Posted in Genitals: A User's Guide

A Hymn to the Hymen

The inspiration for this one came from a pub conversation.  It’s time for…

Firstly…

The hymen is a often described as a ‘membrane’.  It is membranous tissue, but this can lead to some confusion-

This is called an ‘imperforate hymen’.  The main reason it needs treatment (i.e. surgical removal) is that it means that menstral blood cannot drain during a period.

So, as with many aspects of genitals, individuals can be VERY different and this is completely normal.

 

References (a note): 

When I have an idea for something, I usually start by looking at some standard Gynae textbooks and then try to find reliable looking online sources (e.g. NHS, clinical guidelines).  They failed me somewhat on this topic.  I’ve found a teeny tiny amount of information from my textbooks (mainly on imperforate hymen).  This is basically a way of explaining why my main source is a wiki page (here)!

Posted in Where Do Babies Come From?

WDBCF #2: Euphemisms

A friend of a friend reckons reports that as a child they were told that babies were made by ‘mummy and daddy having a very special hug’.  Subsequently they were terrified every time their grandparents tried to hug them, convinced that this would leave them impregnated!

Posted in Genitals: A User's Guide

Bartho-What?!

Now let’s finish our exploration of the vulva with something a little more than skin deep: the bartholin’s glands.  These are two paired glands that lie within the vagina.  Their position is roughly shown here: as the two little blue lumps.  They lie just inside the entrance or ‘introitus’ of the vagina, as shown here.  They can’t be seen directly.  However, sometimes they can become infected and inflammed.  This can cause pain and swelling as pus collects and is unable to drain – a condition known as a bartholin’s cyst or abscess.   Treatment includes antibiotics to target an infection, or drainage and insertion of a ‘word catheter’ – a piece of tubing that can be placed and inflated to prevent pus from reforming and allowing the tissue to heal.

Posted in Genitals: A User's Guide

VuVaLicouS!

Lots of people seem unsure about what makes up typical XX genital anatomy – the uterus, ovaries and vulva ensemble.  Unlike penises, the majority of the bits that ‘do’ something are hidden – either internally or amongst lots of indistinct lumps that are hard to view on self-examination.

Let’s start with the external genitalia – the vulva.  Sometimes people refer to it as the ‘vagina’, although this is the name for a specific part of the vulva.

This is my version of a typical textbook diagram:

To orientate yourself, imagine that the person you’re looking at is lying on their back, bottom on a surface below and legs akimbo.  You are standing at the foot end, looking ‘into’ the vagina and at the vulva from here.  The person’s bum is at the bottom of the picture and any hair covering the vulva at the top of this image.  Without pretty sound gymnastic skills and an ingenious mirror system, it is unlikely that anyone has ever seen their own vulva from this angle.  However, it is the view that a doctor or nurse (for example) would obtain to do a gynaecological exam, which is probably why it gets used in diagrams so often.

The bits that make up the vulva are as follows:

Clitoris: A bundle of sensory nervous tissue.  It can feel good to touch or otherwise stimulate here.  In Alice Walker’s novel ‘The Colour Purple’, Shug refers to her clitoris as her ‘little button’ that gives her pleasure.

Urethra: An opening for urine to pass from.  A tube (sometimes with a bag) called a ‘catheter’ can be passed here to drain wee in some circumstances.

Labia Majora: The ‘big lips’ – the bigger folds of tissue that cover the front of the vulva.  If a person with a vulva were standing up, walking around, this is probably the only bit you could make out.  All other bits mentioned here would be hidden by it and the legs.

Labia Minora: The ‘little lips’ – smaller folds of tissue surrounding the inner part of the vulva.  Although there is relatively less tissue here than the labia majora, there is a huge amount of variation in the size and shape of the labia minora between individuals.  Surgery to reduce the amount of tissue here is called ‘labiaplasty’ and it is usually this that people mean when they refer to ‘designer vaginas’.  This area is not really called the vagina though…

Vagina: This is the passage in to the body and the rest of the reproductive tract (i.e. the cervix and womb).  A penis (or other objects!) can go in and believe it or not a baby can come out of here.

