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!

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.)

Teen Pregnancy and the Rhythm Method

I read in the news today about a report released a few days ago by the Centers for Disease Control (CDC).  The headline that emerged in numerous articles as a result of this report was that the use of the rhythm method to prevent pregnancy by teenagers rose from 11% in 2002 to 17% in 2010.  This is quite a jump.  The report was made to investigate why the teen pregnancy rate has risen markedly in recent years.  In fact, the United States has the highest teen pregnancy rate of any developed country in the world and one of the highest teen abortion rates.  So, I have decided it is time to tackle the issue of the rhythm method.

So, what is the rhythm method?  If there is such a great leap of teenagers responding that they have used it, it is pretty important for young women (you, the reader!) to understand what it is.  In general terms, the rhythm method is a means of birth control by which the female avoids sexual contact during the supposed window of fertility based on a calendric monitoring of her menstrual cycles.  In other words, if a young woman has a consistent 28 day menstrual cycle, she can estimate the days she will be fertile by following the “rhythm” of her menstrual cycle.  Here is an example of what a menstrual calendar would look like (with menstruating days in red and fertile days in green):

With perfect use, meaning that a young woman meticulously keeps track of her period without fail and strictly avoid sex on possibly fertile days, pregnancy still happens 9% of the time.  If you wanted to avoid pregnancy, would you really want to take a 1 in 10 chance?  But, keep in mind that virtually all forms of birth control are not used perfectly.  So, with typical use (a slip up here and there), the rhythm method results in pregnancy 25% of the time.  That is 1 in 4!  So, needless to say that the rhythm method is not a terribly effective means of preventing pregnancy.  Other factors make the rhythm method less reliable, especially for young women.  In particular, a woman’s period does not become regular (and therefore predictable) for quite some time after the first period, called menarche.  Hormones are in flux during adolescence and early adulthood, so the monthly time of fertility is particularly unpredictable for young women.  Other times in a woman’s life when the rhythm method is especially ineffective include just after giving birth (as hormones are again in flux), after discontinuing the use of a oral contraceptive (“the pill,” which manipulates hormones), and around the time of menopause when, yet again, hormones are in flux.  Hormones can be affected by a variety of factors including stress and emotions.  So, the rhythm method can never be 100% effective.

The rhythm method has generally been rejected as a useful means of birth control [page 375] (except, notably, by the Catholic Church) in the past few decades, so it is eyebrow raising that teenagers are suddenly reporting a significantly increased use of it.  The rhythm method was first proposed in the early twentieth century.  Before this time, the function of ovulation as the key to fertility was not yet understood.  When science could finally understand these processes, it was determined that in the normal menstrual cycle a woman ovulates once occurring about 14 days before the beginning of the next period.  When this was discovered, gynecologists promoted it to patients as a means to help promote pregnancy.  Some years later, in 1930, a Catholic physician in the Netherlands began to promote this as a means to help avoid pregnancy.  Catholic organizations in Europe and America also began to advocate this means of birth control throughout the 1930s.  By the 1960s, the popularity of the rhythm method as a means of birth control had begun to wane, especially with the introduction of the birth control pill in 1960.

Avoiding pregnancy is generally the point of using the rhythm method, but it extremely important to point out that the rhythm method in no way stops the spread of sexually transmitted diseases (and neither do birth control pills).  Condoms are the safest and most effective way to avoid spreading or getting a disease during sex.  Abstaining from sex altogether is the only 100% effective method of avoiding both disease and pregnancy.  So, if you are a young woman considering using the rhythm method, please keep all of this in mind.  If you have any comments or questions, I’d be glad to hear from you!

Vulva

I live!  I apologize greatly for such a prolonged absence, but it was important for me to focus these months on school.  It has paid off because as of today I hold a Master of Arts degree in Bioethics and Medical Humanities.  Hurrah!  Now, I hope to devote the proper amount of time to this blog.  I began writing an article about the vulva before my hiatus and decided to finish it for my return.

So, what is the vulva? What’s the difference between the vulva and the vagina? Isn’t it all just one, connected thing down there? Why are there different names if it’s just a vagina, after all?  What does the vulva do?  All good questions. All questions I hope to answer.

The word vulva comes from Latin and was used to mean “womb” or, more generally, “female genitals.”  In modern usage, the word vulva refers specifically to the the external genitals of the female.  The word vagina is often used as a catchall term to refer to both the internal and external reproductive organs of a female; however, to be completely correct, the vagina is an internal structure only and the vulva is the external structure only.  These external components that make up what we call the vulva include the clitoris, the labia majora and minora (outer and inner lips), the pubic mound (mons pubis), the vestibule of the vagina (the area inside the labia minora that includes the openings for the urethra and vagina), and the vaginal orifice (the actual opening of the vagina).

