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Women's Health: What's Normal, What's Not [pamphlet]


What's Normal?
Women experience physical and physiologic changes each month and over the course of years. So it sometimes can he hard to tell what's normal and what isn't.

You are in the best position to know your own body. The more you know about how your body usually functions, the more likely you will notice changes and know when to get medical help.


The Normal Menstrual Cycle
Menstrual cycles are regulated by the hormones secreted by the brain and the ovaries. These hormones adjust and control the monthly cycles.

How does it work?
A menstrual cycle is the time from the first day of one period to the first day of the next.

Right after the period starts, estrogen hormone levels rise. Estrogen stimulates the lining of the uterus to grow and thicken.

When estrogen reaches a peak, the ovary releases an egg. This is ovulation. The ovary then produces progesterone to help the uterus prepare for a possible pregnancy.

If the egg passes through the uterus without being fertilized, hormone levels drop. This signals the uterus to shed the lining. Periods [usually] last about 5 days.

Then the whole process repeats itself again... and again... and again, unless pregnancy or some other factor (illness, some birth control methods, stress, weight loss) interrupts it.

Most women menstruate every 25 - 40 days. The variable part of the cycle is the time from the first day of the period until ovulation - about 14 days. But it can be as little as 10 or as long as 25 days.

From ovulation to the next period is 13 15 days in every woman's cycle.


Menstrual Changes
Many women notice changes in their bodies as they go through the menstrual cycle.

When you ovulate, you will have a clear, slippery mucus discharge that looks like raw egg white. You may feel a twinge in the lower abdomen when the egg is released. Sometimes you'll see a small amount of blood in the vaginal discharge at this time.


Premenstrual Syndrome (PMS)
1 - 10 days before your period, you might feel bloated or have diarrhea, nausea, backache, or cramping.

You might notice mood changes such as irritability, depression, and decreased coping skills. These common symptom are called premenstrual syndrome (PMS).

Some women have all of these symptoms every cycle, some never have any. Most have some symptoms with some cycles.


Cramps
You might get cramps the first few days of your period. These can be full, achy pains in your abdomen. Or they can be sharp and severe.


Normal Vaginal Discharge
A healthy v****a has a special discharge that keeps it clean and moist, and protects it from infection.

Normal discharge is whitishand doesn't smell bad, although it might have a characteristic odor. It's different at different times of the menstrual cycle.

Just after your period, the discharge is thicker and whiter. At ovulation, it is clear and slippery. After ovulation there is less discharge, and it gets thinner.

When you are sexually aroused, the amount of fluid increases to make intercourse comfortable. The vaginal lips may become a little swollen and enlarged. This is normal.


What is Vaginitis?
Yeast infections and bacterial vaginosis are caused by an imbalance in the organisms that normally live in the v****a. This imbalance can be caused by antibiotics, heat, stress, or a number of other factors.

Women with vaginitis usually notice a change in vaginal discharge. It may be heavier and/or smell or look different.


How to Prevent Vaginitis
- Keep the vaginal area clean and dry. Wash daily with warm water, rinse well and pat dry.
- Use mild soap. Don't use douches, strong soaps, deoderants, or sprays.
- Wear cotton underwear.
- Don't wear tight fitting clothing or panty hose.


What You Can Do About PMS
- Cut down on salt and refined sugar
- Don't use caffeine - found in coffee, tea, cola drinks and chocolate.
- Get regular exercise.
- See your health care provider if symptoms are severe.


What You Can Do About Cramps
- Rest with a heating pad on your abdomen.
- Try an over-the-counter pain reliever, such as Advil or Aleve.
- Regular exercise can help prevent cramps.
- If you have regular, severe cramps for several months, see your health care provider.


Normal Breasts
Breast size is determined by genetics and body weight. The amount of fatty tissue, which surrounds and protects the milk glands and milk ducts, varies widely from woman to woman. It is normal for a woman to have one breast larger than the other.

During the premenstrual part of each cycle, your breasts might feel fuller and more tender. This goes away once your period starts. Your breasts may also seem lumpier at this time.

Check your breasts each month. A good time is right after your period. Your health care provider can show you how [or check out this sticky, post 4].

You might have inverted nipples. This is normal.

Occasionally you might notice discharge from a n****e. If this occurs after stimulation of the n****e, don't worry. The more you stimulate the n****e, the more there might be. If you have a spontaneous discharge, see your health care provider.


When Should I See A Health Care Provider?

