Ovaries

Today, I tackle a body part upon which I consider myself to be somewhat of an expert. Had my left ovary behaved years ago, I would not be typing this today–and I would still have both ovaries. Speaking with other women, it becomes obvious very quickly that we tend to know very little about our ovaries.  Hopefully, I will shed some light on this for you today!

Where are the ovaries?  It’s safe to say we know they’re in our pelvis, but where exactly?  A good estimate is to make a triangle with with your index fingers and thumbs and place that over your pelvis with the index fingers pointing downward.  In the upper corners is about where your ovaries are.  (They tend to be a bit lower and more centralized than most assume they are.)  The ovaries are held in place by a network of ligaments which also attach to the uterus and Fallopian tubes.  The ovaries are not connected directly to the Fallopian tubes.  Many diagrams shows the fimbriae (the leafy looking parts on the far left and right below) of the Fallopian tubes as been directly adjacent to the ovaries, which leads many to believe that the ovaries are directly attached to them.  They are not.  (Read more about the relationship between the ovaries and the Fallopian tubes in the section about Fallopian tubes.)


The ovaries are, ironically, shaped like eggs but are smaller than the chicken eggs that one typically purchases at the grocery.  The ovaries are about the size of a walnut, are slightly pearl colored, and have bumpy, soft surfaces.  The ovaries are responsible for producing a variety of sex hormones.  At birth, the ovaries of a healthy baby girl contain between one and two million eggs.  By the time puberty begins, most of these have wasted away leaving about 300,000 eggs–plenty for the reproductive lifespan.  Thus, a woman has a finite number of eggs, but men have a different mechanism that continually makes sperm.  This is why women have “childbearing” years, but men can father children throughout their adult lives.

The eggs have a complicated lifespan before they are even released for potential fertilization.  The term “egg” is generic and refers to a single cell’s journey through maturation.  Before maturation, the egg is referred to as an oocyte.  Once it finishes maturing (see diagram below), it becomes an ovum and three polar bodies.  The polar bodies are actually inside of the ovum and serve to “fuel” the egg once it is fertilized continuing cell division and replication before it implants in the uterine lining (where it forms a network of blood vessels that forms the placenta and umbilical cord).

Each month, the ovaries usually release one mature egg (not one from each).  The ovaries are covered in cells called follicles and within each follicle is a single egg.  Once an egg is matured, the process of ovulation can begin.  During this time, the follicle that houses the mature egg expands and eventually ruptures forcing the egg outward.  This rupturing is completely normal–it would be abnormal for ovarian follicles to never rupture, and in fact some women can actually feel a quick pain when the rupture occurs.  The diagram below is an illustration of the ovulation process, beginning in the upper-left hand corner and going clockwise.


Following a woman’s “childbearing” years, the ovaries continue to play an important role.  For years, many doctors prescribed a surgery called a hysterectomy to remove the ovaries (as well as the uterus and Fallopian tubes) once a woman was finished having children.  This was performed to prevent cancer from developing.  However, we now know that ovarian cancer can actually develop anyway after the ovaries have been removed.  This is because the ovaries share tissue with the internal cavity that remains following a hysterectomy.  Leaving the ovaries intact provides a number of hormonal benefits throughout menopause that are difficult to replace.  Thus, the benefits of leaving the ovaries intact often outweigh the drawbacks.  (This is something that should be discussed with a physician, because each individual has a different medical history that will affect any such decision.)

There is a lot more that could be said about ovaries, but let’s save that for another day.  Hopefully this gives you a better understanding of how the ovaries work!

Herpes and Hepatitis B

Herpes and Hepatitis B are two sexually transmitted diseases that are often confused with one another because of their similar names.   The similarities end there.  What are the differences between the two?  And what are the symptoms, the causes, and the treatments?

The technical name for herpes is herpes simplex and it is caused by one of two viruses:  herpes simplex virus 1 (HSV-1) or herpes simplex virus 2 (HSV-2).  (Pretty obvious names, right?)  HSV-1 causes oral sores commonly called cold sores (pictured below).  HSV-2 causes genital herpes, the dreaded sexually transmitted disease that about 1 in 7 adults in the United States currently have.  Herpes goes through cycles of being active and inactive (when sores are present or not present).  Genital herpes can be spread during both the active and inactive cycles, even when being treated.  Herpes has no cure and will last a lifetime if contracted.


Herpes is not a fatal disease (though it can be if passed between a mother and baby during childbirth) but it can be quite annoying and embarrassing.  There are treatments to help moderate the disease, but it is important to remember that herpes can always be spread even when it is in an inactive stage.  The treatments for herpes are anti-viral and the best choice for you can be determined by your physician.  There is currently no vaccination to prevent herpes, but there may be in the future.

Herpes is a disease that is quite easy to detect visually, unlike that other H-disease hepatitis B.  Hepatitis B (often shortened to hep-b) is also caused by a virus, called hepatitis B virus (HBV; pictured below).  Hep-b is a disease that affects a staggering number of people.  Over 2 billion people are believed to have the disease.  It is spread by the transmission of bodily fluids (notably through blood transfusions and sexual acts, as well as other ways).

