Posted in Genitals: A User's Guide

It’s What’s Inside that Counts?

My weakest area at med school was definitely anatomy. I enjoyed it though. Each week, we would go to the anatomy suite where the cadavers were kept and I would learn another thing I was previously mistaken about. The relationship between what we see and understand on the outside and what and where it is on the inside is often not straightforward.

The stomach, for example, is not the low down bit of the abdomen people hold when they have ‘bellyache’ – that’s more like bowels. This is part of the gut, but with has a distinct and different function. What a lot of people think of as the ‘vagina’ (the passage from the external body to the womb) would actually be better described as the ‘vulva’. In my experience, these misconceptions are rife in ideas about our reproductive organs. Let’s have a look at some of the internal xx anatomy…

Vagina: a passage leading from the outside to internal parts. It’s made up of muscular, stretchy tissue that can deform and accommodate various things (tampons, fingers, foreign objects, a baby…).

Cervix: the lower bit of the womb. Roughly tube shaped and typically around 2-3cm long. It has a hole (the cervical ‘os’) which leads from the vagina to the womb. It can change shape, size and consistency under hormonal control – e.g. getting smaller and opening during childbirth.

Uterus: Or ‘womb’. This is where a baby can grow. Sits just behind the bladder in non-pregnancy. The lining of this cavity is called the ‘endometrium’. It is the endometrium thickening and then shedding that is experienced as periods. The top bit of the uterus is called the ‘fundus’.

Fallopian tubes: connect the uterus to the ovaries. Also called the ‘salpinges’ or a ‘salpinx’. Each one ends in a ‘fimbria’. This is a little fringe of tissue that helps convey eggs in to the tubes from the ovaries.

Ovaries: whitish lumps of tissue where eggs are released from. They also produce hormones so have an important endocrine role.

All of these structures sit quite low down in the abdomen. Sometimes problems that feel like they are coming from this reproductive tract can be mistaken for problems with the bowel and vice versa. We’ll have a look at some of these problems another time…

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/}