Friday, June 20, 2008

Female Reproductive System

Understanding your reproductive system is an important part of knowing how to prevent or increase your chances of pregnancy. While most women know the basics, many don't realize that there is more to your reproductive system than just your period.

  • Ovulation and the Menstrual Cycle

Every month, your body goes through normal and natural changes that assist your ovaries in releasing an egg, which may or may not get fertilized during the month. This process is known as the menstrual cycle. Day one of your cycle is the first day of menstruation; this is the first day that you bleed during your period. The length of your cycle can vary every month. To determine your cycle's length, simply count the days from the first day of your period up to, but not including, the first day of your next period. The average woman's menstrual cycle last about 28 days but it is perfectly normal for your cycle to last anywhere from 24 to 34 days.
The typical menstrual cycle begins with your period during which time your low hormone levels signal to your body to begin producing more hormones. Although your egg follicles will begin to develop as many as 20 eggs, only one will mature and be released into your fallopian tube about halfway through your menstrual cycle. The process of your egg follicles releasing the egg is known as ovulation. On average, ovulation occurs 14 days before the start your period. However, it is normal for a woman to ovulate anywhere from 12 to 18 days before menstruation.
This increase in hormones not only helps to develop an egg but also your endometrium (the lining of the uterus), which becomes thicker and more suitable for implantation of a fertilized egg. Your cervical mucus also changes as your cycle progresses, going from dry and thick at the start of your cycle to thin and slippery around the time of ovulation. This thinner cervical mucus will make it easier for sperm to swim towards the fallopian tubes and the released egg.
Once an egg has been released, the sides of the fallopian tube periodically spasm aiding the egg in traveling down the tube towards the uterus. If the egg fails to be fertilized during this time, it will break up once it reaches the uterus. Additionally, since your thickened endometrium is also no longer needed as there is no fertilized egg to implant itself into the lining, the lining will shed over a period of three to eight days. This discharge is what makes up your menstrual flow.

The uterus, located in a woman's abdomen, is a hollow, elastic reproductive organ, where a baby develops during pregnancy.

  • A Woman's Reproductive System
Your reproductive organs are comprised of a vagina, a cervix, a uterus, fallopian tubes and ovaries. All of these organs work together to help you menstruate, conceive and carry a baby to term.

  • Vagina: This tube like structure connects your internal reproductive organs with your external genitalia. It ends at the cervix and is the point of entry for the penis during sex as well as the final passageway through which a baby exits when it is born.
  • Cervix: This part of your reproductive organs is situated between the vagina and uterus. It secretes mucus that can help or obstruct sperm from fertilizing an egg. The cervix is the opening that sperm must pass through in order to get to an egg. A baby must also go through the cervix as it exits the uterus and enters the vagina.
  • Uterus: Also known as the womb, the uterus is a muscular organ made up of three layers: the peritoneum (outer layer), myometrium (middle layer)and endometrium (inner lining). An egg that has been fertilized will implant itself into the endometrium lining and will continue to develop in the uterus throughout the pregnancy.
  • Fallopian Tubes: The fallopian tubes extend off the upper sides of the uterus and lead up to the ovaries. They have 20 to 25 finger-like structures on their ends that hover just above the ovaries and work to collect the mature egg when it is released. It is in the fallopian tubes that fertilization of the egg will take place.
  • Ovaries: Women usually have two ovaries, one on each side of the uterus. Ovaries are the storing house for your egg follicles; every month, one of these egg follicles will mature and release an egg into the fallopian tubes. The ovaries are also responsible for producing estrogen and progesterone, which are vital for proper reproductive function.
  • Conception and Pregnancy:Once an egg has been released from the ovaries, it will begin to travel down the fallopian tubes towards the uterus. As it advances towards the uterus, it begins to produce an enzyme that helps to attract and guide any sperm that may have been ejaculated into the female reproductive system during sex.
    Although a man releases millions of sperm when he ejaculates during orgasm, only a few hundred will be able to make it all the way from the cervix up into the uterus and then into the correct fallopian tube. Just one sperm will then be able to make its way through your eggs tough coating to fertilize the egg. The fertilized egg will then continue traveling down the fallopian tube to the uterus. Once in the uterus, the egg will implant itself into the endometrial lining and officially become an embryo. Your body will also probably start letting you know that it is pregnant now.
  • Trying to Conceive
A woman is fertile only for a few days during each menstrual cycle. If you are trying to conceive, it is a good idea to chart and monitor the changes in your body every month. This will help you identify just when ovulation is taking place. Charting your monthly changes can also be beneficial to those women who are trying to avoid pregnancy. If you know when you are ovulating, you can know when to abstain from sex or use birth control.
You are most likely to become pregnant if you have sex on or near the time of ovulation. Once ovulation has occurred, there is only about a 24-hour window in which the egg can be fertilized. However, while an egg has a very limited lifespan, sperm can remain viable inside a woman anywhere from three to seven days. Therefore, a woman is thought to be most fertile from several days before to one day after she has ovulated.


If you are thinking about becoming sexually active, or if you are already engaging in sexual activity, you may be thinking about investing in a reliable form of birth control. When used effectively, birth control methods can help to guard against unplanned pregnancies, and may even help to protect against certain STDs. The diaphragm is a very popular choice for women when it comes to contraception. A very comfortable and affordable option, the diaphragm can be washed and reused, and has been proven to be very effective against pregnancy.

What is the Diaphragm?The diaphragm is a type of barrier birth control that is used to prevent sperm from entering the uterus. Made out of a thin, flexible silicone rubber, the diaphragm looks much like a small dome or cup. Designed with a flexible ring around the top, the diaphragm is inserted into the vagina prior to sexual intercourse. The diaphragm should be used along with a spermicidal cream or jelly in order to increase its effectiveness. Diaphragms are available by prescription from your health care provider.

