The Naked Truth
Genital and Reproductive Health
Amenorrhea is the medical term referring to the state of a woman who has missed at least three periods. The name of this disorder comes from Greek, in which “a” means without and “menorrhea” means menstrual flow. It is easy to write-off missed periods as a convenience, but amenorrhea indicates your body has a problem that is preventing it from functioning normally. Athletes participating in physically demanding sports often have low estrogen levels, no matter how well balanced their diets are. Low levels of this hormone promote bone density loss, and by the time these athletes lose their period, their bones have suffered significantly. Amenorrhea can have a negative impact on reproductive, endocrine, and muscular-skeletal systems, so you should see a doctor if you go longer than 12 weeks without a period and need help to start menstruating again. Starting or ending contraception disrupts the body’s normal hormone levels, and it may take up to six months for your period to return to normal. Pregnancy is the most common reason women stop menstruating, but if you’re definitely not pregnant, here are some possible causes of amenorrhea:
- low body weight
- low body fat
- stress, perhaps from a change in environment
- malnutrition, often from eating disorders
- hormonal changes
- breast feeding
- strenuous exercise
Endometriosis occurs when some of the tissue which lines the uterus (the endometrium) grows in another part of the body, usually somewhere in the pelvic area. Endometrial tissue existing outside the uterus responds to hormone changes of the menstrual cycle, just as the lining of the uterus does. When hormone levels tell the body to shed the uterine lining in the form of a period, endometrial tissue in other areas breaks off as well, but unfortunately has no where to go. This can result in internal bleeding, cysts and scar tissue. Symptoms of endometriosis include pelvic pain during menstruation, ovulation, or sexual intercourse; pain during bowel movements or urination; excessive menstrual flow; bleeding between periods; infertility; or, no symptoms at all.
Treatment depends on the severity of your case and whether or not you wish to have children. Choices include, pain killers, hormone therapy, conservative surgery (to remove implanted tissue and maintain fertility), and hysterectomy.
Importance of Folic Acid for Women
Folic acid is an essential nutrient to prevent birth defects in a developing fetus. Although you may not be ready to have a baby yet, folic acid is only effective when part of a woman’s diet before pregnancy. Additionally, if you’re sexually active, there is always a chance that you’ll become pregnant, and if you decide to give birth it is important that you’ve been eating enough folic acid. This nutrient is found in orange juice, green leafy vegetables, and enriched breads, cereals, pastas, and rice. If you can’t get adequate amounts from food, try a multivitamin or folic acid tablets.
It is recommended that women first see a health care provider in their late teens or when they become sexually active – whichever comes first. After the first visit, women should get routine pelvic exams and Pap tests every one to two years. Named for the man who developed it, a Pap test can prevent cervical cancer by detecting abnormal cells on the cervix. Pap tests are usually done during pelvic exams, when your doctor inspects the external genital region for reproductive problems or abnormalities. You should have a pelvic exam if you experience the following:
- vaginal pain, burning, or itching
- vaginal sores
- abnormal discharge
- possible pregnancy
- more than 12 weeks without a period, even if you know you can’t be pregnant
- irregular bleeding
- unusual or persistent pelvic pain
- painful intercourse
- severe menstrual cramps
An ovarian cyst is an abnormal, but usually benign swelling in the ovary. Either fluid-filled or solid, cysts are common among women between puberty and menopause. If the cyst is not the result of an underlying disease or disorder, it is termed “functional,” and will probably shrink and disappear on its own. Many functional cysts do not cause symptoms, and are rarely palpable during routine pelvic exams. You may need an ultrasound to be certain you have cysts. Symptoms of ovarian cysts usually include pain or aching in the abdomen, irregular menstrual cycle, nausea, and breast tenderness. Some women regularly develop cysts at a certain time during the menstrual cycle, which come and go each month.
