July 31, 2000 -- Donald Smith hesitates outside the door of a basement classroom at the Kaiser Permanente Hospital in San Diego, Calif. He's 56, with gray hair, but the anxious expression on his face makes him look like a school kid who forgot his homework.
Before Smith has time to fake a stomach ache, Bruce Bekkar, MD, a Kaiser obstetrician-gynecologist, persuades him to come on in. "You're in the right place," says Bekkar, who teaches the class called "PMS, the Menopause, and You."
This three-hour crash course for men about women's anatomy and health concerns is believed to be the only one of its kind in the United States, although Bekkar hopes it will become a trend. His premise is straightforward: Teach men to understand why their wives or girlfriends may sometimes feel crabby, bloated, or on fire. By doing so, relationships are saved, and often grow stronger. Trouble brews, he says, when guys don't understand what their wives or girlfriends are going through.
Soon, Smith is sitting in the classroom, surrounded by 13 other men, most of whom look as uncomfortable as he does. They busy themselves reading handouts, eyes glued to the printed materials. Bekkar, who has taught the classes monthly for two years and always has a full house, warms them up quickly with his easy lecture style, punctuated by jokes, jazzy slides, and a wit honed by his stand-up stint at a San Diego comedy club. As he teaches the men, women attend a similar class next door to discuss their own concerns about PMS and menopause. Some of them are the girlfriends and wives of the guys in the class.
While most of the men are here because their partners asked them to come, about a third came to the class even though their wives didn't. James, 50, became concerned a few months ago when his wife Jan showed signs of unusual behavior. Three times in six months she forgot to mail the credit card bill. "Never in her life has this happened," he says. She was feeling stressed-out and out of control. When his wife's friend suggested it could be menopause, James decided to come and get educated.
Ignorance Is Widespread
As his class settles in, Bekkar assures them that they're not the only ones in the dark about women's anatomy. As proof, he displays the drawings he collected at a focus group conducted while the class was in the discussion phase. He asked several men, ranging in age from 25 to 55, to draw and label the female reproductive system as accurately as they could.
He shows three of the winning drawings, which he also includes in his book, Your Guy's Guide to Gynecology, written with his colleague, Udo Wahn, MD. "This is one of the better ones," says Bekkar, grinning. The "first prize" drawing Bekkar refers to is a childish picture that resembles a faceless rabbit with ears (the ears are actually meant to be the fallopian tubes). Another winning drawing looks like a close-up of the same rabbit, and the third, charitably speaking, could be compared to a flower. And these were drawn, Bekkar points out, by educated men: a banker, a computer consultant, and an administrator.
Undoing the Ignorance
Using a blitz of slides, background music, and nonstop patter, Bekkar plunges in. He shows the men accurate pictures of the female anatomy, drawn simply on a slide with crucial parts labeled. Another slide shows the complicated ebb and flow of hormones during a typical monthly cycle.
Then he introduces premenstrual syndrome, or PMS. PMS is defined as physical or emotional symptoms, or both, that precede menstruation and that are severe enough to disrupt work or other activities.
Most women experience some symptoms, such as breast tenderness, bloating, crying spells, or anxiety, but some women are affected more severely. Women who have PMS, he says, may feel "powerless and guilty. It's not like they wake up and say, 'I'm going to be hard on my partner.' "
Just when stuff begins to get heavy, Bekkar turns comic and shows a slide entitled "The Top Ten List of Things We Don't Recommend You Say to a Woman With PMS" while he plays David Letterman's background music. Among the no-nos: "Hey, those jeans used to be real loose on you, didn't they?" and "Aw, c'mon -- that PMS stuff is all in your head!"
Next, Bekkar turns to menopause. First he defines it (the cessation of monthly periods, occurring on average around age 51), then discusses symptoms (fatigue, hot flashes, forgetfulness, decreased sex drive, heavier periods before they cease entirely), and finally, treatments (synthetic hormones, natural [plant-based] hormone substitutes, and other remedies).
Squashing That Fix-It Mentality
Knowledge is power, but is only part of the equation, says Bekkar. Men must also overcome their urge to fix, fix, fix -- and, instead, "shut up and listen." He calls these the "four magic words." The 14 guys in class smirk when they hear this.
To illustrate, Bekkar cites an example of a woman with PMS who has had a hard day at work. She flew off the handle with a co-worker and now feels terrible. At home, she wants to talk to her partner about it. If he's like most men, Bekkar says, her partner quickly suggests how to fix the situation.
Instead, guys should listen, give their partner time to vent, and then ask a question pertaining to what she just said -- showing they really thought about her words.
After Bekkar gave his "shut-up-and-listen" drill at one class, one man approached him during the break and said, "My girlfriend has been telling me this for eight years." Somehow, hearing it from Bekkar made it ring true.
Helping Out More
Besides listening, a guy whose partner has PMS can help out more around the house when symptoms flare up, be understanding of her moods, and encourage her to exercise. "That does not mean pointing to the door while munching a big bag of Doritos and saying, 'Honey, take a lap around the block,' " Bekkar says. Instead, he suggests, offer to watch young children while she works out or suggest going for a walk together.
Men with partners going through menopause might help by being patient about sex, encouraging their partner to stay on hormones or other medications, if prescribed, and to keep doctor's appointments, Bekkar says. Most women appreciate their partner's help in trying to decide on the best options.
At the end of the class, Bekkar gives each guy a "supportive guy" diploma. At the bottom is a cartoon-like supportive guy, looking muscular in a Superman costume.
Smith, the originally hesitant student, was glad he came. He hoped to gain an understanding of what his girlfriend, 52 and menopausal, was going through -- and he did. He had already mastered some of Bekkar's suggestions: "I try to keep things as mellow as possible," he says. He also listens -- and reassures. His girlfriend was concerned that her symptoms, particularly her heavy menstrual flow, were getting in the way of the relationship. In true supportive-guy style, he reminded her that relationships aren't all about sex.
As for James, when his wife, Jan, learned he had sought out the class and enrolled, she says, "My first reaction was shock -- that they would have this class and that he would go. It kind of shocked me out of my denial [about menopause]. His going persuaded me to go to the doctor. And I was touched that he cared enough to go."