  • How Does the Diaphragm Work?

The diaphragm works by creating a barrier between sperm and your uterus. The diaphragm slides into place behind your pubic bone, completely covering your cervix. This prevents any sperm deposited during sexual intercourse from swimming through your cervix and into your uterus, where fertilization of an egg could take place. Spermicide placed inside of the dome and around the rim of the diaphragm helps to kill any sperm that comes into contact with it. As a result, sperm is prevented from slipping around the diaphragm and swimming into your uterus.

  • Fitting a Diaphragm
Unlike other birth control options, diaphragms need to be fitted by your health care provider. It is essential that you get a diaphragm that is well fitted because improperly fitted diaphragms can lead to pregnancy. During a pelvic exam (in which your health care practitioner feels your ovaries, fallopian tubes, and cervix) your vagina will be measured in order to determine the size of your diaphragm. Your doctor will insert a number of different sized rubber rings inside your vagina. Your diaphragm will correspond to the largest sized ring that you find comfortable.
It is important to get your health care provider to check the fitting of your diaphragm every year or so. If you gain or lose weight, become pregnant, or give birth to a baby, it is likely that your diaphragm will no longer fit properly. This could increase your chances of pregnancy. Diaphragms need to be replaced every two to three years. They typically cost between $30 and $70.

  • Using a Diaphragm
When you are fitted for your diaphragm, your health care provider will teach you how to insert, remove, and use your diaphragm properly. Diaphragms can be inserted up to six hours prior to intercourse. However, you will need to add more spermicide inside of your vagina every two hours, or each time you have sexual intercourse. For this reason, it is usually recommended that you insert your diaphragm no more than two hours prior to sexual intercourse.
Before inserting your diaphragm, you will need to place spermicide jelly or cream inside of the cup of the diaphragm. About a teaspoon is required. Also rub spermicide around the rim and edges of the diaphragm. To insert the diaphragm, pinch the rim of the cup together, so that the diaphragm folds in half. Push it inside of your vagina until the diaphragm cannot move anymore. Fold the tip of the diaphragm up behind your pelvic bone. You should not be able to feel the diaphragm.
You should not remove the diaphragm until at least six hours after you have had sexual intercourse. Do not leave the diaphragm inside your vagina for more than 24 hours. To remove, place your finger under the rim of the diaphragm and pull down and out. Be careful not to puncture the rubber diaphragm with your fingernail. Wash the diaphragm with warm water and soap and place it inside of its protective case. Do not put talcum powder, vaginal creams, or oil-based lotions on the diaphragm; this can cause it to crack and increase your risk of pregnancy.

  • How Effective is the Diaphragm?
When used correctly, the diaphragm is a very effective way of guarding against an unplanned pregnancy. However, as with the cervical cap and lease shield, the failure rate associated with the diaphragm does vary, depending upon how you use it. It is essential that your diaphragm fits well and that you use it every time you have sexual intercourse. You must also use it in combination with a spermicidal cream or jelly. When used perfectly, the diaphragm is more than 91% effective.

  • Advantages of Using the Diaphragm

The diaphragm is associated with a number of advantages:
The diaphragm is easy to insert and remove.
The diaphragm is inexpensive and reusable.
When inserted correctly, the diaphragm cannot be felt by either partner.
The diaphragm does not affect future fertility or your menstrual cycle.

Disadvantages of Using the Diaphragm

The diaphragm does come with a few disadvantages:
If left in for more than 24 hours, the diaphragm can increase your risk of Toxic Shock Syndrome (TSS).
Continual use of spermicide can irritate the lining of your vagina and possibly increase your risk of contracting an STD.
The diaphragm can increase the likelihood of bladder infections.
The diaphragm does not protect against STDs In order to protect against STDs, it is imperative that you use a condom every time you have sex.

Having Sex During Your Period: Q&A

  • Is it Safe To Have Sex During Your Period?

Many men and women worry that having sexual intercourse during a woman�s period is unhealthy. Though frowned upon in many cultures and faiths, sexual intercourse during menstruation is entirely normal and completely healthy.
Worries about this act generally stem from societal misconceptions about menstrual blood: most girls are taught from a young age that their menstrual blood is unclean and "dirty," and therefore should be hidden and contained at all times. However, menstrual blood is an entirely natural bodily fluid, and does not in anyway affect a man�s penis or a woman�s reproductive tract. As long as you are engaging in safe and protected sexual intercourse, it is entirely alright for you and your partner to have sex during your period.

  • What About Oral Sex?
Though some men and women may find the thought of oral sex during menstruation a little bit off-putting, many partners do engage in this act. If you and your partner are considering having oral sex during your period, rest assured, it is entirely safe to do so. However, because menstrual blood can contain STD bacteria or viruses, it is essential that you and your partner use appropriate protection. Use a dental dam throughout oral sex as well as a condom during sexual intercourse.

  • Does Sex Help to Manage Period Pains?
Many women find that sexual intercourse actually helps to relieve period pains and menstrual cramps. This is because an orgasm can cause your uterus to contract, enabling it to use up excess prostaglandins in the process. Prostagladins are hormones produced by your uterine lining. They help to stimulate contractions that move menstrual blood out of the uterus, and are also responsible for those cramps that occur throughout your period.

  • Can You Get Pregnant During Your Period?
Though possible, it is highly unlikely that you will get pregnant during your monthly menstrual cycle. During your period, your body works to shed the uterine lining that it has been building up over the last month, in preparation for pregnancy. When you don�t become pregnant, small uterine contractions begin, encouraging the unfertilized egg and unused endometrium to be shed from the uterus and through the vagina. This means that there is no egg in the fallopian tubes to become fertilized and no lining to help a developing embryo to implant properly.
This being said, there is a small possibility of pregnancy during your period. Women often mistake slight bleeding that can occur with ovulation as their period. Unprotected sex at this time can greatly increase your chances of becoming pregnant. Additionally, sperm can live in the female reproductive system for up to three days. Because some women ovulate at the very end of their menstrual periods, sperm may still be alive at this point, and able to fertilize an egg.