Pelvic Inflammatory Disease
Pelvic Inflammatory Disease (PID) is an infection of the female reproductive organs, usually caused by sexually transmitted bacteria that ascend from the vagina into the uterus and upper genital tract. PID frequently results from STIs like Chlamydia and gonorrhea that are left untreated because patients don’t necessarily show symptoms. The infection may also result from bacteria introduced to the reproductive tract in other ways, for example during the insertion of an IUD (intrauterine device) or during an abortion.
In the US, the rate of PID is highest among teenagers, but often goes undetected because women do not have symptoms, or do not get treatment for the symptoms they experience. They unfortunately learn they have had PID when getting treatment for fertility problems later in life.
Don’t hesitate to see a gynecologist if you suspect PID because symptoms may be minor or not present at all, especially if the infection results from Chlamydia. Most cases are cured with antibiotics. Symptoms of PID may include:
- pain in lower abdomen, pelvis, and lower back
- pain during intercourse and urination
- heavy, foul-smelling discharge
- irregular menstrual bleeding
- fever, fatigue, diarrhea, or vomiting
Premenstrual Syndrome (PMS)
About 85% of women experience at least slight affects of premenstrual syndrome, commonly known as PMS. The cause is unknown, but can be treated to some degree in most women. There are a vast number of symptoms that affect women both emotionally and physically. You may experience mood swings, depression, social withdrawal, forgetfulness, and lack of concentration. Physical symptoms can include abdominal bloating, sore breasts, food cravings, headache, clumsiness, and fatigue.
Getting regular exercise and eating a diet rich in whole grains, fruits, and veggies is good advice for better health in general, and applies well to the treatment of PMS. Regular exercise throughout the month can reduce PMS symptoms, fluid retention, and stress. Women who suffer each month should consider these lifestyle changes as well:
- increasing calcium in your diet through food or calcium supplements (you need 1000 mg per day) because it is the only supplement linked to decreased symptoms of PMS
- reducing stress
- eating smaller meals more frequently during PMS to avoid feeling full and bloated, and to reduce irritability associated with low blood sugar
- reducing sodium to limit fluid retention
- avoiding caffeine and alcohol
If these changes don’t improve symptoms, you may consider medication. Medicine that may help:
- diuretic pills to reduce fluid buildup
- pain relievers
- birth control pills
- mood-altering drugs, such as antidepressants
Urinary Tract Infection
Urinary Tract Infections (UTIs) begin in the urinary system, and won’t affect other organs if caught early. Otherwise, the infection can cause major health problems by spreading to the kidneys. Although UTIs may affect men, they are far more common among women, infecting one in five women during their lifetimes. Not everyone experiences symptoms, but the most common signs are:
- frequent urination in small amounts
- pain and burning during urination
- bloody or strong-smelling urine
Usually the cause of a UTI is bacteria that have entered from the outside into the urethra. The urinary tract is not usually an environment conducive to bacteria (urine has antibacterial properties), but certain situations will make the urethra more vulnerable.
- Sexual activity that pushes bacteria into the urethra.
- Contamination of the genitals with E. coli from the anus.
- The presence of STIs in the vagina, such as herpes and Chlamydia
UTIs are treated with antibiotics, but you can help prevent them by
- drinking plenty of fluids
- avoiding holding in urine for extended periods
- avoiding feminine deodorants and douches
- wiping from front to back after bowel movements
- washing the genital area daily (best done in shower, not bathtub)
Vaginitis, one of the most common reasons women seek healthcare, refers to any irritation that causes vaginal discomfort and abnormal discharge. Although it’s not usually serious, vaginitis can be annoying and uncomfortable. Symptoms include vaginal itching or burning; abnormal discharge (maybe with unpleasant odor); and the urge to urinate frequently.
