, the HLA system analysis and DNA analysis enabled people to exclude or confirm paternity. Aim. Presentation of the structure of non-paternity events in expert opinions provided by the Forensic Medicine Institute of Poznan University of Medical Sciences in the years , judging the influence of the method used for parental testing on the percentage of non-paternity events and presentation the influence of demographic changes in Poland on the number of paternity tests run by the Forensic Medicine Institute of Poznan University of Medical Sciences. Material and methods. The research material were the results of the paternity test conducted in the Forensic Medicine Institute of Poznan University of Medical Sciences in the years : 4387 serological test, 679 HLA system tests and 1252 DNA analyses. Results. The percentage of non-paternity events in serological test in the years reached 24.25%. In HLA system analyses in the years non-paternity events were 14.29% and in DNA analyses they were 20.85%. Conclusions. The method used for parental testing does not influence the non-paternity events percentage but the demographic changes had influenced the number of parental tests run by the Forensic Medicine Institute of Poznan University of Medical Sciences. KEY WORDS: parental testing, serological analysis, HLA analysis, DNA analysis. Streszczenie Wstęp. Ustalenie tożsamości między ojcostwem biologicznym i prawnym przez wieki było problemem nierozwiązywalnym. Dopiero w drugiej połowie XX w., dzięki postępom w naukach medycznych, udało się rozwiązać ten problem. Klasyczna ekspertyza serologiczna, badania układu HLA i analiza DNA pozwoliły na wykluczenie, a następnie potwierdzenie ojcostwa. Cel. Przedstawienie struktury wykluczeń ojcostwa w ekspertyzach Zakładu Medycyny Sądowej UM w Poznaniu w latach , ocena wpływu stosowanej metody analizy na procent wykluczeń oraz przedstawienie wpływu przemian demograficznych w Polsce na liczbę wykonywanych badań w Zakładzie Medycyny Sądowej UM w Poznaniu. Materiał i metody. Materiał badawczy stanowiły wyniki badań ustalenia ojcostwa przeprowadzonych w Zakładzie Medycyny Sądowej Uniwersytetu Medycznego w Poznaniu w latach : 4387 ekspertyzy serologiczne, 679 badań układu HLA i 1252 analizy DNA. Wyniki. Odsetek wykluczeń ojcostwa przy zastosowaniu klasycznej ekspertyzy serologicznej wynosił w latach ,25%. W przypadku ekspertyz układu HLA w latach wykluczenia ojcostwa stanowiły 14,29% wyników. Z kolei w wyniku analiz DNA w latach wykluczenia ojcostwa stanowiły 20,85% wyników badań. Wnioski. Stosowana metoda ustalania ojcostwa nie wpłynęła na odsetek wykluczeń w badaniach. Wpływ przemian demograficznych na liczbę badań ustalenia ojcostwa w Zakładzie Medycyny Sądowej UM w Poznaniu jest wyraźnie zauważalny. SŁOWA KLUCZOWE: ustalanie ojcostwa, ekspertyza serologiczna, ekspertyza HLA, analiza DNA. Introduction Each year in Poland courts hear several thousand cases related to the problem of paternity. Those cases concern mainly affiliation and denial of paternity. The trial in those cases in ended by a verdict stating or denying the identity between the biological and legal parentage. The problem of parentage is dated back to the ancient times. The only methods available used for checking whether the man was the biological father of a child ORIGINAL PAPERS

4 422 Piotr Kordel, Małgorzata Koralewska-Kordel were, for many ages, the anthropological methods basing on the physical resemblance between the father and the child, which were an imperfect tool, and the knowledge on the time of conception. The second method was also faulty because promiscuous nature of human beings. The thing that proves best the weakness of those methods is the Roman maxim Mater semper certa est, pater semper incertus est and the legal presumption of legitimacy pater est, quem nuptiae demonstrant, which is also present in Polish family law (art. 62 of the Polish Family and Guardianship Code, Polish Official Journal No ). The advances of medical sciences enabled people to solve the problem of stating the biological paternity. The first method used for exclusion of paternity was the serological expertise. Introduction of the study of blood groups into courtroom practice as an evidence was possible thanks to many discoveries such as Gregor Mendel s inheritance patterns or Karl Landsteiner s distinction of the main blood groups. In 1911 Ludwik Hirszfeld proved that blood groups are inherited according to rules stated by Mendel. Poland was one of the first countries which allowed serological expertise in courts in 1926 professor Jan Olbrycht ran serological test for an alimony trial for a court in Krakow and professor Ludwik Hirszfeld did the same for a court in Warsaw [1]. Through the years the range of serological expertise changed thanks to discovering new serological systems. The Polish Society of Forensic Medicine and Criminology set 11 systems, which were used for serological expertise: AB0, MNSe, Rh, Kell-Cellano, Hp, Gm(1), Gc, Blood Acid Phosphatase, Phosphoglucomutase, D Esterase, GLO I. The efficiency of the classic serological expertise in excluding paternity reached 88% [2]. In the latter half of the 1970 s the HLA system expertise became a legal evidence. The first HLA expertise in Poland was conducted in Poznan in 1980 [3]. The HLA system analysis was used as the 2 nd degree analysis for the classic serological expertise. The excluding power of those two combined methods reached 97% [4, 5]. The 1990 s brought a significant change in paternity testing. The DNA analysis methods developed by A.J. Jeffreys i K. Mullins [6] enabled scientists not only to exclude parentage but to confirm it with the probability reaching 99.99% [7]. Between 1991 and 1997 in the Forensic Medicine Institute of Poznan University of Medical Sciences the DNA analysis was used as the 3 rd degree analysis together with serological and HLA tests. After 1997, due to high costs, the HLA expertise was abandoned and the serological test were run extremely rare because the DNA analysis turned out to be the most effective method. Aim The aims of the article are: Presentation of the structure of non-paternity events in expert opinions provided by the Forensic Medicine Institute of Poznan University of Medical Sciences in the years for the legal trials concerning affiliation and denial of paternity. Judging the influence of the method used for parental testing on the percentage of non-paternity events in the expert opinions provided by the Forensic Medicine Institute of Poznan University of Medical Sciences. Presentation of the influence of demographic changes in Poland on the number of paternity tests run by the Forensic Medicine Institute of Poznan University of Medical Sciences. Material and methods The research material were the results of the paternity test conducted in the Forensic Medicine Institute of Poznan University of Medical Sciences in the years : 4387 serological test, 679 HLA system tests and 1252 DNA analyses. The methods used for serological tests concerning red blood cells group antigens were standard methods using diagnostic serums provided by Biotest, Fresenius, Organon, Bheringwerke, Immuno and Ortho. For marking the antigens of the HLA system a microcytotoxicity tests were used with serums provided by Behringwerke, Biotest, Fresenius and Hintel and a rabbit complement. The DNA analyses were run using DNA hybridization and the polymerase chain reaction with multiplex PCR amplification and analysis of STR DNA Loci by AmpF Identifiler system by Applied Biosystems. Results The standard serological expertise was conducted in the Forensic Medicine Institute of Poznan University of Medical Sciences up to Since test were conducted in which 1064 excluded paternity of the alleged father. As Table 1 shows it were 24.25% of all tests. Depending on year the percentage of non-paternity events varied from 28% to 11.7%. Table 2 presents the percentage of non-paternity events using the HLA system analysis. As it can be seen the exclusion percentage for this method is much lower and reaches 14.29%. It results from the fact that HLA system analysis was used as the II nd degree analysis, that means that it was used when the classic serological test was unable to exclude paternity. Table 3 presents the percentage of non-paternity events for DNA analysis method which reaches 20.85%. Conclusions Analyzing Tables 1, 2 and 3 it is possible to say that the method used for parental testing does not influence the non-paternity events percentage. It seemed that the increase in test sensitivity should produce growth of the parentage exclusion percentage but we observed a significant drop from 24.25% for serological tests to 20.85% for DNA analysis. ORIGINAL PAPERS