  • Can You Avoid Catching an STD if You Have Sex During Your Period?

There are a number of myths going around that it is impossible to contract a sexually transmitted disease if you have sex while you are menstruating. Unfortunately, this myth is completely false, and you and your partner are still at risk for contracting any type of STD if you have unprotected sex during menstruation.
Menstrual blood, like semen and vaginal secretions, contains the HIV virus as well as the bacteria associated with a number of other STDS, including Syphilis and chlamydia. Additionally, many women experience herpes outbreaks during their monthly periods, which may actually increase your risk of spreading this disease to your sexual partner. When engaging in sex, no matter what time of the month it is, it is necessary to wear a condom in order to prevent STD transmission.

  • Can Having Sex During Menstruation End Your Period?

If you have had sexual intercourse during menstruation you may have noticed that your period comes to an abrupt end within a day of intercourse. Though you may be worried that somehow your menstrual blood has "backed up" or gotten stuck somewhere in your reproductive tract, this is not the case. In fact, your period has probably ended because sexual intercourse has stimulated an increased number of contractions in your uterus, causing your body to expel your menstrual blood more quickly.
During orgasm, your uterus goes through a number of muscular contractions, which can help to speed up menstruation; as your uterus contracts, the endometrial lining begins to shift and is forced out through the vagina. Additionally, semen contains prostaglandins, hormones responsible for causing uterine contractions. The combination of prostaglandins and orgasm may contribute to an increased number of uterine contractions and therefore cause the rest of your menstrual blood to be quickly shed.

  • How do You Avoid Making a Mess When Having Sex During Your Period?

Women and men often dislike having sex during menstruation because of the mess that it can cause. However, with a little careful planning you can keep the mess contained and focus on enjoying the experience.
If you are going to have sexual intercourse, try to get your partner to straddle you while you are lying on your back: this will help to slow the bleeding. Lay down some spare towels or sheets beforehand, so that it will absorb any excess blood. You may want to think about wearing a Diaphrgm or cervical cap during sexual intercourse. These will protect you from pregnancy and work to contain any menstrual fluid. However, these barrier methods of birth control should not be used on an everyday basis to collect menstrual blood. Although they are similar, diaphragms and cervical caps are not the same as menstrual cups.

Monday, June 9, 2008

Illustrations of the hymen in various states

This shows the names of the parts of the vulva. The rest of the illustrations do not have labels.

This is a perfect annular hymen. It is called annular because the hymen forms a ring around the vaginal opening. As the hymen starts to erode from sexual or other activity, the hymen becomes less ring-like.

This is a crescentic, or lunar, hymen. It forms a crescent shape, like a half moon, above or (as in this case) below the vaginal opening.

The hymen of a female with some sexual or masturbatory (internal) experience is apt to look something like this. Note that it is much less ring-like than the annular hymen.

This is what the hymen of a female who has only had a small amount of sexual activity or object insertion would look like. Health professionals who examine hymens for signs of sexual abuse are usually most interested in the posterior part of the hymen, from the 3 o'clock to 9 o'clock position. This is normally where the hymen breaks when the vagina is first penetrated.
This is the vulva of a woman who has given birth. The hymen is completely gone, or nearly so.
One in 2000 girls is born with an imperforate hymen. A doctor will do surgery to create a hole in the hymen of such a newborn.
This is a rare cribriform hymen, characterized by many small holes. This type of hymen lets menstrual and other fluids out with no problem, but sexual activity and the insertion of tampons can be problematic.
This is a rare denticular hymen, so called because it looks like a set of teeth surrounding the vaginal opening.

This is a rare fimbriated hymen, with an irregular pattern around the vaginal opening.

This rare labial hymen looks like a third set of vulvar lips.

Some girls are born with only a tiny hole in their hymens. Surgery is also necessary for these newborns to create a larger vaginal opening.

This rarity is called a septate hymen because of the piece of hymen that makes a septum, or bridge, across the vaginal opening.

This is the rare subseptate hymen, similar to the septate hymen only not making a bridge all the way across. Doesn't this remind you of the view into your throat with the uvula hanging down?

Saturday, June 7, 2008


is one of the easiest ways of attaining and maintaining good
health and well being. It’s a healing instinct, innate
in all of us, to rub an aching knee, or stroke a furrowed brow.
Headaches, aches and pains, insomnia, tension and stress can
all be alleviated with one simple instrument -- our hands.

The basis of massage is touch. There is increasing medical evidence to
show the great value of touch. Touch is so natural that without
it people become depressed and irritable. Observations show
that children brought up in families where parents and children
touch each other are healthier and more able to withstand pain
and infection than those children deprived of touch. They tend
to sleep better, are more sociable and generally happier.

all the evidence to show the benefits of touch, we are still
hesitant about touching each other. We think this is due to
a confusion between sensuality and sexuality. Because we are
so afraid of the connection between sex and touch, we have formalized
touch. There are only a few occasions when adults are allowed
to touch each other freely. Massage removes the taboos of touching
and allows people to touch in a positive way.

Benefits of Massage

Massage has amazing effects on the health of the person being massaged.
It improves circulation, relaxes muscles, aids digestion, and
by stimulating the lymph system, speeds up the elimination of
waste products. These direct benefits, combined with the psychological
benefits of feeling cared for quickly produce a wonderful feeling
of well-being that cannot be matched by modern drugs.
You can
easily manage to massage yourself. Use self-massage to energize
yourself before school or work in the morning, or to unwind
in the evening. You can massage your feet while watching TV,
or massage your hands while talking on the phone. You do not
need to undress, but you must be comfortable. Use oil if you
are massaging on bare skin. Sit in a chair or on the floor,
or lie down with your knees bent and your feet on the floor.


