The Big C: Cancer–The Disease in a Nutshell

Cancer is arguably the most feared disease in the Western world.  In America, cancer is the leading cause of death of people between 35-65 years of age.  Nearly 1 in 7 deaths worldwide in 2007 was due to cancer.  Cancer rates are exploding throughout the world as developing nations industrialize and eat diets that are less nutritious (think of pollution and McDonald’s).  Because of physiological and social reasons, gynecological cancers are some of the most lethal types of cancer in women.  To better understand gynecological cancers, let’s take a step back and get to grips with the basics of cancer.

Cancer is a disease affecting humans, and other animals, that is a result of abnormal cells growing out of control.  Cancer can happen in virtually any part of the body and there are more than 100 distinct types.  The cells in our bodies are continually regenerating.  There is a saying that our bodies completely regenerate every seven years.  (In fact, each type of cell–each part of the body– regenerates at a different pace.)  When our bodies dictate the script (DNA being the script) that causes cell reproduction, occasionally there is a typo.  Many different things (such as smoking) can cause a “typo.”  When this happens, the body has difficulty righting the mistake and it can grow out of control resulting in cancer as seen in this illustration:


The top half of the illustration is a process called apoptosis, by which a damaged cell is removed through programmed cell death.  (I jokingly think of apoptosis as telling a “bad cell” to “pop off.”)  A lack of apoptosis is when the damaged cells are not programmed out.  This is where cancer begins.

If this growth of abnormal cells is caught in an early stage, it usually can be treated easily by removing the growth.*  Stages are a means by which the cancerous growths can be classified by how far along it has progressed.  There are four main stages, and with specific types of cancers there are further subdivisions such as “Stage II-C.”  Usually by the time a cancerous growth has reached the fourth, most advanced stage it has undergone a process called metastasis.

Metastasis is when the cancer spreads from its primary site to other sites.  So, if you hear an official cancer diagnosis, it may sound something like, “metastatic breast cancer” or “metastatic cancer primary to the liver.”  This indicates where the cancer began and that it is present in other locations.  Metastasis usually occurs through the body’s lymphatic system.  That’s why one often hears about lymph nodes in relation to cancer.

There are innumerable ways in which cancer is diagnosed.  Once it is found and diagnosed, there is a great divergence between how cancer behaves and how it is best treated depending on the type of cancer, medical history, and other factors.  If you ever find yourself receiving a cancer diagnosis, you will need to create a very specific plan with your physicians–no two diagnoses are ever exactly identical.  Hopefully this brief overview of the Big C helps build your understanding of the disease if you ever find yourself in close contact with cancer.

*(In my case, I had a very slow-growing cancer.  So, even though it was not caught at all “early,” it was still in an early stage.)

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The First Visit to the Gynecologist: A Guide (Part Two)

Finding Eve returns with Part Two of this first-timer’s guide.  (Click here for Part One.)

During your appointment:

  1. LISTEN!  You will be given a series of instructions throughout your appointment.  Things will generally be more comfortable for you if you follow them.  They may want the paper gown to open in the front or the back or the side.  They may want you sitting, standing, lying on your back.  Just pay attention and things will go much more smoothly.
  2. Be vocal.  Now that you’re getting into the stirrups and down to business, it’s up to you to make sure your doctor knows how you feel.  For example, if you have a bad back and lying a certain way hurts, let the doctor know she or he will usually be happy to accommodate.
  3. Remember your breasts.  Most, but not all, gynecologists will give your breasts a once-over to check for lumps, bumps, and irregularities.  So, be prepared for this.  This might be the most awkward you’ll feel since the doctor will be nearly face-to-face with you at this point.
  4. Be prepared for some unusual sensations.  No matter your level of comfort with your genitalia, your first appointment with the OB/GYN will be something new.  The doctor will need to insert a few things in your vagina.  It’s an unavoidably strange situation, but it doesn’t have to be a nightmare, so be prepared for the following:
  • The first thing in will generally be a speculum.  This is a device that goes in to spread the vaginal walls to allow the doctor to see in.  There will be bright lights focused on your vagina to aid in this.  While the doctor looks around, she or he will also use a swab to take a sample of cells from your cervix.  You’ll barely be able to feel the swab, so don’t be too worried about it.  The swab is then sent away for testing to see if you have (pre-)cancerous cells.  This is called a Pap smear.  REMEMBER, this only tests for one type of gynecologic cancer (cervical).  Keeping track of your periods and pelvic health is your best bet for detecting other types of cancer.
  • After the swab for the Pap smear has been collected the doctor will “manipulate” your pelvis.  That is to say, it’s time for the rough and tumble part of the exam.  Really, it is not as bad as it sounds or may look in the diagram below.  (Believe me, I have had several severe pelvic surgeries and I make it through the pelvic manipulation fine.)  This, to me, is the most important part of the exam.  The doctor is using her or his hands to “see” what’s inside you and to make sure all is well.  It’s normal to grimace.  It’s not the most normal feeling, but it will soon be over!
  • Ask questions!  Generally, after the manual exam, the doctor says you can sit up.  This is your invitation to ask questions.  Since this is your first time, you should ask as many questions as you want.  Many doctors’ offices will schedule first-timers with longer appointments because they expect the patients to have more questions.  Don’t be shy.  If there is any thing that you don’t understand or have reservations about below the belt, ASK!  The doctor will be able to help explain whatever it may be, and this will put your mind at ease.

