Posted in Genitals: A User's Guide, Uncategorized

Seeing Red…

I’d like to take a look at periods!

Even though it’s an *extremely* common experience – there are estimates that 800 million people in the world are having a period every single day – this is one of the topics that often gets the most ‘yucks’ and discomfort in schools.

In my experience, people often have misconceptions about periods in the UK. Despite this, I find that there’s a tendency to talk about period stigma as a purely foreign problem – often only acknowledging problems in low income countries. Unicef recognises that period stigma is a global issue.

As someone who regularly talks to young people about menstruation, it seems sadly alive and well in the UK. Often, just bringing out (completely new and unopened) tampons and other period products is enough to evoke palpable – and audible – signs of discomfort in the classroom. I firmly believe that the way to tackle this is to talk to all people about periods – whether they have them or not themselves…

Firstly, let’s start with the basics – what is a period?

It’s bleeding through the vagina from the uterus, usually for a few days, most often once a menstrual cycle (more on variations and problem periods later). The bleeding is the lining of the uterus being shed. It’s made up of clots, tissue and blood – so is very different to the ‘fresh’, bright red blood you might get from veins or arteries from a cut.

Usually (but not always) people use something to manage this bleeding. Different types of period products include:

Pads: Either disposable or reusable material that is attached to underwear and soaks up blood. Disposable pads are widely available. They usually contain some sort of plastic to make them waterproof and are single use – i.e. they are thrown away after being used. Reusable pads are made from fabric and can be washed and reused. At least in the UK, they can be a bit harder to get hold of. Some brands sell them online, or independent makers sell them through websites life Etsy.com. If you are craft savvy, you might like to make them yourself.

Tampons: These are cylinders of cotton wool-like material. They are inserted into the vagina. The walls of the vagina keep them in place, where they can absorb blood. They are removed by pulling on a little ‘string’ attached to them. Concerns about tampons getting stuck, lost or causing harm seem quite common. Although people do sometimes find they can’t remove a tampon, this doesn’t seem to happen very often. Even if it does, the vagina is a closed ‘space’ and a healthcare professional should be able to remove it using special tools (I have had this job at one point). Like anything that is inserted in to the body from outside (including food) there is always going to be some risk of infection with inserting a tampon. Again, this isn’t very common, especially if tampons are removed and changed regularly and you make sure to wash your hands before removing or inserting one.

Period Cups: Shaped a bit like an egg-cup without a stand and made from a squishy but solid material. They are inserted in to the vagina, where they sit underneath the cervix (entrance to the uterus) and collect blood. They can then be emptied and washed – rinsed out in between uses and sterilised (e.g. in boiling water) in between cycles. They usually have a little ‘pull’ on the end that can be used to remove them – a bit like the string on a tampon. Along with fabric pads, they are another type of reusable period product.

Period Disks: They work in a similar way to period cups – but are shaped differently. They are a flattish ‘disk’ shape, rather than a ‘cup’ shape, but are still inserted in to the vagina, where they sit and collect blood. They don’t have the little ‘pull’ piece, and sit a bit higher up in the vagina.

Pants: These are shaped and worn like regular underwear. But the ‘gusset’ (the bit that sits underneath the vagina in people with vulvas) is made from absorbable material, to soak up period blood. As with reusable pads, these are washed and then reused.

Freebleeding: Some people don’t use any particular product when they are menstruating – bleeding ‘freely’ on to their clothes. This can be by accident, or it has been used as a political statement.

Busking it: Sometimes people use anything to hand, such as tissues or cloth, to soak up period blood. One reason for this might be period poverty – the inability to afford period products. It is thought that millions are affected by this, even if high income countries like the UK.

How do people choose which period product to use? People are different – and what is good for some, isn’t for others. Also, your needs and your cycle might change over time or in different circumstances. For example, personally I like to use a period cup during the day because it can be reused and is fine to take swimming. But at night I prefer period pants, as they feel more ‘secure’ which I’m moving about in my sleep.

Another thing that doesn’t get talked about very much is problem periods. There’s sometimes a feeling that periods are meant to be unpleasant – for example, painful. Whilst some discomfort is common, there is such a thing as as a problem period. A period might be a problem might be one that:

  • Is too painful (e.g. effects your ability to do the things you would usually do), including pain just before your period.
  • Is very heavy (e.g. you have to change pads or tampons very frequently or no period products seem to deal with period blood at all), including last for a very long time (i.e. longer than 8 days).
  • Causes you lots of emotional distress, including just before your period.
  • Is very irregular (e.g. your cycle varies by more than several days between each period).