5 Parental testing in the Forensic Medicine Institute of Poznan University of Medical Sciences Table 1. Non-paternity events in serological tests conducted in the Forensic Medicine Institute of Poznan University of Medical Sciences Tabela 1. Zaprzeczenia ojcostwa w ekspertyzach serologicznych przeprowadzonych w Zakładzie Medycyny Sądowej Uniwersytetu Medycznego w Poznaniu w latach Number of serological tests Number of non-paternity events % of non-paternity events Total Table 2. Non-paternity events in HLA analyses conducted in the Forensic Medicine Institute of Poznan University of Medical Sciences Tabela 2. Zaprzeczenia ojcostwa w analizach HLA przeprowadzonych w Zakładzie Medycyny Sądowej Uniwersytetu Medycznego w Poznaniu w latach Number of HLA tests Number of non-paternity events % of non-paternity events Total ORIGINAL PAPERS

6 424 Piotr Kordel, Małgorzata Koralewska-Kordel Table 3. Non-paternity events in DNA analyses conducted in the Forensic Medicine Institute of Poznan University of Medical Tabela 3. Zaprzeczenia ojcostwa w analizach DNA przeprowadzonych w Zakładzie Medycyny Sądowej Uniwersytetu Medycznego w Poznaniu w latach Number of DNA tests Number of non-paternity events % of non-paternity events Total Table 4. Illegitimate births in Poland Tabela 4. Urodzenia pozamałżeńskie w Polsce w latach Number of illegitimate births Illegitimate as a percentage of total live births Data from Demographic Yearbooks of Poland published by Central Statistical Offi ce. Opracowanie własne na podstawie roczników demografi cznych GUS. ORIGINAL PAPERS

7 Parental testing in the Forensic Medicine Institute of Poznan University of Medical Sciences Interesting conclusions come from comparing the number of parental tests run in the Forensic Medicine Institute of Poznan University of Medical Sciences with the illegitimate births rate in Poland published by the Central Statistical Office (Główny Urząd Statystyczny). Table 4 illustrates that since 1970 up to 2011 a constant growth of illegitimate births rate can be observed. In 2011 every fifth child was born outside marriage. This could lead to a presumption that the number of court tri- als related to the problem of paternity should grow and so should the number of paternity tests. But as can be seen in Figure 1 there is no such correlation. What is more, a significant drop can be seen. When it comes to the HLA system analyses (Figure 2) the drop results from introducing the DNA analysis method. But when the classic serological expertise is concerned (Figure 3) a significant difference between 1980 s and 1990 s can be observed. It results from a severe drop of the live birth rate in Poland (Figure 4). Figure 1. Number of paternity test conducted in the Forensic Medicine Institute of Poznan University of Medical Sciences Rycina 1. Liczba ekspertyz w sprawach dotyczących ustalenia ojcostwa w Zakładzie Medycyny Sądowej Uniwersytetu Medycznego w Poznaniu w latach Figure 2. Number of HLA analyses conducted in the Forensic Medicine Institute of Poznan University of Medical Sciences in cases related to the problem of paternity Rycina 2. Liczba analiz HLA przeprowadzonych w Zakładzie Medycyny Sądowej Uniwersytetu Medycznego w Poznaniu w sprawach dotyczących ustalenia ojcostwa w latach ORIGINAL PAPERS

8 426 Piotr Kordel, Małgorzata Koralewska-Kordel Figure 3. Number of serological test conducted in the Forensic Medicine Institute of Poznan University of Medical Sciences in cases related to the problem of paternity Rycina 3. Liczba ekspertyz serologicznych przeprowadzonych w Zakładzie Medycyny Sądowej Uniwersytetu Medycznego w Poznaniu w sprawach dotyczących ustalenia ojcostwa w latach Figure 4. Live birth rate in Poland Rycina 4. Urodzenia żywe w Polsce w latach Data from Demographic Yearbooks of Poland published by Central Statistical Offi ce. Opracowanie własne na podstawie roczników demografi cznych GUS. ORIGINAL PAPERS

9 Parental testing in the Forensic Medicine Institute of Poznan University of Medical Sciences Figure 5. Number of DNA analyses conducted in the Forensic Medicine Institute of Poznan University of Medical Sciences in cases related to the problem of paternity Rycina 5. Liczba analiz DNA przeprowadzonych w Zakładzie Medycyny Sądowej Uniwersytetu Medycznego w Poznaniu w sprawach dotyczących ustalenia ojcostwa w latach The more or less constant level of number of DNA analyses run by the Forensic Medicine Institute of Poznan University of Medical Sciences from 2001 to 2011 (Figure 5) may be a result of counterbalance effect which the growth of illegitimate birth rate has on the drop of the total live birth rate. References 1. Turowska B. Badania grupowe krwi w sprawach spornego ojcostwa przeprowadzone w Katedrze i Zakładzie Medycyny Sądowej w Krakowie w latach Archiwum Medycyny Sądowej i Kryminologii, XLVII: Dobosz T, Świątek B. Dochodzenie spornego ojcostwa poprzez badanie polimorfizmu DNA. Post Med Sąd Krym. T. III: Stawarz M, Przybylski Z. Polimorfizm układu HLA locus A, B, C i jego przydatność przy dochodzeniu spornego ojcostwa. Archiwum Medycyny Sądowej i Kryminologii. XXX: Kordel M, Kątniak R, Kordel K. Częstość i struktura wykluczeń ojcostwa w układzie HLA. Post Med Sąd Krym. 1988, T. I: Pepiński W, Janica J. Częstość antygenów HLA ABC oraz częstość i struktura wykluczeń w badaniach spornego ojcostwa w populacji Polski Północno-Wschodniej. Post Med Sąd Krym. 1995; T. II: Mullis KB, Faloona F. Specific synthesis of DNA in vitro a PCR reaction. Methods Enzymol. 155: Bjerie A, Syndercombe D, Lincoln P, Morling N. A report of the 1995 and 1996 paternity testing workshop of the English speaking working group of the International Society for Forensic Haemogenetics. Forensic Sci Int. 90: Correspondence address: Chair of Social Sciences Poznan University of Medical Sciences 79 Dąbrowskiego Street Poznań, Poland phone: kordel@ump.edu.pl ORIGINAL PAPERS