The area within the labia minora in to which the urethra and vagina open up can be called the vestibule.  The area between the vulva and the anus is called the perineum.

Posted in Genitals: A User's Guide

Your Whostsaname

Genitals.  Everyone has them.  Sometimes they have weird and wonderful bits.  Do you know where to find a raphe of a penis?  How about the bartholin’s glands?  Occasionally we don’t seem to know how to use them, or what they are for.  Sometimes they go wrong.  Ever feel like we should be handed a manual?  You know – ‘Genitals: A User’s Guide.’  Maybe it could be issued sometime before puberty.  That’s what I’d like to create over the next few months – ‘Genital’s: A User’s Manual’.   With words and pictures.

Let’s start with the basics.  The external genitalia.  For a lot of people there are two basic flavours:  the penis ( and it’s sidekick the scrotum or testicles) or the vulva get up. Note that I don’t (and won’t) use the words ‘male’ and ‘female’ to delineate these two.  Chromosomal and genetic sex is separate from gender identity – people of both and any gender can have either genitalia.  Also, it is possible for people to be born with genitalia that do not fit in to this penis/ vagina divide – again, more on that later.

We tend to be pretty familiar with the basic components of penises – the pole and two balls, depicted for generations on the walls of public loos.  A little more mysterious seems to be the vulva.  People often refer to this as a ‘vagina’.  Technically though, vagina is the name for the hole bit – the bit that connects the outside world to the inside (more detail on that next week). The vulva is the word used to describe all of the external parts.

Here are a very small collection of words that we use for genitals in English.  I think it’s important to have the vocabulary to describe genitals if we’re going to talk about them in more detail.  Enjoy – and let me know (@SquiSquaSque) if you’ve got any favourite words for ‘down there’ that I haven’t included.

Posted in sexual health

Alienation and lip gloss free with every issue.

My friend M and I were reminiscing about the ‘Just-17’ magazine era of our lives recently.   I say ‘reminiscing’, but ‘looking back with discomfort and some introspection’ might be more apt.  We had just attended a volunteer training day with the lovely people at Sexplain – an organisation that provides inclusive sex education.  As part of this, we had been asked to reflect on messages we had picked up about sex when we were younger.   M and I went to school together in the 90s.  This was when the likes of Bliss, Sugar and Cosmo-Girl were the height of sophistication for an adolescent girl.   Contained within their pages were a mixture of fashion, make-up tips, celebrity gossip and relationship advice – with the edgier ones including advice on ACTUAL SEX.  They often came with free lip gloss.

Ostensibly, sounds great – a place to get informal and confidential information on sex.  However sometimes the tone and implicit assumptions of these magazines were what I would now describe as ‘problematic’.   There was very much a dominant, heteronormative view of relationships.  There was an implicit assumption – within advice pieces on how to give a good blow-job, for example – that being anything other than straight just wasn’t an option.  Advice on how to deal with your boyfriend came in many guises, but never what to do if you might want a girlfriend, or something else.  Sex was defined very narrowly as penis-in-vagina penetrative sex.  In addition, the endless parade of smiling, white, stick-thin celebrities and models did nothing good for my self-esteem.  All of that said, before the unfettered internet access of today, this was one of the few places that talked about sex.  Every week.  With an opportunity to write in and ask anonymous questions.

I used to buy the magazine during my trips accompanying my Mum to the supermarket on a Saturday.  I  was interested in them from the ages of about 11 – 14 years (i.e. a fair while before I was going to have sex).  There was a real gap of sources of information for curious teenagers wanting to know more about sex and relationships.   Even if they didn’t do it as deftly as you might hope, they did fill a niche in a way other sources didn’t.  Sex Ed classes at school were too staid and delivered by a deeply out of reach authority figure.   My parents were well meaning, but I think honestly relieved to just get over ‘the talk’.   My friends generally knew as little as I did.