If this or something else is bothering you about your period, it’s probably worth talking to a healthcare professional – like your GP – about it!

Resources:

I cannot recommend the book Red Moon Gang by Tara Costello enough, for anyone who has periods (or who doesn’t, and wants to know more). Informed by Costello’s extensive research, as well as interviews with what seems to be a huge range of people who have periods (including people of different genders). There is also a blog and information site of the same name, which includes a really nice and short article on what a period is!

I wrote ‘The Body’ chapter in Sex Ed: An Inclusive Teenage Guide to Sex and Relationships, which is available from Walker Books now! This chapter includes loads of information about periods, and the rest of the book is full of other RSE info for young people!

This video from Amaze.org is a nice summary of the basic of a period (although briefly gets a bit reproductive focused).

Episode 23 of the Guilty Feminist is all about Periods! Nice, normalising discussion of periods. The guest on this episode is Evelyn Mok, who talks about being diagnosed with PCOS (i.e. problem periods).

This short film about getting a period for the first time might be a nice conversation starter!

Follow the Bloody Good Period campaign on social media for period education.

I am the Co-Founder of PeriodPal – an online app for tracking periods that aims to be inclusive and ethical. This is funded by donations, with no subscription fees. To sign-up for a free account to track periods and your health, go to periodpal.eu.

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About Me

Emma Chan works as a Facilitator for The School of Sexuality Education, delivering inclusive and sex-positive sex and relationship workshops, mostly to secondary aged children, across the UK.  Emma is a co-author of School of Sex Ed’s book, ‘Sex Ed: An Inclusive Teenage Guide to Sex and Relationships’

They qualified as a doctor (BMBS) in 2015 from the University of Nottingham, going on to begin speciality training in Obstetrics and Gynaecology in 2017. They previously studied Psychology (BSc), also gained at The University of Nottingham. They are currently working towards an MSc in Reproductive and Sexual Health Research at the London School of Hygiene and Tropical Medicine.

Emma is a member of The Candid Collective, regularly helping to run ‘Genital Making Magnets’ workshops.  Emma been interviewed about topics relating to sexual health by The Independent Online, Cosmopolitan Online, Ask Ella, BBC Sound’s Jacob Hawley: On Love and even BBC Radio Devon! They have appeared as a guest speaker at UCL’s Institute of Education, as part of the ‘Gender, Sex and Education’ MSc module.

Emma’s pronouns are she/her or they/their. They are comfortable with the gender label ‘woman’. However, they are conscious of this having been strongly ‘externally’ imposed through a life-time of social conditioning. For example, Emma attended an all-girls secondary school in North London and still has the pink baby name band she was given at birth. If they had grown up in the fearless post-feminist, gender-stereotype-free utopia they would like to try to bring about, maybe this label would not be so appropriate…

Posted in contraception, Genitals: A User's Guide, Uncategorized

Put a Ring On (?/In) It!

Last week I was interviewed for Cosmopolitan about ‘femidoms’ or internal condoms. These are one of a handful of contraceptives that often get talked about in sex ed classes, but appear to be less commonly in use.

Another type of contraception that this can be said about is the vaginal ring.

It gets its name from it’s shape – it’s a ‘ring’ made from a soft rubber like materials, about 5 cm across. It is inserted in to the vagina by the user and once inserted sits just below the cervix.

It’s another type of hormonal contraceptive – which means it protects against pregnancy by affecting the womb, ovaries and the fertility cycle.

It contains the same hormones as the combined pill – oestrogen and progesterone. Because of this, it works in a very similar way:

  1. Stops the ovaries from releasing an egg.
  2. Helps make the lining of the womb stay thin, rather than building up (a thick womb lining is needed for a fertilised egg to implant in and grow).
  3. Helps create a thick ‘plug’ of mucus in the cervix – the entrance to the womb. This helps stop sperm from entering the womb from the vagina in the first place and coming in to contact with an egg.

Also like the combined pill, the vaginal ring is used for three weeks and then not for one week – usually with a ‘withdrawal bleed’ in this week off. The main difference is that whilst the pill is delivered to your system by swallowing a pill, the vagina ring releases these hormones in to your system slowly over time.