10 Medical News 2013, 82, 6, URSZULA KLUCZYŃSKA HOW TO BE A FATHER? AN ANALYSIS OF SELF-HELP BOOKS AND MAGAZINES FOR PARENTS JAK BYĆ OJCEM? ANALIZA PORADNIKÓW I CZASOPISM DLA RODZICÓW Department of Medical Education, Poznan University of Medical Sciences, Poland Head: prof. Maciej Wilczak Abstract The aim of this article is to define mainstream and alternative ways of realizing roles and duties of a contemporary father presented in magazines and self-help books for parents. The article shows the transformation of the concept of fatherhood and the ways of defining roles of a contemporary father and mutual conditions and relations in constructing these categories. The main changes in the concept of masculinity and fatherhood are presented. It also proposes periodization of the fatherhood portraits that are dominant in the Western culture. It argues that just as there are many concepts of masculinities there are many patterns of fatherhood. The impact is being put on the analysis of the category of new fatherhood which is said to be the dominant contemporary construction of fatherhood. The division into culture of fatherhood and conduct of fatherhood proposed by R. LaRossa is presented as a vital element in explaining the lack of precision with regard to the prevailing belief of the dominant pattern of fatherhood and implemented by the fathers of tasks and activities. Results of research on magazines and self-help books for parents are presented. KEY WORDS: fatherhood, gender, masculinity, magazines for parents, self-help books for parents. Streszczenie Celem pracy jest określenie propagowanego wzorca ojcostwa przekazywanego w ramach materiałów (czasopism, poradników) skierowanych do rodziców, a także wskazanie alternatywnych modeli ojcostwa funkcjonujących w naszej kulturze. W ramach artykułu autorka ukazała przemiany konstruktu ojcostwa i sposoby definiowania zadań współczesnego ojca, wzajemne uwarunkowania i zależności konstruowania owych kategorii. Zaprezentowano główne przemiany w obrębie męskości, stanowiące tło analiz ojcostwa. Przedstawiono propozycję periodyzacji portretów ojcostwa dominujących w ostatnim czasie, podkreślając, iż współcześnie wychodząc z założenia o istnieniu wielu męskości można mówić także o funkcjonowaniu wielu wzorców ojcostwa. Skupiono się na analizie kategorii nowego ojcostwa (new fatherhood) jako dominującej współcześnie kultury ojcostwa. Odwołano się do zaproponowanego przez R. LaRossa podziału na kulturę ojcostwa (culture of fatherhood) i zachowania ojcowskie (conduct of fatherhood), jako istotnego elementu wyjaśniającego nieścisłość w odniesieniu do panującego przekonania o dominującym wzorcu ojcostwa i realizowanych przez ojców zadań i czynności. Zaprezentowano analizę poradników i czasopism dla rodziców. SŁOWA KLUCZOWE: ojcostwo, gender, męskość, czasopisma dla rodziców, poradniki dla rodziców. A fatherhood is social constructed and the way of being a father is defined in various cultures and times in a different way. Patterns of fatherhood usually coexist, but one of them is defined as the dominant one. A fatherhood is closely linked with the masculinity concept, and changes among masculinities cause changes among fatherhood concepts. Social research shows that there is no one pattern of masculinity that can be found everywhere [1]. What is more we need to speak of masculinities, not masculinity. The initial premise of the analysis of masculinity is a rejection of an approach stating that there is only one right and essential form of true masculinity and the conviction that we deal with masculinities which are socially constructed and rendered within the discourse because masculinities are neither programmed in our genes, nor fixed by social structure, prior to social interaction. They come into existence as people act. They are actively produced, using the resources and strategies available in a given social setting [1]. What is more there is abundant evidence that masculinities do change. Masculinities are created in specific historical circumstances and, as those circumstances change, the gender practices can be contested and reconstructed [1]. Different cultures, and different periods of history, construct gender differently. Following those assumption we cannot define masculinity or fatherhood in one way, because it is easily changeable category. Changes of culture of fatherhood In the past the answer to the question: what it means to be a father? was clear, standards of defining fatherhood were strictly defined with reference to masculinity. It helped men to fulfill their social role. Nowadays the answer is not as simple, it is more complicated, we cannot answer this question without any doubt because there are various patterns of masculinities and fatherhood. ORIGINAL PAPERS