Have regular pelvic exams. You and your health care provider can decide how often you need one [usually once a year]. Besides routine check-ups and Pap smears, you should have a pelvic exam if any of the following are true.

Vaginal Changes
- You have vaginal pain, burning or itching.
- You have sores on your v****a or vulva.
- The discharge has a bad odor or is yellow or greenish in color. This can indicate a sexually transmitted disease (STD).
- You have more discharge than normal.


Breasts
- If you think you feel a lump, wait until your period is over to see if the lump goes away. If it doesn't, see your health care provider.
- Call your provider immediately if the breast lump is associated with infection - if the skin is red, warm and tender to the touch.
- Breast cancer is rare in women under 40 and most breast lumps are benign. But always have a lump checked.


Menstrual Cycle
- You think you might be pregnant.
- You have gone more than 12 weeks without a period, even if you know you can't be pregnant.
- You have irregular bleeding, not associated with ovulation.
- You have unusual or persistent pelvic pain, not associated with ovulation or your period.
- You have severe cramps with your periods.
- You have a hard time coping with PMS.


Other Changes
- Intercourse is painful.
- You are having side effects from birth control.


The Pelvic Exam
The pelvic exam takes only a few minutes.

It includes an exam of your external sex organs for growths or rashes.

It includes a biannual exam to check your internal sex organs: v****a, uterus, ovaries, and fallopian tubes.

Your health care provider will put on a sterile glove and then place 1 or 2 fingers in your v****a until they touch the cervix. With the other hand, he or she gently presses your abdomen.

It may include a speculum exam to do a Pap smear, a painless test to check for cervical cancer. The speculum is a metal or plastic instrument that is used to spread the v****a.

Your health care provider gently puts a warm speculum in your v****a. Cell tissue is gently taken from your cervix with a brush or cotton swab. The cells are then checked by a lab.


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The information in this post is from ETR Associates. I do not own any of this information, nor am I trying to profit from it.

Young Women's Sexual Health [pamphlet]


What Sexual Health Issues Do Women Frequently Ask Questions About?

The most common sexual health questions woman ask frequently fall into 2 categories:

- Contraception
- Sexually transmitted diseases (STDs)

This brochure provides basic information to help answer some of these questions. It is important for a woman to consult with her pharmacist, doctor, or other healthcare professional for additional information.

What about birth control?
Once a woman becomes sexually active, there is always a chance of pregnancy. If she does not want to become pregnant, there are many options available. The following is a table that outlines the different methods of birth control available. There are no instructions on how to use the method. A woman should consult with her pharmacist for more details.


So Many Birth Control Methods. Choose the One That's Right For You

Name: "Birth Control Pill" or "Oral Contraceptive"
What is it?: Pills that contain hormones that a woman takes by mouth to prevent a pregnancy. These are taken for either 21 or 28 days (a cycle).
How does it work?: The Pill contains hormones that prevent ovulation. Hormones also make cervical mucus thicker to stop sperm from getting into the uterus.
Where to get it: A woman gets a prescription from her doctor or sexual health clinic, and fills it at a pharmacy.
STD Protection?: The Pill does not protect against STDs, including HIV. Condoms should be used every time.
Additional information:
- Each brand of birth control is slightly different. Doctors make sure women use the Pill that is right for them.
- The pill is very effective when taken correctly, and has few side effects.
- Not for smokers over 35.
- Weight gain is unlikely with the newer birth control pills.


Name: Injectables ("The Shot" - Depo Provera)
What is it?: A hormone injection given every 3 months.
How does it work?: Hormones make cervical mucus thicker to stop sperm from getting into the uterus. It may stop ovulation.
Where to get it: A woman can get a prescription (and injection) from some doctors and sexual health clinics, and pharmacies.
STD Protection?: Injectables do not protect against STDS, including HIV. Condoms should be used every time.
Additional information:
- Effectiveness and side effects are similar to the birth control pill.
- Women may experience some weight gain while using injectables.


Name: The Patch ["Ortho Evra"]
What is it?: The patch is placed on the skin and delivers hormones into the bloodstream. It is changed once a week (3 weeks on, 1 week off).
How does it work?: The Patch contains hormones that pervent ovulation. Hormones also make cervical mucus thicker to stop sperm from getting into the uterus.
Where to get it: A woman gets a prescription from her doctor or sexual health clinic. Prescription filled at pharmacy.
STD Protection?: The Patch does not protect against STDs, including HIV. Condoms should be used every time.
Additional information:
- Effectiveness and side effects are similar to the birth control pill.
- If you weight over 195 lbs, effectiveness is decreased.
- Some women may be sensitive to the glue used with the Patch.