    After your appointment:

  1. Follow through!  If the doctor recommends that you take care of yourself with some therapy, medicine, or change, do it.  If it is something drastic, feel free to go to another doctor for a second opinion.  It is your body, after all.
  2. If you are having testing for sexually transmitted diseases (STDs), you may be asked to make another appointment at a lab.  Larger doctors’ offices usually have their own lab, so you may be escorted across the hall to have blood taken.  If you’re afraid of having blood drawn, be prepared!  Drawing blood is crucial to many standard gynecological tests, so don’t be worried if you’re referred for blood work.
  3. Keep in touch.  You will most likely receive your test results (Pap smear, blood work, etc.) in the mail or over the phone in the subsequent two week.  If, after 2-4 weeks, you have not heard anything, call your doctor’s office!  You paid for those tests, so you have the right to know how they turned out.   Things can get lost in the mail or misplaced, so take the reins and find out.  The office staff won’t begrudge you at all.
  4. Remember to make an appointment for next year.  You should never go more than a year without a visit to the gynecologist’s.  Most insurance will only cover one visit in a 365 day period, so if you went on May 1st one year, you will have to wait until least May 1st of the next year.

Remember, this guide is intended as a rough guide to your first visit.  No two appointments will ever be identical.  It is important to do what is right for you.  Please feel free to add your comments and questions and thanks for reading!

The First Visit to the Gynecologist: A Guide (Part One)

A young woman’s first visit to the gynecologist can be daunting.  Women who have already been for a gynecological check-up generally report that it’s unpleasant.  So, naturally, this scares others and many avoid going until they have to.  BUT!  I’m here to help quell those fears and insist that all young women go for a check-up.  My first visit to the gynecologist was about as traumatic as possible, but I know that I might not be alive today if I had not gone.  So, it is of the utmost importance that you take your health seriously and face any fear you might have of going to the gynecologist.  Almost every young woman comes out after that first visit and says, “That wasn’t as bad as I thought it would be.”

Before your appointment:

  1. Do your research!  If you’re reading this blog, you’re off to a good start.  Continue on by finding a local gynecologist that you are comfortable visiting.  Many young women who nervous about their first appointment find it easier to visit a female physician.  It will serve you well to talk to friends about who they go to and why.  Also, look into insurance matters.  It can be really confusing, but ask the office staff of your doctor of choice to help you confirm what is or is not covered by insurance–they’re experts and can find out what you need to know.
  2. Monitor your period.  This is an important habit to keep up your whole life.  If you’ve never kept track of your periods before, start right now!  Keep a calendar record of when your periods begin and end and make notes about any irregularities (more pain, heavier flow, etc.).  You’ll be expected to know how regular (or irregular) your periods are at the doctor’s.
  3. Decide on a day and make the appointment.  Once you known when your “safe times”* are, call the doctor’s and make that appointment!  Just making the appointment is half the battle–the next half is keeping the appointment.  You can do it!

* Many gynecologists will not perform an exam when a woman is menstruating since the blood may obscure their view of the vaginal structures–they look for any abnormalities that are visible to the naked eye.

The day of your appointment:

  1. Shower!  Or bathe!  Just get clean somehow.  Doctors encounter enough unpleasantness throughout a working day–they will thank you for not adding to it.
  2. Try to stay as calm as possible.  Being nervous and jumpy will make the appointment even more lousy.  Take deep breaths, listen to calming music, think happy thoughts.  It might be a good idea to take a friend with you if you’re really nervous.
  3. Get to your appointment on time!  Most doctors’ offices will give a recommendation of how early you should arrive.  Follow it.  If you have a bit of time to spare, you might even show up earlier than that.
  4. Almost across the board, a gynecological appointment requires the patient to provide a urine sample.  So, about an hour or so before your appointment start sipping on water (or your beverage of choice).  They will collect the sample before your actual appointment with the doctor begins and you’ll want to have something in your bladder to give.
  5. Be prepared to answer questions!  Each doctor’s office will ask a different set of questions, but here are some of the most common ones:  When was the first day of your last period (menses/menstruation/etc.)?  What medications are you taking?  (Don’t forget non-prescriptions like vitamins!)  Have you been experiencing any problems, pain, or irregularities?  Do you have a family history of cancer . . . anything?  Are you sexually active?  (BE HONEST!  If you’re nervous about a parent finding out, don’t be.  Doctors, by law, have to respect your confidentiality.)
  6. Wear clothes that are easy to remove.  Wearing clothes with lots of buttons and buckles and so on are a rookie mistake.  You’ll be glad to have a shift dress or sweatpants or what-have-you when they only give you 90 seconds to disrobe!  You might have more time than this, but more often than not I have been given very little time to climb out of my clothes and into the paper clothes.  (Also, wear nice socks.  You’ll want something warm on your feet when you rest of you is clothed in paper.  Your feet will be in the doctor’s face for much of the appointment, so pick nice ones.


The is just the first half of the guide!  Part Two will be published soon.  As always, feel free to add any comments, recommendations, or questions.

(Here is Part Two.)

Female Orgasm and Resolution

By popular demand (or at least one demand), today’s entry will make a complete circle of Masters and Johnson’s human sexual response cycle.  So, what happens after arousal?  For women (and sometimes men), arousal does not always result in the obvious:  orgasm.  Many women have trouble reaching orgasm, while many others reach multiple orgasms.  These are variants of the M & J sexual response cycle, but we’ll get to that.

So what happens during a woman’s orgasm?  Following the changes that occur during the excitement and plateau phases (arousal), several other physiological changes occur.  For instance, when a woman nears orgasm the glans in the clitoris moves inward under the clitoral hood and the labia minora darken.   The vagina tightens, then lengthens and dilates while becoming more engorged.  The muscles of the uterus then begin to rhythmically contract.  Dutch researchers found earlier this year that it is possible to objectively determine orgasms in women by measuring the frequencies of contractions in the uterus, vagina, anus, and pelvic muscles.  It is not uncommon, however, for other muscles to contract and spasm.  The well-known toes poking out from the sheets is probably the most commonly cited “non-sexual” muscle contraction during orgasm.

Women have a more difficult time reaching orgasm than men and can often go through only the first two stages of sexual response, but still feel they had a satisfactory sexual experience.  To make up for the greater difficulty of achieving orgasm, women do have a few checks in their column.  Women usually have longer orgasms than men.  Men’s are usually only a few seconds long.  Women are also able to achieve much hyped “multiple orgasms” (note that, oddly, about 5/6ths of the “multiple orgasms” section of this article is devoted to males).   This means that a woman can achieve the third stage of sexual response multiple times without necessarily having to go through the fourth and first stages again–the woman simply reverts to the second stage, then returning to the third stage again.

Following orgasm, the woman enters into the fourth and final stage of the human sexual response cycle:  the resolution (sometimes referred to as the refractory period).  During this phase, the body returns to its original, pre-arousal state.  Some of the changes required to return to normal take place right away, while others take longer.  Technically speaking, women do not have a refractory period and men do.  The refractory period is the time frame within the resolution after which the sexual response cycle can begin again.  The refractory period can be anywhere from a few minutes to a few days depending on the health and age of the man.  Women do not have a refractory period because their bodies, generally speaking, are always ready to reenter the sexual response cycle (thus the ability to achieve multiple orgasms).

Another difference between women’s and men’s orgasms is their source, so to speak.  While virtually all male orgasms are a result of stimulation of the penis, female orgasms can come from a variety of places.  Many orgasms can result from stimulation of the clitoris (homologous to the penis).  Other orgasms result from stimulation of the “G spot.”  Some women have no trouble achieving orgasm from vaginal stimulation (such as simple intercourse).  Orgasms can also originate in other erogenous zones, notably the breasts (especially the nipples) and anus.  I have heard women speak of orgasms resulting from stimulation of the neck, toes, and arms.  Really, it just depends on what your body responds to.

So, those are the basics of the female orgasm and resolution.  I know I did not cover it all.  Have a question or a comment?  Go for it.

Female Sexual Arousal

What IS female arousal? With men, it is pretty straightforward to determine whether a man is aroused or not. Is the penis erect or not? Of course, there are nuances to this but, overall, that’s the litmus test for men. What physiological signs are present when a woman is sexually aroused?

When sexually aroused (usually a combination of psychological and physical stimulation), women’s breasts usually become enlarged and the nipples become erect. Of course, there are various reasons for enlarged breasts and erect nipples, but they are usually present to some degree when a woman is aroused. The enlargement of the breasts is usually slight enough that it is rarely noticed. The veins in the breasts also become more visible as the breasts swell. Additionally, the skin may flush during arousal especially on the chest and neck. This is most visible in fair-skinned individuals. Approximately 50-75% of women experience flush during arousal, while only about 25% of men experience flush.