11 How to be a father? An analysis of self-help books and magazines for parents 429 Although it is a dizzying array of possibilities of forming an individual way of being the father of the man, we can observe some crucial patterns. J. Pleck presents the proposed periodization of the fatherhood portraits which are dominant at the moment: moral overseer, distant breadwinner, sex role model, and new father. Eighteenth century and the beginning of nineteenth century was a period of moral overseer. A father used to be a moral educator who taught his children what God and the world expected from them [2]. According to J. Demos emerged picture, above all, of active, encompassing fatherhood, woven into the whole fabric of domestic and productive life. Fathers were a visible presence, year after year, day after day. Fathering was thus an extension, if not a part, of much routine activity [3]. The next model was called distant breadwinner (XIX/XX). It was a time of growing importance of the role of the mother, who was responsible for every domain of children s life. In psychological theories the mother played a crucial role in childrens development. At that time the home and the father s workplace became separated, causing a growing physical and emotional distance among the family. As J. Demos describes: for the first time, the central activity of fatherhood was sited outside one s immediate household. Now being fully father meant being separated from one s children for a considerable part of each working day [3]. Sex role model ( ) appeared as an effect of the criticism of excessive influence of the mother. After the wars the father was often defined by absence, which was considered dangerous for the identity of the son [2]. As a critique of former models new father appeared, called by E. A. Rotundo the androgynous father [4]. New father is present during childbirth, and engaged in everyday care not only older children, but also infants. New father is involved in the lives of his children, spends time with them, feeds them, helps them with homework; he is also responsible for children and takes part in everyday decisions like buying clothes or going to the doctor [2]. New fatherhood in the context of cultural transformations of masculinity It seems important to wonder how we can describe contemporary fatherhood. Researchers very often highlights that new father can be defined by involvement. According M. E. Lamb parental involvement consists of three components: engagement time spent in one-on-one interaction with the child (feeding, playing with the child); accessibility less intensive level of interaction, parent doing one thing (e.g. cooking, cleaning) but is available when the child needs them; and responsibility which can be described by things like making sure that the child has clothes or shoes or like going to pediatrician [5]. New father, as a critique of former models, is described by J. Pleck as a father who is present at the birth; he is involved with his children as infants, not just when they are older; he participates in the actual day-to-day work of child care, and not just the play; he is involved with his daughters as much as his sons [2] According to Rotundo androgynous father involves himself in a more expressive and intimate way with his children, and he plays a larger part in the socialization process that his male forebears had long since abandoned to their wives [4]. Appearing of the new fatherhood was an effect of few coexisting occurrences. The most important seems to be the critic of mother s center role in the child development but also mothers expectation directed to fathers. Women expected from men commitment in parenthood. In this situation a crucial role played femininity and masculinity changes, and gender order changes. J. Pleck points up that this image, like the dominant images of earlier periods, is ultimately rooted in structural forces and structural change. Wives are more often employed, and do less in the family when they are; men are spending more time in the family, both absolutely and relative to women [2]. Changes in fatherhood models were the effect of the social, cultural and economical transformation. Men and their roles same as women, changed because of the modification of the social reality. New situation required redefinition of roles, duties, identity from women and men. But the important thing is that it gave men the opportunity to participate in the private sphere without fear of their masculinity. The appearance of a new model do not mean that the older models does not exist any more, it is rather according to R. LaRossa change in the culture of fatherhood [6]. According to LaRossa the institution of fatherhood includes two related but still distinct elements. There is the culture of fatherhood (specifically the shared norms, values, and beliefs surrounding men s parenting) and there is the conduct of fatherhood (what fathers do, their parental behaviors) [6]. As researcher stated we can observe the asynchrony between the culture and conduct of fatherhood; the culture of fatherhood has hanged more rapidly than the conduct of fatherhood [6]. Probably in various periods of time different models of fatherhood coexisted, and depending on dominant version of masculinity or redefinition of masculinity, some of them predominate over others. Those models of fatherhood which were established as dominant were describing culture of fatherhood of a particular period. Portrayals of fatherhood in magazines for parents Description of self-help books and magazines for parents who is a receiver? It is important that titles of magazines and self-help books are addresses to both parents. Whereas titles of self-help books do not highlight gender of receiver, except situations when a book is directed to fathers (e.g. You can be super father, I am a father ), title of magazines are never addressed directly to fathers (e.g. I have a child, Your child, Parents, Child, My family, Your baby, M for mother, Mummy it s me ). Subtitles of magazines intensify the message, that both parents are the targets of the product. ORIGINAL PAPERS

12 430 Urszula Kluczyńska It is worth to supplement this message with analysis of covers of self-help books and magazines for parents. The aim of covers is to inform readers of the theme of a magazine or a book, and encourage people to buy a magazine or a book. On covers of publications are presented a child or a mother with child. Pictures of fathers are only on covers of self-help books directed to men. On the basis of covers we can conclude that a parent should be read as a mother. In magazines and self-help books for parents feminine grammatical form is used (sometimes plural form); only books directed to fathers use masculine grammatical forms. This construction of transmission in magazines and self-help books indicate that a child affects women identity rather than men identity. A father is defined as a second parent, who is responsible just for some aspects of parenting. A father who wants to know more has to read information in feminine grammatical form, so he has to put himself into a mother s place. It is more possible that a man who wants to feel more secure will read just information directed to fathers. A distinctive feature of magazines for parents are letters to the editor. Letters published in magazines for parents contain information or advices, usually connected with everyday baby nurture, products for child or health problems. But there are no letters from fathers, that allows you to present some hypotheses. First, it is possible that fathers do not read magazines for parents, which is why they do not send letters to the editor. Or perhaps fathers, who usually do not participate in daylong care or just participate partly, do not have enough experience to share it. Finally men might read letters to the editor, but do not perceive them as an area for men, who often treat asking for help as a sign of weakness. Mother s and father s duties and behaviors presented in magazines and self-help-books for parents The main aim of the analysis is the description of ways how fathers are presented and defying their parenting duties in contexts of masculinity. As I demonstrated earlier, the main receiver of magazines for parents are women, whereas to fathers are directed short fragments, which usually are separated from the main part of a magazine. Good example is the magazine Mummy it s me, which contains some parts: a main part, mother zone and father zone. Mother zone contains information about beauty, spending free time without children, fitness, diets, and relaxing. Father zone shows fathers who are engaged in children s lives. When we compare those zones, we get a clear message mothers sometimes have a break from taking care of their babies, whereas men sometimes take up this role. What kind of subjects are bring up in father zone and self-help books directed to fathers? Analysis shows that fathers are perceived as a playmate, especially during out door activities [7]. According to researchers spending free time with children and playing with them are ways to maintain the bond between them, to communicate and to inculcate values in children. It is also important that this way of closeness does not undermine cultural masculinity standards, because being active is a male practice [8]. In articles the father is described not only as a everyday playmate, but also as a person who organizes free time during weekends or holidays. To fathers are directed instructions about arranging holidays, planning car journey or preparing first aid kid. But array of men s thing is limited to those tasks. There is nothing about packing child s clothes or toys. Magazines for parents define carrying of child and home duties as a natural women activity. Taking over duties by father is an unusual situation: Every day you take care of baby like every mother does. But you need time to take care of yourself: go to a hairdresser s or beautician. So on Saturday let the father take care of your kid [9]. The article directed to fathers A day without mum determines caring of baby as a woman s task, whereas a father day long care is a special event. Men are perceived as a helpless and unaware of ways of protecting and carrying baby. Those special situation are define not as a duty, but great fun: You can have a lot of fun [10]. There is no suggestion that fathers take over domestic duties during such a day. What is more there is no suggestion that fathers take over household duties and carrying for child, while a mother goes to work. Daylong care is define as a mother task. A good example of this statement is the article 20 gadgets, which make young mother life easier (not a mother and a father!). Magazines which determine receiver as a mother show traditional way of sharing private and public sphere among women and men. Man is perceived as a person who sometimes helps a mother in parenthood and take part just in some duties. What is more those duties are voluntary only for men. Being a mother is described as natural, but being a father is not. Mothers have to teach men how to be a father: Engage the future dad! You will be a mum because you will give birth to your child. A future father has to learn how to be a father, and you can help him do it [10]. It means that woman in a natural way become parent, and she is responsible for engage man and support him in discovering a new role. This conclusion support once again that most of magazine and self-help books form parents are directed to mothers, who are obligated to educate their partners. Articles in magazines highlight very often gender differences with reference to parenthood: One thing is obvious, mum love in different way than dad [11]. Further part of article contain statement about different way of communication depended on gender. In the article the ORIGINAL PAPERS