As I’ve said, I was reading the likes of Just-17, Bliss, Sugar, and Cosmo-girl well before I was actually having sex.  By thta time the internet had come along and I could rely on a dubious combination of the world wide web and rumours spread amongst my (now slightly more experienced) peers.  The magazines I remember are now defunct, having died along with much of print media.   Teen Vogue, established in 2003, seems to be the contemporary thing anything like the mags of my youth.  Thankfully, it is somewhat different in content as well as form (online only since 2017).  It contains a ‘news and politics’ section.  It is queer friendly and controversial with it – it first came to my attention during the furore over their publication of an anal sex guide.   I thought a guide to bra fittings was pretty revolutionary in my adolescence – this puts it in to a whole different perspective.  And in an age of sexting, online grooming and internet pornography ‘desensitising’, I see this as a hugely welcome step.   Technology it seems has opened the flood gates on some pretty scary things, but also allowed in a new perspective on sex and relationships.  And I never really liked the lip balm anyway…

Posted in reproductive rights

Come on Ireland, #RepealThe8th

On Friday, The Republic of Ireland will vote on whether or not to repeal the 8th amendment.  This is a piece of legislation from the1980s which acknowledges the ‘right to life of the unborn’, guaranteeing a fetus ‘equal rights’ to the pregnant person carrying it.  This means that terminating a pregnancy in the island of Ireland is effectively illegal in all circumstances.  Many travel to the England and Wales for termination with more illegally obtaining pills online (IFPA).

Abortions are requested for many reasons. To me the individual reasons are not important. Your body, your choice.

Broadly speaking, terminations are either medical (tablets are given to make entrance to the womb open and the uterus contract) or surgical (instruments are used to remove the products of conception from the womb).

The body that regulates doctors in the UK who perform such procedures has this to say:

Abortion is a safe procedure for which major complications and mortality are rare.’

and

‘Women with an unintended pregnancy… are no more or less likely to suffer adverse psychological sequelae whether they have an abortion or continue with the pregnancy and have the baby.’ 

-RCOG, 2011

Nevertheless, the abortion act of 1967 does not extend to Northern Ireland.  Even within it’s borders, these citizens of the United Kingdom must travel to England or Wales to access abortion care.

From my home in England I’ve been watching the ‘Yes’ campaign, mainly through the medium of twitter.  I wish all of those who want greater freedom and reproductive rights luck on Friday and hope that their hard work is rewarded.

 

 

REFERENCES FOR IMAGE:

Royal College of Obstetricians and Gynaecologists. The Care of Women Requesting Induced Abortion. Evidence-based Clinical Guideline 7. London: RCOG Press; 2011

Posted in Genitals: A User's Guide

Does My Labia Majora Look Big In This?

Today I was at a teaching session for trainee Obstetrician/Gynaecologists.  At one point, these words were uttered:

“If a woman’s been told by her boyfriend that her vulva looks abnormal, it’s YOUR job, especially YOU [points to the two men in the room] to say that you’ve seen far more than him & it ISN’T.”

Insecurities about genitals is the idea behind The Great Wall of Vagina (dull accuracy announcement: it’s actually vulvas, not vaginas, but still great).

There is a huge amount of variation in how external genitalia look.  Humans have a great variety in height, build and skin tone.  We are all so different that we find it remarkable when we find someone whose face is a little like ours.  Why would this be any different in your nether regions?

Posted in contraception, reproductive rights

Contraception Top Trumps!

Here’s a round-up of contraception methods, envisaged as the childhood game ‘top trumps’. If you feel I’ve left important pros/ cons or pieces of information out, please tweet me @SquiSquaSque !

I’ll try to update daily with a new card everyday for the next fortnight or so.

Hoping and praying: *for various reasons (lack of knowledge or planning, inability to negotiate) sometimes people do! ** This is an estimate based on the statistic that 80%trying to get pregnant do so within a year.

Fallopian Tube Sterilisation: either clips can be put on to block the Fallopian tubes, or they can be surgically dissectedclosed off. I’ve seen this performed a few times at elective Caesarian section, on request. It isn’t very common in the UK where contraception is widely available. I’ve been told by an Obstetrician that in his home country (a developing nation) it is much more popular for financial and cultural reasons.

