Posted in Genitals: A User's Guide

The Egg and Sperm Race…

A message we all seem to consistently pick up in Sex Ed and elsewhere is “you have unprotected sex, you get pregnant”.  However, if we think about this, we know that it isn’t quite the whole truth.   An often quoted statistic is that around 84% of couples trying to get conceive and having sex twice or more a week will get pregnant in a year (e.g. NHS, 2019).  If you do the sums, you can see that that’s an awful lot of sex not resulting in a pregnancy!

So, why not?  Well, pregnancy relies on four conditions that need to be met (Impey and Child, 2012):

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Firstly, an egg must be produced.  An egg is produced by the ovaries once every cycle and is only viable (capable of being fertilised) for a few days.   Sex outside of this time is less likely to result in pregnancy – remember though that sperm can live inside the vagina for up to seven days.  This means that penis-in-vagina sex that happens up to seven days before this ‘fertile window’ can still result in pregnancy!

Secondly, adequate sperm must be released.  ‘Adequate’ means that the number and quality of the sperm in ejaculate must be sufficient to fertilise an egg.

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Thirdly, sperm must reach the egg.  Lots of contraceptive methods work on this part of the process – for example from preventing sperm from entering the vagina and the womb (condoms) or by preventing the egg from travelling from where it is produced in the ovaries to the womb, via the fallopian tubes (tubal ligation, sometimes called ‘female sterilisation’).

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And lastly, the embryo (i.e. an egg fertilised by a sperm) must implant in to the lining of the womb.  This allows the embryo to survive and develop.  Again, some contraceptive methods work partly by altering this process (e.g. the copper coil or the ‘morning after’ pill).

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So, all of these four factors need to align to result in pregnancy!

 

 

References

Impey., and T. Child., (2012) Obstetrics and Gynaecology. Fourth Edition. Wiley-Blackwell: Electronic Copy.

NHS online, Overview Infertility, (Accessed online 2nd April 2019).

 

 

Posted in Genitals: A User's Guide

Unwelcome Visitors: Thrush

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Thrush is one of the causes of unusual vaginal discharge. Usually not ‘offensive’ smelling, it is often described as ‘cottage cheese’ – it has that kind of lumpy and white quality.  Or like the chest of the bird thrush, which is speckled and light compared to the rest of its body!

Unlike other causes of abnormal discharge, it is not a sexually transmitted infection.  STIs are spread from person to person, through direct contact such as skin-to-skin or bodily fluids (saliva, mucous, semen, blood, etc).  Thrush however, is an overgrowth of a type of fungal yeast (candida albicans) that ordinarily lives in other parts of the body, without causing an infection.

As well as the discharge, it is usually accompanied by an itching feeling.  Thrush proliferates in damp parts of the body.  As well as being able to cause infection in the vagina, in can therefore cultivate under the foreskin of the penis, or in skin folds around the rest of the body.

Vaginal thrush is treated with a cream, a pessary (i.e. a ‘tablet’ that comes with a device to be put straight in to the vagina), an oral tablet or combinations of these.  In the UK, this treatment is available ‘over the counter’ – you can go to a pharmacy and get it without a prescription.  However, it’s a good idea to go to your GP if it’s the first time you’ve had thrush.  They can then check that this is what it is.  It’s important to get further medical help if you’ve had regular infections or tried the treatment before and it isn’t working.  You may also need to see your doctor if you have other medical complications as well.

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References:

NHS, ‘Thrush in Men and Women’, accessed 14.11.2018.

Wikipedia, ‘Candida Albicans’, accessed online 14.11.2018.

Centre for Disease Control and Protection, ‘Candidiasis’, accessed 15.11.2018.

EMC, ‘Canestan Duo Patient Information Leaflet’, accessed online 15.11.2018.

 

Posted in Genitals: A User's Guide

Filling in the Blanks

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Every now and then I see an image of a penis whilst out and about.  Various public places lend themselves particularly to this, such as the back of loo doors or bus seats.   I bet you know exactly what it looks like.  In fact, you’re probably picturing what it looks like now, a sausage shape with two circles for testicles.  If the artist is paying particular attention to detail, you might get some strands of hair sticking out of them, or some ejaculate coming out of the top.

As yet, I’ve never seen a vulva presented in quite the same way.  Occasionally they are seen as a piece of more formally displayed art – The Vulva Gallery is my current favourite maker and curator of such images.  Why is this?  Is it the different social-cultural meaning that the different genitalia have?  Or maybe it’s just not being quite sure what to draw.

With this in mind, here’s my step-by-step guide to drawing vulvas.  I’m not encouraging you to draw on public property, but I’m wishing that more people could.

First, draw a leaf- type shape.

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This is the vestibule, the smooth bit that is usually covered by the labia.

Next, draw two ‘lips’ either side like so:

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These are the labia majora, the fatty pads of tissue that surround the vulva.  If you like, hair can be added here.  They often cover the rest of the bits that we’re going to draw, but which are still external.

Let’s add a bit more detail.  We now need to make two more ‘inner lips’, of the labia minora.

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These can be either hanging out beyond the labia majora, or can nestle within.  When people (incorrectly) talk about a ‘vaginoplasty’ or ‘designer vagina’ they are often referring to labiaplasty , or surgical reduction of this area.

We now need to start adding some detail.  First, let’s add a little round circle.  Let’s go wild and make it red.

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This represents, you’ve guessed it – the clitoris.  Or at least the bit of the clitoris that can be seen externally.  There are a lot of misconceptions about the clitoris.  Suffice to say, the bit that you can see here represents just a small part of the total structure of the clitoris. It is a sensitive area, which contains millions of nerve endings and is often overlooked because its main purpose seems to be sensual with no conventional reproductive function.

Moving on to another often over looked area of the vulva is the first of the two ‘openings’ in to the internal part of the body, the urethra.  Let’s draw another small circle in the vestibule to represent the area where urine comes out, running straight from the ‘storage’ area of the bladder:

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An important point to note is that this is a separate and distinct area from the vagina.   Urine comes out of this.  Babies, periods and discharge from infections of the internal reproductive tract do not.   They come from the second ‘hole’ in the vestibule, the vagina.  Of course, in real life it isn’t a hole that maintains itself and is ‘squashy’, although can accomodate being made larger – e.g. by neonates’ heads, tampons or penises, for example:

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So if it’s a bigger than this, or more squashy, that’s spot on.

You can stop here.  Because it’s often overlooked, I’m going to add some remnants of the hymenal tissue.  Note that in health, this is not a complete covering or seal.

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Voila!  And remember – this is only a schematic.  Vulvas you have seen may look completely different from this AND THAT IS ABSOLUTELY FINE.

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.