13 How to be a father? An analysis of self-help books and magazines for parents 431 author describes a stereotypical way of communication, and gives an example: What mum says: Please put on your wellies. If your feet get wet, you will stay in bed and take medicine. What dad says: If you don t put on your wellingtons, you will not go outside [11]. A father is described as a less emotional, distant, using orders and more consistent person than a mother. Authors of magazines and self-help books assume that a mother has more knowledge about child development and needs than a father, and present a stereotypical picture of an irresponsible father and an over-protective mother: The father tosses the infant up to the ceiling, catches it then tosses it again. Do you know such games? Don t allow them. Be fi rm [12]. Redefi nition parental duties as a masculine In father zone we can observe attempts of redefinition parental duties as masculine. Some behaviors are described as masculine to encourage men to take them up. On the other hand a lot of subjects in magazines and selfhelp books are the reflection of stereotypical way of thinking and abilities of men and women. First activity of men is he baby nurture. Some tasks are redefined by emphasis different aspects than those linked with mother s task. Baby s bathing and personal hygiene become a way of confirming men s strength and domination: Bathing an infant is a job for men. A baby will feel safe in the big and strong hands of its father [13]. Next area, which is refined in magazines as a masculine is touch, closeness, and sensitivity. A model of distance father is described as improper and destructive. Authors of the article [14], refer to American psychologist, persuade fathers to the importance of intimacy and touch. Touch is described as a kind of cure or therapy, which supports child development. Touching and closeness are regarded as beneficial for a child and treat as a kind of a masculine behavior: It is time to get rid of men s insensitivity [14]. Fatherhood is very often stereotypically described as the end of freedom and irresponsibility. But in father zone we can find attempts to redefine this way of thinking: Is it end of freedom? No, it s not! Childbirth is just a begging of new, different life [15]. In magazines men get information about ways of supporting pregnant women. Most of magazines and self-help books for parents try to redefine the moment of turning into a father. Authors of articles convince men that they are fathers since the moment of conception and supporting pregnant women is a part of the father's role and something what real men do. Fathers are described as active during pregnancy and a childbirth. In magazines and self-help books we can find instructions like: do shopping, support your women emotionally, and let her take a rest [11]. Some of the tasks are interchangeably defined as masculine, for example punishment. A fatherhood is linked with domination, exercising power, and controlling a situation. You re a man. A rational guy, who is aware that in relation with his biggest treasure child will need to punish his or her. As same as your father punished you, and your grandfather punished your father [13]. The way of naturalization of fathers involvement is presentation famous fathers (e.g. Marcin Baszczyński, Marcin Prokop, or Bartosz Obuchowicz). Famous sportsmen, actors, newscasters declare that fatherhood is an important part of their identity. One of the footballer said that his son was for him more important than football. Conclusions Magazines and self-help books for parents confirm a traditional model of fatherhood in terms of conducts. In the analyzed material we can find signs of involved fatherhood, or even suggestions like: you should be an active father or you should engage in your child's life, but there are limited examples of father s ways of involvement in every day baby care. We can find more specific activities described or redefined as fatherly in father zone, but those tasks are often traditional, clearly linked with the stereotypical masculine role. Magazines for parents define carrying of child and home duties as a natural women activity. Daylong care is define as a mother task, whereas taking over duties by fathers is an unusual situation. Being a mother is described as natural, but being a father is not. Mothers are obligated to teach men how to be fathers. In terms of conducts fathers are mainly perceived as a playmate. Articles in magazines very often highlight gender differences with reference to parenthood, and a father is described as less emotional, distant, using orders and more consistent than a mother. Some of duties in child care are redefined as masculine. The most often baby s bathing is described as a father s duty. This activity is perceived as a way of confirming men s strength and domination. Another redefined task is touch. Touching and closeness are regarded as a beneficial for a child and treated as a kind of masculine behavior. Most of magazines and self-help books for parents try to redefine the time of turning into a father as ORIGINAL PAPERS

14 432 Urszula Kluczyńska a moment of conception. Some of the tasks are interchangeably defined as masculine, for example punishment, as a result fatherhood is linked with domination, exercising power, and controlling a situation. LaRossa assumes that culture of the fatherhood fallows conduct seems to be justified. Beliefs surrounding men s parenting, and idea of new fatherhood is just a part of culture, whereas particular conduct do not change so rapidly. We can read in magazines and self help books for parents about engaged fathers, but most of behaviors and tasks connected with child care are still described as a part of the feminine role. References 1. Connell RW. University of California Press, Berkeley, Los Angeles, 2000; 10, 10 12, Pleck JH. American fathering in historical perspective. In: Kimmel MS, editor. Changing Men. New Direction in Research on Men and Masculinity, Sage, Newbury-London-New Delhi, 1987; Demos J. The changing faces of fatherhood: A new exploration in American family history. In: Cath S, Gurwitt A, Ross J, editor. Father and child: Developmental and clinical perspectives. Litte, Brown, Boston, 1982; , Rotundo EA. American Fatherhood. A historical perspective. American Behavioral Scientis. 1985;27:7 25, Lamb ME. Introduction. The Emergent American father. In: Lamb ME, editor. The father s role. Cross-cultural perspectives, Lawrence Erlbaum, Hillsdale, NJ, 1987; LaRossa R. Fatherhood and Social Change. Family Relations. 1988;37: Russell G. Fatherhood in Australia. In: Lamb ME, editor. The Father s Role Cross-cultural Perspectives, Lawrence Erlbaum, Hillsdale, NJ, 1987; , Harrington M. Sport and Leisure as Contexts for Fathering in Australian Families. Leisure Studies. 2006;25(2): Mamo to ja. 2007;6: Mamo to ja. 2006;3: Twoje dziecko. 2008;6:96, Mamo to ja. 2007;5: Mamo to ja. 2006;5: Mamo to ja. 2007;2: Mamo to ja. 2007;10:114. Correspondence address: Chair of Medical Education Poznan University of Medical Sciences 70 Bukowska Street, level E Poznań, Poland phone: ulaku@wp.pl ORIGINAL PAPERS