Most people suffer from occasional stiff necks, aching shoulders
and headaches, so the shoulders are the perfect place to begin

Stroke your right shoulder with your left hand. Mold your hand
to the curves of your body. Starting at the base of your skull,
stroke down the side of your neck, over your shoulder and down
your arm to the elbow. Glide back to your neck and repeat at
least three times. Then do the other side.

Make circular pressures with your fingertips on either side
of the spine. Work up the neck and around the base of the skull.
Then knead each shoulder; squeeze and release the flesh on your
shoulders and at the top of your arms.

Loosely clench your left hand into a fist and gently pound your
right shoulder. Keep your wrist flexible. This springy movement
improves the circulation and can be very invigorating if you
are tired. Repeat on the other side.


Finish by stroking softly and smoothly both hands.
Start with your hands on the side of your face and glide them
gently down under your chin. Slide your hands past each other
at the front of the neck, so that each hand is on the opposite
shoulder. Stroke gently over your shoulders, down your arms
and off at the fingertips. Repeat as often as you like. This
hypnotic stroke is so relaxing and can relieve headaches and


Knowing how to massage your own legs is very useful whether you are athletic or not. Leg massage can relieve aching after standing
too long & help tired muscles recover after exercise.
It stimulates the lymph system and regular thigh massage is believed
by many to improve the appearance of thighs by smoothing them
out & preventing cellulite. Do the whole sequence on one
leg first, then the other one.

First, mold your hands to the shape of your leg, rest your foot
flat and bend your knee up. Start by stroking your whole leg
from ankle to thigh with one hand on each side of the leg. Begin
at the foot and stroke smoothly up the calf, over the knee and
up to the top of the thigh. Repeat five times.

Knead the whole thigh, paying attention to the front and outside.
With alternate hands, rhythmically squeeze and release the flesh.
This regular kneading can really improve the shape & texture
of the thighs.

After that step, smooth your thigh by stroking it. Stroke up
the thigh from the knee with one hand following the other.

Pummel the front and outside of your thighs with loosely clenched
fists. This bouncy movement brings blood to the surface and
relieves stiffness after sitting down for too long.

. Massage all around your knee, stroke the area
gently, then apply circular pressures with your fingertips around
the kneecap. Finish by stroking softly behind your knee up toward
your body.

Knead your calf muscles with both hands, alternating squeezing
the muscle away from the bone & then releasing it. Then
gently soothe the area by gently stroking, one hand following
the other up the back of the leg.


It's easy to massage your own feet. If you are sitting up, rest one
foot on the opposite leg. Bad posture, back ache and fatigue
can all stem from unnoticed foot problem. By massaging your
feet daily you can refresh your whole body.

Put one hand on top of the foot and the other under the sole,
then stroke smoothly from your toes to your ankles. Glide your
hands back to your toes and repeat.

Support your foot with one hand and work on each toe individually.
Squeeze it firmly, and gently stretch each toe with a gentle

one thumb on top of the other, do a line of firm pressures down
the center of the sole and lines on either side. Then, with
one thumb, do circular pressures on the arch and the ball of
the foot.

Support your foot with one hand and make the other into a loose
fist. Do knuckling movements all over the sole by rippling your
fingers around in small circular movements.

Then, still holding the foot with one hand, hack the sole with
your other hand, Flick your hand away the moment you touch the
foot, so that the effect is light and springy.

Stroke around the ankle with your fingertips, as you stroke
up toward the leg and gently as you glide back. Finish by stroking
the foot as you did at the beginning.


It is natural to rub your stomach when it aches, and any form of
massage, however basic, is extremely comforting. It is also good
for menstrual cramps. Lie down to massage your abdomen with your
knees bent up.

Stroke clockwise around your abdomen with one hand following the
other in a circle, using the whole surface of your hands.

Knead all over your abdomen with your fingers and thumbs. Then
roll onto your side to knead your hips and bottom. Turn onto your
back and stroke around your abdomen again.

Pummeling hips: To wake yourself up after a massage, pummel your
hips and bottom vigorously. Stand up and with loosely clenched
fists, pummel the area very quickly. Not only does this leave
you feeling refreshed and energized, it also improves the circulation,
muscle tone and skin texture.
your wrists very flexible. Flick your hands away as soon as you
strike the skin.

What is Dysmenorrhea?(painful menstruation)

This condition refers to the pain or discomfort associated with menstruation. Although not a serious medical problem, it’s usually meant to describe a woman with menstrual symptoms severe enough to keep her from functioning for a day or two each month.Many teens don't suffer from dysmenorrhea, as their uterus is still growing, and yet they may get it several years after their first period begins. Symptoms may begin one to two days before menses, peak on the first day of flow, and subside during that day or over several days.The pain is typically described as dull, aching, cramping and often radiates to the lower back. The pain from your period that is severe enough to be given this name by your health care provider is thought to be the result of uterine contractions, caused by prostaglandins (a hormone-like substance, normally found in your body). Prostaglandins are known to stimulate uterine contractions. In addition to pain other symptoms may include, headache, diarrhea, constipation, and urinary frequency and fainting.

How Can I Get Relief?
There are many over-the-counter drugs NSAIDs -- (ibupofen and naproxen), and acetaminophen that may provide relief. A heating pad works well for cramps when used OTC pain meds. Some women benefit from exercise, some from rest. There are also prescription drugs to help alleviate this painful disorder. Talk to your health care provider about them. Before you diagnose yourself, see your health care provider to be sure the pain you are having is not associated with another condition like PID endometriosis, or any other medical conditions.