During sexual arousal, a woman’s vagina and reproductive organs undergo several changes. The vaginal lining moistens with lubricating fluid within 10 to 30 seconds of the beginning of arousal. This fluid is believed to be the “sweating” of the vaginal walls. The sweating resulted from the increased blood supply and the engorgement of vaginal tissues. Also the vaginal walls lengthen and distend, which pulls the cervix and the uterus slowly back and up into the false pelvis (the part of the pelvis above the hip joint). The engorgement of the vagina is a type of vasocongestion, a phenomenon also seen in menstruation, REM sleep, allergic reaction, and deeply emotional responses.

The glans in the head clitoris also become swollen and erect like a penis. (The clitoris, after all, is homologous to the penis–see this illustration for a better idea of how much like a penis a clitoris is, or really vice versa.) This reaction to arousal varies in degree between women. The labia majora swell as do the labia minora, though to a lesser degree.

Women’s blood pressure, breathing, and heart rate increase considerably during sexual arousal. This happens in order to accommodate the increased blood supply to various parts of the body with sufficient oxygen. Muscles throughout the body also become tense because of this. These and the above signs of arousal occur during the first two stages of the human sexual response as outlined by Masters and Johnson: excitement and plateau.

There are various other individual idiosyncratic responses that can occur during sexual arousal. For instance, some women report unprovoked sneezing, increased ticklishness, and swollen lips. So the next time you lay eyes on the one that makes your heart jump remember what’s going on with your body. Comments or questions? You know where to leave them. Thanks!

Lactation: Mother’s Milk

So, since we talked about conventional cow milk a couple of days ago as well as soy and organic milks, I thought we should spare a thought for human-produced milk.  I have no firsthand experience with human lactation, so please feel free to jump in with your two cents!  Many new mothers will tell you, though, that they did not realize how difficult breastfeeding would be.  Babies, unfortunately, don’t just attach themselves naturally to a woman’s breast and easily begin to suckle.  It is a skill that must be cultivated.  (No wonder wet nurses came to be.)

During a woman’s pregnancy a woman’s breasts become enlarged, to varying degrees, due to a chemical released by the placenta called human placental lactogen (HPL).  The first stages of lactation begin during the latter part of a woman’s pregnancy.  During this period a woman’s breast begin to produce “first milk” called colostrum that can be yellow in color.  Progesterone during this time is too high to allow true milk production.

When the placenta is delivered following birth, the woman’s body experiences a sudden drop in progesterone, HPL, and estrogen.  This shift causes the breast tissue to begin to produce real milk.  Milk will usually be produced within a day or two of birth, though it is not uncommon for it to take longer.  Colostrum production will slowly cease over a two week period as mature breast milk as steadily produced.  Colostrum is an important part of breastfeeding, though, because it contains larger amounts of antibodies and white blood cells helping to protect the child from germs and food allergies.

After the breasts become more accustomed to producing milk they begin to function on what I call a “made-to-order” system.  A woman’s breasts produce milk as the milk is removed from the breasts (through direct latching, breast pumps, or otherwise.)  Breasts will continue making milk so long as it is being removed.  The only other reasons that would inhibit continued milk production are maternal endocrine disorders, maternal malnutrition, breast hypoplasia, and in some cases lack of sexual activity, as sexual activity increases milk production.

When actually breastfeeding, the mother may experience milk ejection reflex though it is not unusual to not have this experience.  Essentially, the muscles in the breast push out the milk which may result in pain or a tingling sensation.  Another cause of pain due to lactation is contraction of the uterus.  The same hormone that causes the muscles in the breast to contract and express milk also cause the uterus to contract helping it return to its original size.  These contractions may range from mild and menstrual-like to severe and labor-like.  I shudder to think what they would feel like following a c-section.

That, in a nutshell, is the basic biology of lactation, though it does not begin to touch on the enormous issue of breastfeeding (perhaps in later entries).  But here are a few interesting facts about lactation you might not have known:

*Men can lactate, it’s true!  They have mammary glands just like women, and it can result due to a hormone imbalance.

*A woman can lactate without ever having given birth.  It is a phenomenon known as galactorrhea and happens either due to a specific hormone imbalance, continued stimulation to the nipples, and in rare cases is caused by prescription drugs.

*New born babies often lactate, colloquially called “witch’s milk,” as a result of the mother’s hormones just before birth.  It generally only lasts a few hours.

Questions?  Comments?  Don’t be shy.