15 Medical News 2013, 82, 6, NATALIA MARKWITZ-GRZYB WOMEN S SEXUALITY DURING MENOPAUSAL TRANSITION SEKSUALNOŚĆ KOBIET W OKRESIE KLIMAKTERIUM Laboratory of Health Sociology and Social Pathology, Chair of Social Sciences, Poznan University of Medical Sciences, Poland Head: prof. Michał Musielak Abstract Introduction. Sexuality is one of the most fundamental causes which motivate people to build bonds with each other. Biological, emotional, intellectual, and social factors contribute to sexual health. If one of these factors is not functioning properly, the remaining ones also suffer damage. Lack of sexual health may lead to various disorders and complexes. It is crucial for a woman that menopausal transition should become a period in life which will not alter its quality both in psychological sphere as well as in the range of sexual activity. Aim. The aim of this study is to show the approach of women during menopausal transition to their own sexuality. Material and methods. Survey questionnaire research method conducted on 286 women of different social status from Greater Poland. Results and conclusion. The majority of survey respondents 33.3% did not lose interest in sex life. The symptoms of menopausal transition did not influence sexual activity of 32.6% of those questioned. Up to 37.8% of women do not agree with the statement that a menopausal woman should stop being interested in sex. In the research group, the word menopausal transition is most associated with asexuality (44.6%). KEY WORDS: menopausal transition, menopause, woman, middle age, sexuality. Streszczenie Wstęp. Seksualność jest jednym z zasadniczych powodów motywujących ludzi do budowania więzi. Na zdrowie seksualne składają się czynniki biologiczne, emocjonalne, intelektualne i społeczne; jeśli któryś z nich nie funkcjonuje prawidłowo, cierpią na tym pozostałe. Brak zdrowia seksualnego może prowadzić do różnych zaburzeń i kompleksów. Ważne jest, aby dla kobiety klimakterium stało się okresem niewiele zmieniającym w jakości jej życia, zarówno w sferze psychicznej, jak i w zakresie aktywności seksualnej. Cel. Celem pracy jest ukazanie podejścia kobiet w okresie klimakterium do swojej seksualności. Materiał i metody. Badaniami za pomocą kwestionariusza ankiety zostało objętych 286 kobiet o zróżnicowanym statusie społecznym z Wielkopolski. Wyniki i wnioski. U większości respondentek 33,3% nie wystąpiła utrata zainteresowania życiem płciowym. Dla 32,6% z nich również objawy związane z klimakterium nie miały wpływu na ich życie seksualne. Aż 37,8% kobiet nie zgadza się ze stwierdzeniem, że kobieta w okresie klimakterium powinna przestać interesować się seksem. W grupie badanej słowo klimakterium najczęściej kojarzy się z aseksualnością 44,6%. SŁOWA KLUCZOWE: klimakterium, menopauza, kobieta, wiek średni, seksualność. Introduction Sexuality is one of the most fundamental causes that motivate people to build bonds with each other. A contact with another human being can be a source of wonderful experiences. During respective periods of life, the feelings of love reveal themselves in numerous ways and, in many cases, they can have different shades. The love of young people develops very quickly and often draws on discovering the secrets of the opposite sex. Middle age is the time for mature love to blossom, which focuses on partners needs and mutual expectations. In turn, throughout the twilight years, love manifest itself in a positive attitude towards oneself, shared tenderness and understanding. The decisive factor in maintaining sexual activity until old age is the force of sex drive and sexual arousal that a person exhibited during adulthood. People in whom sex drive was strong usually maintain it until advanced adulthood while those with low libido watch its decline much sooner. The period of menopausal transition is often identified with cessation of sexual activity. In the meantime, regular intercourse plays a vital role in woman s health and her sustenance of sexual activity. The research shows that 70% of 50-year old women have a regular intercourse, more than 30% of those have an intercourse at least once a week, and one in three women claims that sex in old age provides her with more intense experiences than during young adulthood. Sex life depends of numerous factors: biological issues, personality, relations with partners and socio-cultural influ- ORIGINAL PAPERS

16 434 Natalia Markwitz-Grzyb ences (for example, a conviction that from a certain age one should not do those things ) [1]. According to World Health Organization, sexual health is an integration of biological, emotional, intellectual, and social aspects of sex life which are essential for a positive development of personality, communication and love. If one of those elements is dysfunctional, the remaining ones suffer damage as well. Lack of sexual health may lead to various disorders, complexes and self- -esteem disturbances. In such cases there might occur: metal health disorders, low self-esteem, conflicts and tensions in relationship with partners as well as oversensitivity in interpersonal relations [2]. The meaning of sexual practices (also during menopausal transition) is of utmost importance for social research. Society encompasses the entirety of individuals. Emotional forces exerted on an individual become forces of social process [3]. Material and methods A survey questionnaire research method was conducted on 286 women in years of age who reside in Greater Poland. A total number of respondents was constituted by women who were admitted as patients to hospital wards because of menopausal syndromes and/ or hormonal disturbances, as well as those who visited doctors offices in order to have preventive medical examination done. The average age of those questioned was 52 years. Women with higher education 41.7% as well as with a secondary one 37.9% were the most numerous group, while those with basic vocational education 11.6% and with a primary one 2.8% were fewer in number. In 27.4% of indications, a rural area was the most common place of residency of the respondents. In the second place was a city over 500 thousand inhabitants 21.9%, next a city from thousand inhabitants 21.5%, a city under 20 thousand residents 20.1% and a city under thousand residents 9.1%. The respondents were in 79.6% working women, 7.8% of them were retired, women on pension constituted 5.6%, 4.4% were unemployed and 2.9% of women were keeping their houses. 77.6% were married, 7.7% of those questioned were widows, unmarried women constituted 7.7%, 4% were divorces and 2,9% respectively were made up of women who were either legally separated from their partner or living in cohabitation. The majority specified their income as lower than the average remuneration 52.98% (reference sum of money was 3,500 of gross income). Results In many societies there exist some prevailing myths and stereotypes concerning eroticism during the period of menopausal transition: women are less sensual, a woman wishes to take a break from sexual activity, an aging woman starts to show some masculine features. There is a pre-established canon in which everything connected to sex is not appropriate for a menopausal woman. It is commonly thought that women during this period are past their prime. Those difficult to reverse, atavistic views contributed to seeing a women over 40 or 50 years of age who enjoys sex life in a negative light. It was not until the 1960s that the subject of sexuality in menopausal women was dealt with. The social atmosphere was not favorable towards sex, seeing women at that age as matrons, and post-reproductive meaning of sexuality was not regarded as a value in the quality of life. The change of customs, emancipation, lengthening of the average life span, health promotion and the standard of therapeutics contributed to the increase in research and publications about sexuality in the age around menopausal transition. The attitude of mature women towards subjects concerning sexual functions depends on a change in their state of health during menopausal transition, a change in a partner s state of health or appearance of a new partner, as well as on cultural, social and religious aspects. Woman s sexual health is also influenced by her lifestyle (smoking, use of alcohol, exposure to toxins, physical activity), taken medicine, relationship with a partner (partner s sexual dysfunctions) and factors of psychological nature (depression, exhaustion, sleep deficiency, stress, lack of sexual education, negative view of one s body, rigorism of customs and religion). It is believed that a successful and fulfilling relationship, attractiveness of a partner, a high level of sexual awareness, a good sexual imagination and a low level of fear are advantageous to one s sexual activity during the period around menopause transition [4]. Respondents asked whether they lost an interest in sexual life during menopausal transition answered that they did not 33.3%. 7% of women loses interest in sex very often and to 15.1% of them it occurs quite frequently (Table 1). Similar answers were obtained for a question whether the symptoms of menopausal transition have any influence on their sexual life. For 32.6% of those questioned the symptoms did not have any influence, whereas for 7% of women they did indeed have a significant one (Table 2). Age affects our needs and sexual vigor, although we do often overestimate it. It is a great deal of work to learn how to recognize this aspect and do not give into stereotypes. In order to take advantage of maturity for the rest of one s life, we should welcome what it gives us. The longer the partnership lasts, the more obvious it becomes that duties and the routine of everyday life cause a decline in mutual attraction and can lower a sexual interest. If conflicts in a relationship such as disagreement, incompatibility of characters or sexual needs are not solved, indifference and even animosity develops between both partners. Sex in life declines or becomes another area of conflict, violence and pretense [5]. The average life span lengthens and estimates show that people over 60 years of age in the European Union countries constitute one third of the general population. The state of health of society also improves which has an impact on sexual and partner relations. In addition to being sexually and psychologically able, more and more mature people look younger. It is enough to compare ORIGINAL PAPERS