Hepatitis B affects the liver by causing acute (short-term) and chronic (long-term) inflammation.  This can result in jaundice, cirrhosis, and sometimes liver cancer.  The earliest symptoms, preceding these maladies, can include nausea, vomiting, body aches, mild fever, and darker than usual urine.  These can be mistaken for other illnesses if testing is not carried out.  These early symptoms often go away on their own but the disease may still be present allowing for more damage to the liver and for it to be spread to others.

So, it is crucial to visit a physician in order to have a test (usually a blood test) performed to determine the exact nature of your illness.  Hep-b very often clears on its own in those who suffer from the acute version.  However, the acute version may develop into a longer course of chronic hep-b.  If this occurs, it can cause serious damage to the liver and may even result in death.  Young adults, children, and infants are much more likely to develop chronic hepatitis B from the acute disease.  Though a virus cannot be totally cured through medication, it can be slowed and inhibited from causing more damage.

Hep-b is a disease that can be protected against.  The best means of protection is by receiving the vaccination against it.  This offers long-term protection.  As in any sexual situation, it is always best to be as careful as possible and in this case a condom will greatly lower the risk of spreading the disease.

So, to sum up, herpes is associated with genital sores, is generally not fatal, and can never be cured.  Hepatitis B has few outward symptoms, can be fatal if not monitored, and can only be cured by the body’s natural virus-fighting processes.  So, if you’re worried at all about either of these diseases, please visit a doctor who can make sure that your issues are carefully dealt with.  Your and your sexual partner’s health rely on it.

The Uterus

Pound for pound, the uterus is the strongest muscle in the human body. The uterus weighs about 40 ounces (2.5 pounds; 1.1 kg) and is about the size of a pear when not pregnant. Yet, in the process of giving birth, the uterus can exert over 100 pounds of force (440 newtons). The uterus is responsible for protecting and nursing a growing fetus during a pregnancy, and also for pushing that fetus out when it’s time to give birth. Let’s further explore this great muscular feat of nature–the human uterus.

The word uterus comes from Latin meaning “womb” or “stomach.”  It is an organ particular to mammals.  The human uterus consists of two parts:  the main body, generally just called the uterus, and the narrow “neck” called the cervix (Latin for “neck”).  In humans, the uterus is labeled as simplex because it is generally a single (simple) compartment, but sometimes the uterus does not end up like this.  When a female fetus is developing in the womb, it starts out initially as an organ shaped like a V–as though the cervix has two horn-shaped compartments.  As the fetus develops, the horns will generally fused into one, “simplex” uterus.  About 6.7% of the time, though, this does not happen resulting in a malformed uterus.

The most common type of malformation is the bicornuate (or “two-horned”) uterus.   Other malformations include unicornuate (“one-horned”) uterus, double uterus (two whole, functioning uteruses), and absent uterus (where the uterus fails to develop at all).  Each of these malformations has its own set of issues, and a medical professional can help counsel a person with a malformed uterus.

The uterus consists of three main “layers,” much like the different layers of skin.  The innermost layer on the inside of the uterus is called the endometrium.  It is a temporary layer that builds up and jettisons away over the course of a menstrual cycle.  The middle layer is called the myometrium.  This is the main, muscular layer of the uterus and consists of smooth muscle mass.  The outermost layer is referred to as the perimetrium.  It is a thin membrane that secretes serous fluid.

Uterus IllustrationIn the reproductive cycle, the uterus receives the egg after it has been fertilized while traveling down the Fallopian tube (labeled here as the uterine tube).  Once the fertilized egg is in the uterus, it will usually implant in the endometrial lining of the uterus (that is normally shed when a woman has her period).  From this implantation, the uterus and the embryo form a network of blood vessels that exist only during the pregnancy.  This is called the placenta and is what the umbilical cord is attached to.

The uterus, besides being key to the reproductive cycle, is also important in the sexual response cycle.  It directs blood flow toward the pelvis and outer genitalia during sex. This directed flow of blood happens during arousal and allows for sex to be pleasurable to the woman.  The uterus is also involved in a somewhat rare type of orgasm called, of course, the uterine orgasm.

The uterus is, arguably, the most central organ to not only reproduction but also sexual response.  Take good care of your uterus and go to the gynecologist for your regular check-up!  Have questions or comments?  Let’s hear ’em.

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.)

Linea Nigra and the “Mask of Pregnancy”: Skin Discoloration during Pregnancy

During pregnancy, a woman’s skin can undergo any number of changes.  This article will exam two of the most common of these dermatological changes:  “linea nigra” and the “mask of pregnancy.”