After the week off, a new one is inserted. This is done by the user – so no need to attend a clinic or other appointment to get it fitted by a health professional, like with other contraceptive methods such as the coil.

From speaking to friends about their personal and professional experiences it seems like the vaginal ring isn’t something that is as easy to get hold of as other forms of contraception, at least in the UK!

Pros and cons

Because it doesn’t form a barrier between the vagina and the penis, it doesn’t protect against STIs. The vaginal ring is a form of contraception (helps reduce the risk of pregnancy) but not protection (doesn’t help reduce the likelihood of passing on infections through sex).

Some people may find it difficult to use – it involves being quite comfortable with your anatomy, slightly more so than a tampon.

On the other hand – it works very well. If used correctly, the vaginal ring is more than 99% effective. For comparison, this is more effective than condoms (98% effective). It only needs removing and replacing every four weeks – unlike the pill, which you need to think about every day.

For further details see:

NHS Contraception advice 

 

Posted in Genitals: A User's Guide, Uncategorized

By Design

Ever heard the term ‘designer vagina’?  This generally refers to a certain type of cosmetic surgery, not to the vagina itself but to the ‘inner lips’ (or labia minora) of the vulva.  Surgery here involves removing tissue from and reshaping the appearance of the labia minora- in other words to ‘trim’ it.   Many people with vulvas have a labia minora that protrudes so that it appears visible – therefore however large this is it is likely to be ‘normal’.  Additionally, in young people biological changes occur during puberty that can change the appearance of the inner labia.  For this reason it is often recommended by the NHS that those under 18 do  not get this type of surgery.  However, there seem to cases of children having labiaplasties.  According to one report over 200 people received labiaplasty procedures funded by the NHS in 2015-2016.  We know that people with visible labia are more likely to think that their genitals look ‘abnormal’ than those without, even though both are equally common (Lykkebo et al, 2017). Some accounts have blamed this on the prevalence of seeing only vulva with neat and invisible labia minora.  Whatever the cause, the desire to have this type of surgery seems increasingly common with a 45% rise seen in labiaplasty numbers worldwide between 2015 and 2016.

 

 

 

Posted in Genitals: A User's Guide, Uncategorized

An Ode to Sanitary Products

Womb carrying folks usually start menstruation (i.e. regular periods) before the age of 16 years*.  I was much older than this when I began to accurately understand what my anatomy ‘down there’ was like.  I think I had a conception of tampons being a cross between a plug and a sponge.  I guess this isn’t completely wrong, but neither is it completely right as the bleeding’s coming from the cervix, with a vagina being a passage way.

I’ve come across a fair few people who have an aversion to using tampons, partly because they are not confident (or downright uncomfortable) with their anatomy and with the idea of placing something in to their vagina.  Even amongst some of my liberated friends, I am considered a bit of a fringe eccentric for using a mooncup – something I’ve done of the last few years.  About the size of an egg cup and made from soft silicone, it sits in the vagina, just below the cervix and catches blood.  It can then be washed, without contributing plastic to the bin or cotton to sewage waste.

n.b. I’ve recently discovered that ‘mooncup’ is just one of many other brands.  This has somewhat blown my mind.

References:

*Lawrence and Impey (2012) Obstetrics and Gynaecology, 4th Ed.

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A Century On…

Today is the 100th anniversary of the UK’s ‘Representation of the People Act’, which gave (some) women (over 30 and living in their own home) the right to vote.  It also extended the franchise to a wider group of men.

Now in the UK, any woman over the age of 18  has the right to vote.  We have a female  head of state and Prime Minister.  However, we also live in a country where women are under-represented in most other positions of power.  This ranges from parliament to the boardroom.   There is also growing recognition that gender equality is a wider issue and that the efforts of  privileged white women is only part of the story, even if it is acknowledged as important.  Let’s remember and celebrate that things got better 100 years ago, but not forget that we still have a way to go.

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Revision special

In just over a week, I’m sitting a professional exam. I’ve been spending most of my doodling time on that, so here’s a scribble from the margins:

Uterine fibroids are growths in the tissue of the uterus (womb). They can be quite common, particularly with increasing age, and can cause pain and per vagina bleeding. Fibroids: probably not your friend.