17 Women s sexuality during menopausal transition 435 Table 1. Frequency of occurrence of menopausal transition symptoms. Source: own work Tabela 1. Częstość występowania objawów klimakterycznych Do you experience a decrease in interest in sex life? Frequency Percentage Percentage of valid Cumulative percentage does not occur sometimes Valid quite often very often overall Lack of data Systematic lack of data Overall Table 2. Influence of the symptoms on sex life. Source: own work Tabela 2. Wpływ objawów na życie seksualne Did the symptoms connected to menopausal transition influence your sex life? Frequency Percentage Percentage of valid Cumulative percentage not at all somewhat Valid moderately very not applicable overall Lack of data Systematic lack of data Overall photographs of 55-year-old men and women from the beginning of the 20th century with their contemporary peers: matrons and old-looking men transformed into people with younger looks. In the past, the average duration of a marriage was years, today it is years [6]. Women who took part in the survey, when asked with which of the statements that evaluate the behavior of women during menopausal transition they completely agree with, answered that: a woman should stop indulging in self-pity 51.6%, dress according to age 16.4%, and take care of their grandchildren 7.3%. They were entirely against such statements as: a woman should stop thinking about herself 46.7%, quit her job 45.0% or stop being interested in sex 37.8% (Figure 1). Only 9.9% of respondents stated that their relations with a husband/ partner had also undergone some changes, especially in the area of sex they rarely have a sexual intercourse, there are more conflicts between them, as well as the fact that they stopped understanding each other (Table 3) % take care of grandchildren stop being interested in sex be completely devoted to family dress according to age stop thinking about herself stop professional work stop indulging in self-pity completely agree completely disagree Figure 1. Evaluation of behaviors (desirable and undesirable) in women during menopausal transition. Source: own work Rycina 1. Ocena zachowań (pożądanych i niepożądanych) kobiet w okresie klimakterium ORIGINAL PAPERS

18 436 Natalia Markwitz-Grzyb Table 3. Change of relationship with a husband/partner. Source: own work Tabela 3. Zmiana relacji z mężem/partnerem Did your relationship with a husband or a partner changed during the period of menopausal transition? Frequency Percentage Percentage of valid Cumulative percentage yes Valid no do not have a husband/partner Overall Lack of data Systematic lack of data Overall As Lew-Starowicz writes, in some couples erotic fantasies, strong desire towards the other person and a satisfying sexual life occur during the initial years of a relationship; as time passes, the interest and desire towards a partner decrease. That what was once a pleasure becomes an obligation. The reasons for such state of affairs might be a loss of physical attractiveness, monotony and routine in the art of love, burnout of love, the influence of illnesses and taken medicine, seeing the other person as generally tiresome, and a decline in sexual drive. Our contemporary society, which is permeated with a cult of youth, would like to treat mature people as sexually neutral. Sex of older people is considered as something unnatural and peculiar, even indecent. In reality, sex is present in our life until old age, changing its intensity and form. In contrast with animals, sex and reproduction in human do not have to go together. Touch, kisses, sexual intercourse are a form of emotional expression, they realize the need of loving another human being and being loved. If a woman is in the right emotional state, the need to engage in sexual activity is constant, irrespective of the stadium of sexual cycle in which she is in. The emotional state is going to remain the most important element which decides about the desire and willingness to have sex, also after menopause. Sex drive seems to be controlled to the same extent by a physical state and sexual hormones. Women at that age can find pleasure and contentment in an intercourse with no fear of getting pregnant, however, they might also create a conviction that losing fertility puts them in a position of less sexually attractive partners [7]. In the research group of women, the word menopausal transition brings about the most common and strongest associations with such statements as: asexuality 44.6%, sex without protection 43.4% and for 25.1% with cessation of fertility (Table 4). Various sexual disorders occur during menopausal period in both men and women. In women, the amount of lubricato (vaginal lubrication) decreases, dyspareunia occurs (painful during an intercourse); in men, erectile and ejaculatory dysfunctions. In spite of what might be expected, the period of menopausal transition in most of people does not lead to more serious sexual dysfunctions. It suffices to take a look at sociosexual reports devoted to sex life after the age of 50 to learn that for the majority of these people it is not only possible, but also successful. According to the reports, people who do not have a sexual partner either start new relationships or realize their sexual needs by sexual self-stimulation [8]. From the collection of studies on sex life conducted by Zbigniew Izdebski entitled Sexuality of Poles on the edge of the 21 st century, which was issued in 2012, it appears that sex is significant to us 58.9% of men and 47.4% of women thought it to be important and quite important. In the group of people over 40 years of age, 57.7% of Poles is sexually active. In older people, the Internet prompts activity (also a sexual one). The Internet has become a tool through which one can meet new partners. In % of surveyed Internet users had a sexual intercourse with a person that they had met on the Internet. This group grows rapidly, also in the generation 50+. Sexologists are unanimous that Poles are poorly educated and are not demanding in intimate relations. Izdebski is of the opinion that we did not learn to speak openly about our expectations, we have a problem with communicating our needs, we do not say when something is missing or lacking. Poland is a country of stereotypes about sexuality of both sexes, however, it changes. Women have increasingly wider knowledge about sexuality, they are less demanding in their relations with a partner. Table 4. Degree of association of the respondents feelings with the word menopausal transition. Source: own work Tabela 4. Stopień skojarzenia odczuć ankietowanych kobiet ze słowem klimakterium Association Strong Weak No associations N % N % N % 1. Asexuality Unprotected sex, at last Cessation of fertility ORIGINAL PAPERS