Progesterone Pill: a.k.a the mini pill. Take it continuously, so no need to remember when to stop and rest as with the combined pill. As with all progesterone based hormonal methods, this stops your ovaries from ovulating (releasing eggs) and also helps to create a mucus plug in the cervix.

Contraceptive Patch: Works in a similar way to nicotine patches- sticks on to the skin and delivers a substance to your blood stream. I’m not convinced that they are very readily available as I’ve only ever seen them on Sex Ed leaflets.

Mirena: Progesterone based, fitted in to the womb.

Progesterone Depo: A twist on a classic- this injection delivers the hormone progesterone subcutaneously, where it slowly releases in to your body. This suppresses ovulation and thickens cervical mucus. Usually given every 8 weeks. A new preparation is available that is given every 13 weeks and can be self-administered at home. A terrible idea for anyone afraid of needles.

The Combined Pill: Tablet containing the hormones oestrogen and progesterone. This helps to stop ovulation (release of an egg for fertilisation). It is taken for 21 days, with a gap of a week, during which a ‘withdrawal bleed’ takes place. In the UK GP services seem fairly well placed to deliver fairly easy access to the pill, at least compared to other forms of contraception (I’m a bit bitter- I’m currently in the midst of a six week wait to get my contraceptive implant sorted). The main difficulty seems to be remembering to take it. Some people have lifestyles and personalities that are more amenable to this than others.

The Diaphragm:  Fits over the cervix, acting as a barrier to sperm.  Unlike true ‘barrier’ methods like the condom and femidom however, sperm is allowed to enter the vagina, so this method does not offer protection against STIs.   There seems to be some belief that only people who have already given birth can have them.  This isn’t true, but anecdotally I’ve heard from friends that some health care professionals can be reluctant to giving nulliparous people some methods (such as this and the copper coil).  So there may be some truth in this!

Natural Fertility Awareness: I’ve never seriously considered this as an option. It relies on a lot of organisation and not having sex some of the time. However, the real reason is that I didn’t think it was actually any good. My gut reaction is not to believe this ludicrously high effectiveness rate* but that may just be a hangover from sex Ed indoctrination. This figure is quoted from NHS choices who probably have less of an axe to grind than my old PRSE teacher.

Femidoms: work in a similar way to condoms, in that they are made of latex and work as a barrier. They sit in the vagina however, rather than over a penis. For some reason, they never seem to have become as commonplace as condoms, therefore seem much less widely available.

The implant: roughly the size of a match. This sits in your upper arm for up to three years, slowly releasing progesterone to suppress ovulation and thicken mucus at the cervix (entrance to the womb in The vagina). Needs to be fitted by someone with training, e.g. nurse or doctor at a GP or sexual health clinic. Waiting for this can make it a bit trickier to get one inserted, but once it’s in place you’re good to go for three years. Has a very low failure rate and fertility returns very quickly once removed.

The Copper Coil: inserted in to the uterus through the vagina, using a special device. The copper helps thicken the mucus at the cervix (entrance to the womb) to stop sperm from entering. It can also help stop a fertilised egg from implanting into the womb. Because of this theoretically it can be fitted a number of days after sex and act as emergency contraception. However, it needs to be fitted by a professional and this often takes time to arrange. For this reason it doesn’t often seem to be used in this manner, at least not in the UK.

Condoms: Widely available in good (and bad) shops everywhere, as well as some loo vending machines. Generally very cheap (I’ve seen packets for sale in Pound shops). Therefore financial limit to access is fairly small, if still present. However there are some schemes in the UK to get free condoms to particular groups. Red-faced teens in chemists up and down the country show that there’s also a social barrier to obtaining them too. Non-contraceptive uses: good for preventing diseases in penile penetrative sex (e.g. penis to anus).

*Lower efficacy rates been reported (e.g 82%). Lower effectiveness is generally linked to inexperience in using them.

References:

BPAS, accessed Friday 23rd February 2018 at {https://www.bpas.org/more-services-information/contraception/for-men/}

NHS choices, accessed Friday 23rd February 2018 at {https://www.nhs.uk/conditions/contraception/}