Help with Cramps -- By Jennifer Johnson, MD
Menstrual cramps are a very common problem for adolescent girls and women. They may be mild, moderate, or very severe. In fact, they are the single most common cause of days missed from school and work. About ten percent of girls are incapacitated for up to three days each month.

What are cramps? About 80 percent of the time, cramps are part of the primary dysmenorrhea syndrome. Cramps are caused by hormones called prostaglandins, which cause painful cramping of the uterus during menstruation. The production of prostaglandins in the uterus is stimulated by the hormone progesterone, which is made by the ovary after ovulation has occurred. These prostaglandins can affect other organs as well. Frequently, back pain, headaches, nausea and vomiting, dizziness, and/or diarrhea accompany menstrual cramps. These symptoms may begin a day or so before the menstrual flow begins; they usually peak by the second day of flow. Medications are the single best treatment for cramps. Other remedies are helpful also. I’ll discuss both in the following sections.

Medications for Treating Cramps Many teens and women do not realize that there are very effective medications that can relieve not only menstrual cramps, but also the other symptoms that may accompany them. Generally these medications fall in the category of nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen. Some NSAIDs are available in both non-prescription strength (over-the-counter, or OTC) and in larger doses by prescription only. Other NSAIDs are only available by prescription.For some girls, cramps begin a day or so before their period starts; girls may also notice signs that their period is coming, such as abdominal bloating or constipation. In this case, it can be very helpful to begin taking the medication before the period actually begins.

For mild cramps, I recommend starting with acetaminophen or ibuprofen at the lower dose, at the lower number of daily doses. Acetaminophen is not an NSAID but is a pain reliever. It works well for some women. Increase as needed to the maximum dosage and frequency indicated in Table I (and on the bottle); if relief is not achieved, switch to a different medication at the higher dosage and frequency.

For moderate to severe cramps, I recommend starting with ibuprofen 200 milligrams four times daily or naproxen sodium 220 milligrams twice daily. Again, increase as needed to the maximum dosage and frequency. If cramps are moderate or severe, it is also important to continue taking the pain reliever regularly, even if there is no pain when the dosage is due. The regimen should be continued until the day when symptoms would subside, which is usually by the third day of the menstrual period. If ibuprofen or naproxen sodium at the maximum daily dose does not relieve symptoms adequately, it’s time to contact your health care provider. Also, there are prescription-only medications that are especially effective against the other problems such as nausea, vomiting, and diarrhea. Don’t give up hope. Under medical supervision, higher doses and other medications are safe and effective

Practical Suggestions for Medications: Since many schools restrict access to medications and because it is simply more often recommend that patients select medications that can be administered three times a day or less. Take the first dose in the morning, the second right after school, and the third about eight hours later. I recommend taking any of these medications with a meal or small snack and a glass of milk, juice, or other liquid. Rarely, a large tablet or capsule may have trouble making its way all the way down the esophagus; the liquid helps wash it down. Review the package directions and warnings carefully, and heed them. Do not take one of the listed drugs together with another one on the list, or with any other NSAID. A girl taking any medication on a daily basis should check with her doctor before starting any of these medications. Sometimes, though, more help is needed for primary dysmenorrhea than just NSAIDs. Of the prescription-only NSAIDs, I find mefenamic acid (Ponstel ®) to be especially useful. It not only works to eliminate cramps, but it can really help with diarrhea, nausea, and vomiting.

What if Pain Medications Don’t Work? I generally work with patients to adjust NSAID treatment regimens for three to six months. Occasionally, we find that even the highest-strength prescription regimens still don’t help. Before changing to other medications, I schedule a pelvic examination to evaluate for other, far less common causes of menstrual cramps. If one of these causes exists, the dysmenorrhea is referred to as secondary dysmenorrhea. Causes of secondary dysmenorrhea include infection in the genital tract, a narrow passageway connecting the inside of the uterus to the vagina (the cervical canal), and endometriosis.Endometriosis is a condition in which nodules (bumps) of tissue just like the lining of the uterus are found on internal organs in the lower abdomen. It can cause very severe, debilitating pain that is not necessarily limited to the menstrual period. Sometimes the tissue nodules can be found during careful pelvic examination. Under these circumstances, I also need to insert a gloved finger into the patient's rectum during the examination.

Hormonal Treatment for Period Cramps: Assuming the pelvic examination is normal and I don't suspect endometriosis or another condition, I recommend adding hormonal treatment for girls with severe dysmenorrhea that has not responded to NSAIDs alone. The hormones prevent ovulation, and thus prevent the ovary from causing the production of the pain-causing prostaglandins. As you probably know, the oral contraceptive pill (OCP) prevents ovulation. And this is the easiest, least expensive way to use hormones to treat severe primary dysmenorrhea. OCPs are 80 percent to 90 percent effective when used for this purpose.

The Pill -- Once in a while, a parent asks me, “Won’t Ashley think that if she's taking the pill, it's license to have sex?” In one sense, the answer might be yes. Not knowing how to get the pill does indeed prevent some careful teenagers from having sexual intercourse. Therefore, I suppose that occasionally a girl who has not had sex because of this concern might start having sex if she were put on the pill for medical reasons. However, most teenagers know that condoms alone are very effective in preventing pregnancy and many sexually transmitted infections. In other words, any concern over the absence of the added protection provided by the pill will not discourage most teens from engaging in sex if they so desire.

Natural Remedies for Cramps - Menstrual cramps have been around for thousands of years, and so have many non-medical treatments. I recommend that nonmedical remedies be used in addition to the pain medications described above. Rest and stress reduction Like many other conditions, cramps may be made worse by fatigue from too many late nights and by anxiety. So, getting enough rest before a period is due can actually help prevent bad cramps.

Heat, in the form of a warm bath or a heating pad applied to the lower abdomen, can be very helpful (and comforting).