Internal and external factors can contribute to the development of vaginitis. Such factors include lack of estrogen, irritants, allergies, and infection. Three infections that are well known to cause vaginitis are yeast infection, bacterial vaginosis, and trichomoniasis. Each infection has slightly different symptoms. Yeast infections cause thick, white, odorless discharge, and a white coating of the vagina. Discharge resulting from bacterial vaginosis is normally grayish and frothy with odor. Trichomoniasis is a sexually transmitted infection that doesn’t always have symptoms, but could cause frothy, musty-smelling discharge.
Vaginitis does not typically cause major problems, but the underlying cause could be serious so it’s important to see a doctor. The only reason you could skip a visit to your healthcare provider is if you’ve been diagnosed with yeast infections before, recognize the symptoms, and know how to treat it yourself. Some tips for prevention:
- keep area around genitals dry
- wear underwear and pantyhose with cotton crotches
- avoid jeans and pants that are too tight
- wash your genitals daily with mild soap and water
- don’t share towels
- wipe genitals from front to back, to avoid spreading bacteria from feces to the vagina
- avoid chemicals in perfumed soap, detergents, and fabric softeners
- use a latex condom during vaginal intercourse
Breast Size and Shape
Breast size and shape vary not only between women, but also between breasts of the same chest. In fact, few women have identical breasts. Breasts can be firm, saggy, smooth, lumpy, large, and small. Age and fluctuating hormone levels lead to changes throughout a woman’s lifetime. For example, breasts become fuller and more tender during menstruation, and more lumpy during menopause. Oral contraceptives may increase the size of breasts, while losing weight will likely decrease the size.
Once you reach 20, you should start examining your breasts once a month to inspect for any changes. If you notice changes in your breasts, clear or bloody discharge from nipples, or a lump, you should visit a doctor. Because breast size and firmness varies during the menstrual cycle, you should conduct a breast self-exam (BSE) at the same time each month to learn what’s normal for your breasts. The best time is one week after the first day of your period, when hormone levels are low. Women on birth control pills should do their BSE during the placebo week.
To conduct a BSE:
- Sit or stand in front of a mirror with good lighting. Place your arms at your sides and look for dimpling or puckering, discharge from nipples, or changes in breast size, color, or shape.
- Continue to look for these signs first with your hands pressed lightly on hips, then as you flex your chest muscles, and then with your arms raised high.
- Lie flat on your back with a pillow under left shoulder. Place your left hand under or over your head.
- With your right hand, keeping fingers straight and together, gently feel your left breast without pressing too hard, using small, circular motions to feel the entire breast. Massage the colored skin around the nipple and squeeze it gently to check for discharge.
- Do the same for your right breast.
- Repeat steps 4 and 5 in the shower, where it is easier to examine the breasts when they are slippery from soap and water.
When you find a lump…
Fortunately, it is not likely to be cancer, especially if you are young. If the lump doesn’t fluctuate during your menstrual cycle, it is probably a fibroadenoma, a benign and fibrous tumor. Painless, firm, and round, fibroadenomas range from one-half to two inches in diameter. The development of these growths is not linked to increased risk of cancer, but if removal is necessary, it can be done with either a local or a general anesthetic. A pathologist will examine the removed lump to ensure it is not cancerous. The cause of fibroadenomas is unknown, but they occur most often in women under thirty, and are more common in black women.
If the lump you find is not solid, it’s probably a cyst, resulting from small sacs filling with fluid. The size of cysts often fluctuates during the course of the menstrual cycle. They will be most prominent during ovulation and right before you get your period, which is when hormone levels cause the breasts to retain fluid. Examining your breasts at these points in your cycle increases the likelihood that you will feel lumps, especially on the sides of your breasts, near the underarms. Whether cysts are present at your first period, or develop later, they are likely to be harmless, but may sometimes be sore. Of course a doctor should check out any changes you detect in your breasts. [top]
If you would like more information or want to schedule an appointment with a health care provider, call UHS at (609) 258-3141. [top]
1http://www.4woman.org/faq/pap.htm#14 “Pap Test” The National Women’s Health Information Center, 7/31/03