Here is a diagram:

Its development occurs during phases, particularly the fetal and pubertal stages.  As the entrance to the reproductive tract, it protects its opening by a “double door”:  the labia majora (large lips) and the labia minora (small lips).  The vagina is a self-cleaning organ with an environment that promotes healthy microorganisms that balance each other out and guard against invading, unhealthy elements.  Cleaning your vulva is important to gynecological health.  Simply use warm water and mild soap on a daily basis.  (Remember, this is for external use!)  It is unwise to use heavily perfumed soaps as they can irritate your vulva.  It is also unnecessary to douche unless a doctor specifically recommends it.  Douches can cause irritation and flush out those healthy microorganisms allowing for infection to set in.  The vulva is more vulnerable to infections than the external genitalia of males.  So, take good care of it.

The vulva is key to sexual functioning.  The external structures of female genitalia are very full of nerve endings allowing for pleasure when properly stimulated.  When aroused, the vulva undergoes several physical changes it making it one of the external signs that a woman is aroused.  First, moisture from the vagina reaches the vaginal orifice, moistening the vulva.  The labia majora become enlarged and spread apart somewhat and can change color somewhat (darkened from increased blood flow).  The labia minora and the clitoris also increase in size.  During orgasm, the various muscles contract, though most of these contracting muscles are not located in the vulva.  Following orgasm, stimulation of the vulva may be uncomfortable or even painful.  The increased blood flow slowly dissipates until the vulva returns to normal.

The vulva performs different functions than the vagina, thus it is important to know the difference between the vulva and the vagina.  Especially if you are talking to a medical professional, be sure to clarify whether you mean the internal structures (vagina) or the external structures (vulva).  Have anything to say about vulvas?  Have you say and leave a comment!

Is Milk Really That Good for You?

After recently spending four days in Cleveland at a bioethics conference I came away with several new, and renewed, perspectives on women’s health issues.  The first that comes to mind is something that my roommate, another bioethics graduate student, and I discussed.  That is early menarche in females.

Now, a little personal background:  I was one of the last girls my age at school to begin menstruating.  I was 11 years and 10.5 months old.  Virtually all of my friends started menstruating at 10 years of age, some at 9, and a few at 11.  I really can only think of one friend who began menstruating after me (12 years old).  To men or other folks reading who wonder:  yes, many women really do talk to each other about such things.

Scientists have not conducted any truly conclusive or in-depth studies to determine why women are experiencing puberty (not only menstruation) earlier and earlier. There are several theories, the most supported being that modern food supplies are riddled with steroid hormones.  Most research that has been done along these lines ignores the effects of hormone-filled foods on early onset puberty.  Instead, the research has focused on the effects of these foods on the incidence of cancer:  breast and prostate especially.

A scientist at Harvard has conducted some rather interesting research in this area.  She found that the amounts of hormones in Mongolian milk are tiny compared to those found in Japan.  Mongolians utilize a more traditional mode of milking cows:  milking them only when they are not pregnant or at least only during the early months of pregnancy, which is about five months of the year.  In more developed nations, cows are milked around the calendar and encouraged to bear as many calves as possible, thus increasing the amount of estrogen found in dairy products 33-fold.  It is fairly well established that the greater one’s exposure to estrogen (and other hormones) the higher one’s risk becomes of developing cancer.  That can be the topic of another post another day.

Another source of such extraneous steroid hormones in our diets comes from our meat supply.  It is illegal in the United States to inject poultry and hogs with hormones.  Beef and lamb, however, are treated with hormones.  (Poultry is commonly treated with antibiotics but this rarely poses a threat to gynecological health.)  Scientists say, however, that because the hormones in our meat supply are often artificially derived (such as zeranol, trenbolone acetate, and melengestrol acetate) they do not wreak as much havoc on the human body as the natural hormones produced in cow’s milk.

So, is milk really that good for you?  I lean towards not as good.  However, I will still be eating my bowl of cereal every morning with a heaping serving of 2% milk.  Oh, incidentally, the above-mentioned Harvard scientist found that skim milk has much lower amounts of hormones similar to the milk in Mongolia.  In any event, this topic definitely warrants deeper investigation and my unprofessional opinion is that parents out not allow their children, particularly daughters, to drink milk unless it is skim until after menarche.  Questions?  Comments?  Let ‘er rip!