Name: Condoms (for men)
What is it?: A latex (or polyurethane) covering worn over an erect p***s.
How does it work?: It catches semen, which contains sperm.
Where to get it: Pharmacies, sexual health clinics, some supermarkets.
STD Protection?: Latex and polyurethane condoms protect against STDs, including HIV, sheepskin (lambskin) condoms do not. For protection, a latex or polyurethane condom should be used every time.
Additional information:
- If people are allergic to latex, polyurethane condoms should be used. They are hypo-allergenic.
- Condoms should be lubricated with water-based lubricants (ex: Astro Glide, KY Liquid).
- If properly used, birth control effectiveness is excellent (note: improper use is primary reasons condoms fail).


Name: Condoms (for women)
What is it?: A plastic (polyurethane) pouch worn inside the v****a.
How does it work?: A woman inserts the condom herself into her v****a before intercourse. It catches semen, which contains sperm.
Where to get it: Some pharmacies and some sexual health clinics.
STD Protection?: The female condom protects against STDs, including HIV.
Additional information:
- Additional water-based lubricantion (ex: Astroglide, KY Liquid) makes the female condom easier to use.
- If used properly, birth control effectiveness is excellent (note: improper use is primary reason condoms fail).


Name: Spermicides (sponge, foam, contraceptive film, gel)
What is it?: Chemicals that kill sperm. Usually nonoxynol-9.
How does it work?: Spermicides are placed in the v****a by the woman or her partner before intercourse.
Where to get it: Pharmacies and sexual health clinics.
STD Protection?: Spermicides do not protect against STDs, including HIV. Condoms should be used every time.
Additional information:
- Frequent use of nonoxynol-9 can cause irritation to the v****a and cervix. This irritation could provide a route of entry for the HIV virus.
- Spermicides should not be used for a**l or oral sex, because irritation can occur.
- Birth control effectiveness is fair to good depending on proper use.


Name: Intra-Uterine Device (IUD)
What is it?: A small piece of plastic is inserted into the uterus. Most contain copper, some contain hormones. Non-hormone IUDs may start in the uterus for up to 10 years.
How does it work?: It stops sperm from reaching the egg. It also changes the lining of the uterus so the egg can not implant.
Where to get it: A doctor inserts IUDs in their offices and at sexual clinics.
STD Protection?: IUDs do not protect against STDs, including HIV. Condoms should be used every time.
Additional information:
- IUDs are often recommended for women who have experienced a pregnancy, because their bodies can handle the IUD better.
- Effectiveness is good, but less effective than the birth control pill.


Name: Fertility Awareness Method
What is it?: A combination of national methods of birth control.
How does it work?: A woman keeps a record of her menstrual cycle. She looks for signs that she is close to ovulation. She and her partner do not have sex around the time of ovulation.
Where to get it: A woman can take a course to learn how to use this method effectively.
STD Protection?: Fertility Awareness Method does not protect against STDs, including HIV. Condoms should be used every time.
Additional information:
- The Fertility Awareness Method can be used to make other methods (ex: condoms) more effective because a woman knows when she is fertile.


Name: Diaphram, Cervical Cap
What is it?: Rubber barrier that covers the cervix at the back of the v****a.
How does it work?: used with spermicide. Holds spermicide in place to kill sperm.
Where to get it: A doctor measures a woman for a diaphram in their office or a sexual helath clinic. Diaphrams are available through most pharmacies. Cervical caps are available in some sexual health clinics.
STD Protection?: Diaphrams and cervical caps do not protect against STDs, including HIV. Condoms should be used every time.
Additional information:
- See "Spermicides".


Name: Emergency Contraception Methods (used if a condom breaks, if there is unprotected sex, or in the case of a sexual assault)
What is it?:There are 2 methods to choose from:
- Emergency contraceptive pill. Two pills containing hormones taken 12 hours apart [or in the case of Plan B, one pill].
- Intra-Uterine Device. A small piece of plastic is inserted into the uterus. Most contain copper, some contain hormones.
How does it work?:
- ECP: Usually stops sperm from meeting the egg. Also stops the egg from attaching to the uterus.
- IUD: Changes the lining of the uterus (making it difficult for an egg to implant) so a woman will not get pregnant.
Where to get it:
- ECP: A woman gets a prescription from her doctor or sexual health clinic. Prescription is filled at a pharmacy. [Nikolita note: In BC, you can get it without a prescription.]
- IUD: A doctor inserts IUDs in their offices or sexual health clinics.
STD Protection?: Both methods do not protect against STDs, including HIV.
Additional information:
- When taken properly, ECP effectiveness is excellent.
- Must be taken within 72 hours (3 days) after unprotect sex (ECP).
- Should not be used by a woman who is pregnant from a previous act of intercourse.
- ECP soon may be available at a pharmacy without a prescription.
- IUD must be inserted as soon as possible within 7 days after unprotected sex.
- IUD effectiveness is good to excellent.