19 Women s sexuality during menopausal transition 437 This liberated woman is very bothersome for some men. A female partner who is exacting and conscious of her needs often makes men uneasy and causes anxiety of not being good enough [9]. Changes around sexual organs will be smaller and appear slower in women who have a regular sex life (in which it is an activity included in their normal everyday routine). Undoubtedly, the thesis that sexual problems during menopause, which are generally much talked about, are usually an expression of personal, emotional or family issues. Perhaps, exactly in this point in life, a woman draws up the most honest balance of failures and successes which had directly influenced her perception of herself [10]. The respondents asked for an evaluation of feelings connected with menopausal transition, as an asset during this period, among other things, they indicated safe sex with no fear of pregnancy and as a loss fertility (Table 5). Ability to engage in sexual activity and to experience sexual pleasures does not change with age. Anatomical parts of the body used during sexual intercourse undergo changes. In the period of menopausal transition, libido might decrease because of numerous reasons, however, the most common cause is not the age of partners, but the quality of their relationship. Other factor that negatively affects a middle-aged woman s libido is stress connected with such issues as: problems with adolescent children, disappointment in marriage, extramarital adventures, troubles at work, financial difficulties, inability to realize one s dreams and life aspirations, as well as every matter that preoccupies our mind which, most probably, may also start to undermine our interest in sex [11]. The most common life situation that causes stress in the surveyed women, which took place during the menopausal transition, was leaving of home by a son or a daughter 40 8%, death of a family member 27.8% as well as serious changes in material status (Figure 2). Menopausal transition is also connected with personality changes. Men at that age often become more sensitive, emotional, domestic, while women judge others more frequently, are more energetic, critical and aggressive. Therefore, there occurs a reversal of roles, but it is not only a matter of hormones, but also a case of the attitude towards oneself and life. Women compensate feminine frustrations in such a way, whereas men, after attaining their professional goals, begin to place greater importance on domestic and social bonds. Discussion and conclusions It is necessary to ensure that for a woman in menopausal age, menopausal transition becomes a period that does Table 5. Evaluation of feelings connected to menopausal transition. Source: own work Tabela 5. Ocena odczuć związanych z klimakterium Feelings connected to menopausal transition Yes N % I gained something during menopausal transition I lost something during menopausal transition Justification (in order of frequency and indication) 1. Safe sex with no fear of getting pregnant 2. New experience 3. Maturity 4. More time for oneself 1. Youth 2. Beauty, attractiveness 3. Wellbeing 4. Health 5. Fertility 6. Energy 7. Ability to concentrate big changes in a family member's state of health appearance of a new family member big changes in living conditions change in eating habits change in the amount of sleep serious changes in a material status death of a family member leaving home by a daughter/son ,8 Figure 2. Life events in menopause transition period. Source: own work Rycina 2. Sytuacje życiowe występujące w okresie klimakterium ORIGINAL PAPERS

20 438 Natalia Markwitz-Grzyb not change the quality of her life, both in the psychological sphere as well as in the range of sexual activity. Our sexuality is a process which means that sexual needs, capabilities, choices, preferences and abilities change according to numerous factors. Nothing is permanent, unchangeable and given once and for all [12]. There is some evidence that those who are sexually active until old age tend to be not only kinder in everyday life, but they also do not wait in queues to see a doctor [13]. Menopausal transition can sometimes cause completely different phenomena and reactions in women. Some of these women, precisely in this period, experience greater interest in sex, and their sexual drive is increasing due to the influence of physiological and emotional factors. Emotional and sociological factors are a result of changes which take place around a woman and society. After children grow up, a woman does not necessarily have to suffer from the empty nest syndrome. Transfer of life energy on sex may follow, what, combined with a feeling of being liberated from rigid rules and house duties, might often have surprisingly positive results. Also, in terms of sociology, the attitude towards sexually active women in menopausal age has changes in recent years. Realistically speaking, we should not expect any growth of interest in sex or boosts in our sexual ability as we age. Nevertheless, it is essential to maintain the highest possible sexual ability and activity in the postmenopausal age as well, through a positive attitude in life, taking care of one s outward appearance and health even more so than during young adulthood. Such highly necessary knowledge about sex and an affirmative attitude towards one s own sexuality is still not being implemented at home; there is no sensible sexual education in school either. References 1. Depko A. Pytania do seksuologa. Warszawa: Wiedza i życie; 2005: Polish. 2. Skorupska S, Szeligowska J, Mamcarz A. Marsz dla zdrowia seksualnego. Prz Menopauz. 2011;6: Polish. 3. Jarząbek G, Pawlaczyk M, Friebe Z. Przekwitanie a aktywność seksualna. Prz Menopauz. 2007;3: Polish. 4. Skrzypulec V, editor. Wstęp do seksuologii. Katowice: Wyd. Kwieciński; 2005: Polish. 5. Jasturn T, Haller O. Aby dwoje naraz. Zwierciadło. 2011;12: Polish. 6. Lew-Starowicz Z. Ona i on o seksie. Warszawa: Świat Książki; 2007: Polish. 7. Grazul-Bilska A, Bilski J. Menopauza bez tajemnic. Warszawa: Iskry; 2009: Polish. 8. Długołęcka A, Lew-Starowicz Z. Jak się kochać? Edukacja seksualna dla każdego. Warszawa: Świat Książki; 2010: Polish. 9. Zuchora A. Fantazja Polaków o seksie. Zwierciadło. 2013;8: Polish. 10. Doucet G, Elia D. Zapomnij o menopauzie. Bądź zawsze kobietą. Warszawa: W.A.B; 1994: Polish. 11. Wells RG, Wells MC. Menopauza środek życia. Warszawa: Vocatio; 1993: Polish. 12. Skrzypulec V, editor. Wstęp do seksuologii. Katowice: Wyd. Kwieciński; 2005: Polish 13. Jasturn T, Korona K. Trenuj seks, choć to nie sport. Zwierciadło. 2013;3: Polish. Correspondence address: Laboratory of Health Sociology and Social Pathology Chair of Social Sciences Poznan University of Medical Sciences 79 Dąbrowskiego Street, Poznan, Poland phone: nmarkwitz@ump.edu.pl ORIGINAL PAPERS