Exercise -- A girl who exercises regularly, and who feels up to it despite having cramps, may find that continued participation in her usual activities helps relieve the cramps. I encourage my patients to continue their daily routine during their period as much as possible.

Bed rest is not a documented remedy for cramps; some doctors believe instead that walking about helps expel the menstrual products, and the prostaglandins they contain, from the uterus. Additionally, anxiety generally increases as a girl worries about making up missed school assignments. On the other hand, cramps are occasionally truly incapacitating, and trying to force a “stiff upper lip” won’t help.

The Menstrual Cycle

The "typical" menstrual cycle occurs regularly over 28 days. Most women have cycles with an interval that lasts from 21 to 35 days. Frequently cycles are unusually short or long during adolescence.

THE FIRST HALF OF THE MENSTRUAL CYCLE (Day 1 to About Day 14 in a 28-Day Cycle)
The Menstrual PhaseThe first day of your menstrual period is considered Day 1 of your cycle. The menstrual phase includes your period. During this time, the endometrium (the built-up lining of the uterus) is shed, along with a little blood. Many of the problems that women experience with their menstrual cycle occur during this phase. For example, some women experience menstrual disorders such as dysmenorrhea (painful periods) or menorrhagia (unusually heavy periods).
The Follicular/Proliferate PhaseDuring the proliferate phase, the body produces a hormone called follicle-stimulating hormone (FSH). Follicle-stimulating hormone promotes the growth of a follicle (egg sac) within the ovary. An ovum (egg) matures in the follicle during the proliferative phase. FSH also stimulates the ovary to produce increasing amounts of estrogen. In turn, the estrogen causes endometrial tissue to build up (or proliferate), lining the interior of the uterus.
THE MIDPOINT OF THE MENSTRUAL CYCLE (About Day 14 in a 28-Day Cycle)
The mature ovum bursts from the follicle about midway (approximately 2 weeks before onset of next menstrual period) through the menstrual cycle. This process is known as ovulation. The ovum then travels from the ovary down the fallopian tube, and into the uterus.
The Luteal/Secretory PhaseOnce the ovum has been released, the follicle becomes a sac known as the corpus luteum ("yellow body," because it contains yellowish, fatty matter). A hormone called luteinizing hormone (LH) causes the corpus luteum to grow and to secrete progesterone, another female hormone.
During the secretory phase, progesterone makes the endometrial lining stronger and spongy in texture. Progesterone also stimulates glands in the endometrium. These glands produce uterine fluid, and their purpose is to support embryonic development if fertilization has occurred at or around the time of ovulation. It is in this phase of the menstrual cycle that women who suffer from premenstrual syndrome (PMS) may begin to experience their symptoms. Generally symptoms are worse during the last seven to ten days of the cycle, ending at or soon after the start of the menstrual period. In a woman who hasn't become pregnant, the level of progesterone peaks about a week after ovulation and then begins to drop along with the estrogen level. The flow of blood to the endometrium decreases, and its upper portion is broken down and shed during menstruation. At the same time, the corpus luteum withers.
The dip in estrogen and progesterone at the end of the cycle help let the body know that it's time to start the cycle all over again. The menstrual cycle doesn't have to be a drag, it actually shows how complex your body is and a sign that it is functioning properly! Congratulations, you are a woman and being a woman is terrific!

The Charts
The Ovarian Cycle chart shows the maturation and deterioration of the ovum and how it occurs every month.

The Endometrial Cycle chart shows how the endometrial lining builds up during the normal menstrual cycle and then is broken down and shed during menstruation (menses). Meanwhile at the same time back at the Ovarian Cycle chart, the corpus luteum withers.

Aren't women amazing! The menstrual cycle is actually a very cool and very complex process that results from the many parts of the body working together. The brain, the ovaries, the adrenal glands, and even the thyroid all have to come together with their different hormonal and chemical influences. I guess you could say it is kind of like a small orchestra in your body.

PMS(Premenstrual Syndrome)