Name: Withdrawal
What is it?: A natural method of birth control.
How does it work?: During intercourse, the man withdraws his p***s from the v****a before ejaculating. Semen (containing sperm) is not released inside the v****a.
Where to get it: A man needs to learn about his sexual response.
STD Protection?: Withdrawal does not protect against STDs, including HIV. Condoms should be used every time.
Additional information:
- Withdrawal requires control and practice.
- Effectiveness is fair to good.


Name: Sterilization
What is it?: Permanent surgical methods of birth control.
How does it work?: For men, a doctor cuts/ties tubes that carry sperm from the testicles (called a vasectomy). For women, a doctor cuts or blocks the tubes that carry eggs to the uterus.
Where to get it: For men, a doctor performs the surgery in their offices. For women, a doctor performs the surgery in the hospital.
STD Protection?: Sterilization does not protect against STDs, including HIV. Condoms should be used every time.
Additional information:
- Sterilization does not affect your sexual response or ability.
- For men, although it is difficult, it may be possible for a vasectomy to be reversed (depending on the surgical technique used).
- Effectiveness is excellent.


Name: Abstinence
What is it?: Not having sexual intercourse.
How does it work?: Pregnancy will not happen without sexual intercourse.
Where to get it: Couples need to communicate and agree that this is best for them.
STD Protection?: Abstinence protects against STDs, including HIV.
Additional information:
- There are many other sexual activities that couples can do which are pleasurable and safe.


Name: Abortion
What is it?: When contraception fails, abortion is available. Abortion is a medical procedure that ends pregnancy.
How does it work?: There are several methods which all cause a miscarriage.
Where to get it: At some hospitals and abortion clinics.
STD Protection?: Abortion does not protect against STDs, including HIV.
Additional information:
- Abortion is legal and safe up to 20 weeks in Canada. Women will be asked to consider future methods of birth control at the time of the abortion. For religious and moral reasons, this method may not be an option for everyone.


What about birth control when breastfeeding?
The birth control methods that contain hormones can affect the ability to breastfeed. However, hormones are unlikely to affect a nursing baby. If used too early, they can reduce or stop milk supply.

Two oral contraceptive options that may be started once the milk supply is well established (usually by the 6th week):

1) Progestin only pills ("Mini Pill"). These pills have only one hormone, progestin. They should not reduce the amount of breast milk. Unlike regular birth control pills, they are taken every day without a break. They are slightly less effective than the regular low-dose birth control pills.

2) Low-dose birth control pills - these pills have two hormones (estrogen and progestin). There is a possibility that they may decrease the amount of breast milk. They are a highly effective birth control method.

Remember, to ensure maximum effectiveness, it is important to take any birth control pill at the same time, every day, without missing a pill.

Another birth control method for breastfeeding moms is called Lactational Amenorrhea Method (LAM). Continuous breast feeding can affect the body's ability to ovulate. It takes a lot of motivation and commitment. There are 3 simple rules:

1) Mother must be fully or nearly fully breastfeeding.
2) Baby must be less than 6 months old.
3) Mother must not have her period yet.

Before trying this method, a woman should get more information from a public health nurse or lactation consultant. With proper counselling and if the rules are followed, effectiveness is excellent.


What About STDs?

What exactly is an STD?
A Sexually Transmitted Disease is a disease that a woman or a man can get from having sex (oral, vaginal or a**l) with someone who is infected. Some health professionals may use the term Sexually Transmitted Infections (or STI) when referring to an STD.

The most common STDs are Chlamydia, Genital Herpes, Gonorrhea, and HPV (Human Papilloma Virus).


Can STDs be serious?
Some STDs can cause serious health problems for both men and women if they are not treated. Some can be cured easily, but others can eventually be fatal. Untreated STDs increase a person's risk of getting HIV (the virus that causes AIDS).