Linea nigra, which is Greek for “black line,” is a dark line that develops on a pregnant woman’s abdomen and can stretch from the pubic mound up to the navel or beyond.  (The length of the linea nigra can have great variation.)  Approximately three-quarters of all pregnancies exhibit linea nigra.  Scientists have not determined what exactly causes linea nigra, and its causes my vary from person to person.  The linea nigra can be more than just a colored line beneath the skin–it can include a new growth of dark hairs along the same axis.  This is all quite normal and no reason to worry

Linea nigra is more common among women with darker skin, hair, and eye pigmentation.  These lines usually appear approximately half-way through a pregnancy and can last well beyond the time of birth.  In some women, the line may persist throughout one’s life.  In others, the lines may disappear but recur due to increased sun exposure.  In most women, though, the linea nigra will eventually completely fade.  If you develop a linea nigra and you really don’t like it, the absolute worst thing you can do is to try to tan your skin to match.  Tanning will only make the line darker and darker and less likely to go away.  In general, it is good to avoid too much UV radiation (sunlight, tanning bed, etc.).  It is especially good to avoid UV radiation during pregnancy so as to prevent problems.  If you are worried about your linea nigra (the color, size, direction, etc.), make sure to consult a physician.  Overall, though, a wide range of different linea nigra is totally normal.

The second skin change I mentioned earlier is usually referred to as the “mask of pregnancy,” though its technical name is melasma.  Melasma is a discoloration of the face in a mask like pattern (think of masquerade masks).  The discoloration is a darkening of the skin and usually appears to be brown (light or dark).  The change in color primarily affects the nose, upper cheeks, and forehead.  In some cases, the melasma can affect other parts of the face.  Melasma can actually occur in both men and women, but it is most common in women who are pregnant.  Melasma also occurs frequently in women taking oral contraceptives (“the pill”).

Melasma, like linea nigra, usually fades with time and intensifies with exposure to sun (as well as tanning beds).  Melasma is totally normal but is more common among women who have naturally dark skin and who are often exposed to high amounts of sun.  There are several treatments to speed the fading of melasma, though they should not be used until after the pregnancy has finished because the chemicals involved may be harmful to the fetus.

Also note that moles, freckles, and areola (the area around the nipples) can also darken during pregnancy.  Like the above-mentioned skin changes, they are perfectly normal, can last for various amounts of time, and usually fade away after pregnancy.  The body goes through so many changes during pregnancy but these changes are among some of the most visible.  If you are ever worried about any of these changes, seek the advice of a medical professional.  Any questions or comments?  Please feel free to leave them here.

Episiotomy

When I was younger I remember hearing the word episiotomy in relation to childbirth but never really knew what it meant.  As I got older, I heard the word less and less often.  That is until my senior year of college when I got to know the meaning of the word quite well without actually experiencing it myself.  In one of my seminar classes, a classmate (a midwife by day) was telling the class about the term paper she was writing.  It was about the birthing practices of rural Nicaragua.  She worked in a tandem network of midwives both here in the US and in Nicaragua.  She said that the practice of episiotomy in the US was almost completely extinct but that it was still commonly used in Latin America.

In a class of about 11 women and 1 man (poor guy!), we all wanted to know more about this “episiotomy.”  So, in the spirit of that midwife taking her time to explain this practice I hope to impart a better understanding of the practice on you.

I have heard an episiotomy rather brutally and frankly described as cutting the vagina to make it wider for a baby’s head to pass through more easily during birth.  This is basically true but is not necessarily as barbaric as it may sound.  The cut is actually a type of surgery and it is done under anesthesia.

Most Western countries (United States, Australia, and Europe in particular) have moved increasingly away from using the episiotomy because of the complications it can cause.  A birth may progress without any need for the vaginal opening to be wider or the perineum (skin at the back of the vagina) may tear on its own.  This, too, is not as gruesome as it may sound.  A natural “tear” is often much shallower than an episiotomy.  Thus an episiotomy may take longer to heal and cause more complications.

There are two main types of episiotomies:  one is basically a straight, lateral cut from the vagina backward–this is called midline.  The other kind is is called medio-lateral and is cut at more of an angle away from the anus.

While there is certainly a time and a place for an episiotomy (as there is for a Cesarean section), I believe that natural tearing is preferable to episiotomy if possible.  The midwife I mentioned earlier explained this in an example I will never forget.  She took a piece of notebook paper and cut it halfway through with scissors.  “This is an episiotomy,” she said.  She took another piece of paper and tore it half way.  She said, “This is a natural tear.”  The torn piece of paper had all sorts of fibers and extra edges to it that the cut piece of paper didn’t have.  These overlapping bits provide a better opportunity to heal.  (Imagine trying to glue the cut piece of paper back–you couldn’t!  But you could with the torn piece of paper.)

Some studies show episiotomies, especially midline, cause greater complications even after the healing has occurred.  For instance, a woman can have trouble with sexual intercourse–it can be painful due to scarring and her vaginal walls can have trouble becoming lubricated.

There are certain therapies (such as massage and perineal dilation) than can help give the vagina preparation for birth that will make it less likely that a doctor will perform an episiotomy.  In any event, it is yet another complicated decision that a mother must make in the birthing process.  Hopefully this sheds a bit more light on it.  Have questions or comments?  Don’t be shy–dive right in!