(Premenstrual Syndrome) is a term used to describe a cluster of physical and emotional distress occurring late in the post ovulatory phase of the menstrual cycle and sometimes overlapping with menstruation. We are talking about the time one or two weeks before your period begins. Remember, every woman is different.
Symptoms usually increase in severity until the onset of your period and then disappear dramatically. Among these symptoms are weight gain, breast swelling and tenderness, abdominal distention, water retention, backache, acne, fatigue, diarrhea, constipation, nausea, sensations of prickling/tickling on skin, herpes/cold sores, bruising easily, joint pain/arthritis, body aches, poor concentration, difficulty making decisions, insomnia, loneliness, greater need for sleep, headache, anxiety, mood swings, depression, crying spells, cravings for sweets or salty foods.
The real cause for PMS is still unknown. It is estimated that 75 - 80 % of all women experience some PMS symptoms during their lifetime. The incidence of PMS seems to increase with age, so as a teenager you may not experience PMS. It seems to be less common in women in their teens and twenties, so as you get older you may find yourself experiencing PMS. But don't stress about that now.
Although PMS is clearly related to the production cycle of ovarian hormones, these symptoms are not directly related to the levels of these hormones. Fluctuations in the balance of estrogen and progesterone may be one of the causes of PMS. I know this sounds confusing, it is still confusing many medical people. One hormonal fluctuation can cause one symptom which leads to another symptom, and so on.
Estrogen excesses, progesterone deficiencies, Vitamin B6 deficiencies, low levels of serotonin (a brain chemical), an excess of prolactin (a protein hormone that induces lactation), and altered glucose metabolism are among the many different theories that attempt to explain PMS, but none have been proven.
(Sept. 2002)... Researchers now know that PMS is not a simple result of an imbalance of estrogen and progesterone — commonly referred to as “female hormones”, or any other single hormone. A number of studies have found nothing abnormal in the levels or ratios of these hormones in women who experience PMS.
A complex interaction of neurohormones and other brain chemicals are suspected to have a more direct relationship in triggering PMS. Exactly how these brain chemicals change with or affect the menstrual cycle remains unclear. However, treatment studies are becoming more focused and will most likely soon lead to a better understanding of the menstrual cycle and the effects of hormones on human behavior.
For example, three recent studies have pointed to calcium deficiency as a main culprit causing premenstrual syndrome. Therefore, calcium supplementation may go a long way toward helping you to relieve your PMS symptoms. In one study, researchers found that women who received 1,200 mg of calcium carbonate each day for three menstrual cycles had a 50 percent reduction in PMS symptoms particularly mood swings or depression, pain, cravings, and water retention — plus many of the other symptoms, as well.
Calcium deficiency triggers an elevation of female hormones in the body to stabilize the imbalance. The relationship between the abnormal calcium levels and female hormones triggers PMS symptoms. If you correct this imbalance, you will return hormone levels to their normal range. Some experts think that PMS may be a simple mineral deficiency, and that PMS symptoms could be a monthly reminder to you that you aren't consuming enough calcium, and possibly not enough vitamin D.
For many years, PMS was believed to be purely psychological. Many women were even diagnosed as being mentally ill from PMS. We now know that PMS is a physical problem involving many of the bodies hormones that work together normally, but are imbalanced during this time of a women's cycle.
Treatment is individualized depending on the type and severity of symptoms. It may include changing what you eat, over-the-counter drugs (ibuprofen (Advil) or naproxen (Aleve), or medication prescribed by your health care provider. One approach to managing PMS provides medical and social support that may include education of the patient and her family and eliminating fear and incorrect beliefs about menstruation. If you suffer from PMS see your health care provider or gynecologist.One of the most important strategies for coping with premenstrual discomfort is developing self-awareness. The more you are aware of a pattern, the better able you will be to develop strategies to recognize and cope with your symptoms, whatever they may be.
When the chemistry of the brain is better understood, we might get a better understanding of this complex disorder that produces such a wide range of symptoms for so many women. The true incidence and nature of PMS has only recently been recognized by some health care providers, and its cause and treatment are still being studied.
While the numbers are staggering the medical profession remains at odds when it comes to identifying a cause, diagnosis and effective treatment. Today many doctors fail to acknowledge the existence of PMS; most lack the knowledge and available time required to effectively treat this female anomaly. You may find that a female health care provider is more empathetic to your needs if you suffer from PMS.

What You Need To Know About Menstruation

If you're a teenage girl you probably have started having a period. If you have not, you might be anxious about the subject or a bit concerned. This whole menstruation thing might seem a bit mysterious, it is to many young women. It's actually very complex, but interesting too.
Menstruation is the outward proof that a girl is becoming a woman. Having a period is your body's way of saying it’s functioning properly.
During puberty, hormones are released from the brain that stimulate the ovaries. The ovaries then produce estrogen and progesterone -- hormones that cause the eggs in the ovaries to mature so the woman can become pregnant when she chooses to. Here's how the process goes:
Every month, one egg leaves one of the ovaries on its way to the uterus via the fallopian tubes. Meanwhile, in preparation for the egg, the uterus starts to develop a thicker lining and it’s walls become cushiony (the endometrial lining). If the egg reaches the uterus and is fertilized by a sperm cell, it attaches to this cushiony wall.
Most of the time the egg just passes right through without fertilization. Since the uterus no longer needs the extra blood and tissue which made up the walls thick, it sheds them by way of the vagina. This cycle will happen nearly every month until the ovaries stop releasing eggs, usually several decades later. (Menopause).
Periods are different for every woman. Some girls start menstruation when they're 9 or 10; some in their late teens. The length of the cycle also varies. Some periods last longer than 28 days, some shorter. If you have just begun your menstruation, your body will need time to regulate itself to these changes. Your periods might be a bit erratic at first. You may have two cycles in one month and miss having one the next month. How long your period lasts also varies . Some girls have their periods for only 3 or 4 days, others as long as a week. The menstrual flow of blood can vary from woman to woman also.
Some girls may have body and or mood changes around the time of their period. Menstrual Cramps are pretty common during the first few days of your period. These are most likely caused by prostagladins. Prostaglandins causes the muscles of the uterus to contract. These cramps tend to become less uncomfortable and sometimes even disappear completely as a girl gets older. Over-the-counter pain medication like ibuprofen or acetaminophen can often give relief; if not, a health care provider can help. If your cramps are severe, see a gynecologist.

As your period approaches, you may experience premenstrual syndrome (PMS). You may find your emotions amplified during this time. Many women get depressed, irritated, angry, and others cry more than usual or get cravings for certain foods. PMS may be related to changes in hormones. Hormone levels rise and fall during a menstrual cycle, affecting the way a female feels both mentally and physically.
Emotions can become more intense than usual, and many women may feel bloated because of water retention. When your period begins, PMS usually goes away. You may also have acne flare-ups.
Periods are a complex part of puberty, but also your body's way of telling you it is functioning properly and you have taken good care of it. You can still exercise, swim and do everything you enjoy. If you have any questions about periods, ask a parent, health teacher, health care provider, or nurse. You can also ask friends or sisters who have already had their periods. In time you will see that periods are a normal and routine part of your life.

Does Size Really Matter?