STDs caused by bacteria, like chlamydia and gonorrhea, can be cured with antibiotics. STDs caused by viruses, like genital herpes and Human Papilloma virus (HPV) and HIV cannot be cured with medication. However, medication can help with the symptoms, like the discomfort of genital herpes. It can also help people with HIV live for many years.

A woman can pass certain STDs to a fetus growing in her body, or to her baby as it is being born. She can also pass HIV to her baby through her breastmlk. It is important for pregnant women to be tested for STDs. Before getting pregnant, women should be tested for HIV, as well as other STDs.


What are the symptoms of STDs?
Women may get symptoms from an STD, and they may not. The only way to be sure is to have an STD test.

A woman should see her doctor if:

- There is anything unusual on her genitals - a bump, a sore or a rash.

- It burns when urinating.

- The fluid coming out of her v****a looks or smells different than usual.

- Sex hurts.

- She bleeds after intercourse or sees blood between periods.

- Her partner has any of the above symptoms.


Do doctors routinely test for STDs?
Doctors may test women for chlamydia and gonorrhea when they have their annual pap test (as part of the external examination). Normally, both men and women need to ask to be tested for STDs. Doctors do not test for HIV unless they are asked for an HIV test.


How can STDs be avoided?
STDs can be avoided by practicing safer sex. Some sexual activities are safer than others. Kissing and touching are save. Oral sex is safe if the genitals are covered. Vaginal or oral sex is safer if a lubricated condom is used every time.


How Can Women Keep Healthy?

How often should a woman have a physical examination?
Once a woman starts having sexual intercourse, she should see her doctor for a check-up once a year. At this time, she will have an internal pelvic examination, routine STD tests and a Pap test. A pap test is the only way to find out of there are any changes in the cervix (opening to the uterus). HPV can cause changes to the cells of the cervix. These changes can lead to cancer.

If a woman is under the age of 18, the cells of the cervix are not fully developed. This makes it easier for these cells to become infected by HPV. Because of this risk, it is recommended that women postpone having sexual intercourse until they are at least 18.

If a woman is over 18, even if she is not having sexual intercourse, she should still talk to her doctor about having an internal exam and pap test.


What about normal vaginal fluids and cervical mucus?
It is normal and natural to have fluids coming out of the v****a. Sometimes they are called discharge or secretions. There are different types.

Cervical mucus is discharge that is made in the cervix. It changes throughout a woman's menstrual cycle. When a woman is about to ovulate, it is slippery, clear and stretchy. When she is about to have her period, it is sticky. Birth control pills can make this mucus sticky most of the time. Sometimes women notice mucus dried on their underwear or when they wipe after going to the washroom. This mucus starts to be made at puberty. Closer to menopause, less cervical mucus is produced.


How can women keep their vaginas healthy?
Vaginas clean themselves. As fluids pass through, old cells are flushed out. Douches and feminine hygeine products are not needed. These products can irritate the lining of the v****a and cause infections. A shower or bath is all that is needed.

Women can also avoid vaginal infections by:

- Wearing clean, cotton underwear every day. Cotton breathes better than polyester or nylon. Pantyhose should have cotton at the crotch.

- Taking off underpants at night.

- Trying not to wear tight-fitting jeans or pants.

- Wiping from front to back after a bowel movement.

- Washing the vulva and bottom regularly with mild soap.

- Using mild laundry detergent and making sure there is no soap left in underwear.

- Using non-perfumed soaps or bubble baths.

- Not using toilet paper, tampons or menstrual pads that contain perfumes or deoderants.

- Using condoms when having sexual intercourse.

- Urinating after sexual intercourse.

Super absorbent tampons and some brands of menstrual pads can cause vaginal irritations and infections in some women. If using tampons, women should try to change them every 4 hours and wear a pad at night.


What if a woman needs more information?
Speak to your pharmacist or your doctor.

A pharmacist can answer many questions a woman (or her partner) may have about anything in this brochure. Doctors and other healthcare professionals can also provide information and resources.


For additional information
Your local Publich Health Departments or Planned Parenthood chapters can also provide additional support.

The following websites can also provide information on sexual health and related issues.

Society of Obstetricians and Gynecologists of Canada
www.sexualityandu.ca

Canadian Health Network (Health Canada and Planned Parenthood)
www.canadian-health-network.ca/1sexuality_reproductive_health.html

Planned Parenthood Federation of Canada
www.ppfc.ca


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The information in this post belongs to Shoppers Drug Mart, with help from Wyeth Pharmaceuticals. I do not claim to own any of this information, nor am I trying to profit from it.

Reserved.