Penis Size Verses Function
Many guys question the adequacy of the size of their penis. We get a lot of email about this question. This is a normal and common feeling especially if you are not sexually active or are considering becoming sexually active. The size of a man's penis is more than adequate for its functions which are for sexual pleasure, and maybe reproduction (also for urinating -- but you're probably not as concerned about that!).
One thing that men can be assured of is that the size of your penis has no relation to sexual pleasure or performance. Performance is about the ability to get and maintain an erection or to provide sexual pleasure to your partner and yourself with or without an erection. Performance, then, is not really related to size -- but dependent on muscles, blood and nerve supply to the reproductive organs.
In reality sexual pleasure is related to: a person's state of mind; to respecting their partner's needs; and their own needs. During intercourse, the opening of the vagina is normally not too small or too large for any penis because it is really a "space" that is surrounded by muscular tissue and will adapt to most size penises.
There are also many ways to express sexual feeling besides intercourse. Sexual touching and intercourse can involve many different positions, methods, angles, pressures etc. that change the way it feels and may increase pleasure. Variation and experimentation will vary the sexual experience in ways that a change in penis size can not ! If you want to know more about increasing pleasure or your satisfaction with sexual experiences then experiment or talk to someone you trust.
If you are still concerned about your penis size, then talk to your health care provider. You shouldn't feel embarrassed to ask questions about your own body. Everyone develops at a different rate, but if you are concerned about how quickly you are or aren't growing -- or if you notice anything that is you feel is unusual about your penis or testicles -- again, don't be embarrassed or shy to talk to your health care provider. Remember, that old saying... it's not how long your pencil is -- it's how you write your name. Or, "it's not the wand it's the magician".

Penis Size -- Determined by Genetic Traits
Here is a quote from the video library on 'Penis Size', by Donald E. Greydanus, MD
The size of your penis is simply determined by factors, called genetic traits, which you inherited from your parents. There is nothing you can do to increase or decrease the size of your penis -- it will develop into its adult size as you change from a boy to a man through the process called puberty. Most boys start the changes of puberty between 10 and 14 years of age, though a few will start earlier or later than these ages. First, the testicles (balls) begin to enlarge and then hair starts to grow around the them. The penis then starts to enlarge, first in length and then later in thickness. Though there is much normal variation, the final penis size is reached four to six years after the testicles first started to enlarge.
This process of normal penis growth can be disturbing to many males. Since the testicles enlarge first (and later followed by growth of the penis), many young male teens do not notice the testicles growing and worry that they are not changing and that their penis is too small. If you are overweight, fat tissue can hide the penis somewhat and give an impression that the penis is smaller than it really is. Some males in your class may have started their changes of puberty well ahead of you and they may seem like they have an adult-size penis-that can be very upsetting! It is difficult to know how large a penis will be in its erect state, simply by looking at it when not erect (or when flaccid).
It is also true that adult penis size varies considerably from person to person. Just as with any body part, different people will have different penis sizes. We live in a society that pushes a myth that the male with a larger penis has a better sex life than one with a smaller penis. This is constantly noted in sexual jokes, in comments heard on TV, or in the movies and in many other places. Well, the truth is that normal penises vary tremendously in size, and sex is just as good for each of these males. You will need to wait a year or two after your overall height has stopped changing to see what final size your penis will be. If at any time during your growing, you are worried that your penis is abnormal, just go to your doctor and ask him or her directly about this. In almost every case, you will be told that it is fine.

The Female Hymen

Many people are under the impression that the hymen is located within the vagina. It is not. It’s a mucous membrane that is part of the vulva, the external genital organs. It’s located outside the vagina. The hymen is a layer of tissue, just like the tissue around the opening of your vagina that partially conceals the vaginal orifice. You may or may not have one, most females do. The hymen is not an indicator of virginity; a girl is a virgin until she has been penetrated by a penis.
The hymen is named after the Greek God Hymenaeus - the God of marriage and weddings, FYI.
During the early stages of fetal development there is no opening into the vagina at all. The thin layer of tissue that conceals the vagina at this time usually divides incompletely prior to birth, forming the hymen. The size and shape of this opening (or openings) varies greatly from person to person.
Sometimes this formation of an opening does not occur, resulting in an imperforated hymen (it lacks the more common opening). Some females have no hymen at birth at all, since the tissue divided completely while they were still in the womb.
Many girls and teens tear or otherwise dilate their hymen while participating in sports like bicycling, horseback riding, gymnastics or inserting tampons, or while masturbating. A girl may not even know this has occurred, since there may be little or no blood or pain involved when this happens. The tissues of the vulva are generally very thin and delicate prior to puberty. The presence or absence of a hymen in no way indicates whether or not a female is a virgin. * You are a virgin until you have sexual intercourse.*
Some hymens are elastic enough to permit a penis to enter without tearing, or they tear only partially, and there is NO bleeding at all. When adequately lubricated the vagina is fairly 'flexible' and will stretch without discomfort for most women. Sometimes, a woman has sex for years with no real 'tearing' at all, only stretching of the hymen and then at another time the same woman might tear from 'rough sex' or sex with a different partner with a larger penis. Remnants of the hymen are usually still present until a woman delivers a baby vaginally.
Sure, see what your vagina looks like with a mirror, it's your body, you should not be afraid of it . Some young women seem to obsess over what is 'normal'. So, put away the mirror after you know what is normal for you. You might see that your labia change as you get older, they might get a bit darker in color or longer, or not change at all. This is not abnormal, unless you are an adult. It is important to know what your body looks like, so you can tell when there is a change or something to see your health care provider about, but don’t obsess over what it is 'supposed to' look like. All of our faces look different and none of our vaginas look exactly the same either. That’s all I have to say about hymens and vaginas for now.
I have some diagrams of different hymens, but some sponsor think they are not appropriate for me to show, even for educational purposes. However, there is a page that does have a photograph of the anatomy of the female vagina. It’s not that hard to find if you do a search. AND, speaking of sponsors, if you would kindly click on the banner ads on the top of the page or on the left here that helps keep this site on the web. That’s who helps me continue to bring you information, kind of like commercials on TV, they are annoying, but they are a reality of our world. Thank you in advance!