Where Women Have No Doctor - A Health Guide for Women (Hesperian Foundation, 1997, 600 p.) Chapter 4: Understanding Our Bodies (introduction...) A Woman’s Reproductive System (introduction...) The reproductive parts on the outside The breasts The reproductive parts on the inside A Man’s Reproductive System (introduction...) Having a baby - Will it be a boy or a girl? How a Woman’s Body Changes (introduction...) Hormones Monthly Bleeding (introduction...) The monthly cycle (menstrual cycle) Problems with monthly bleeding

Where Women Have No Doctor - A Health Guide for Women (Hesperian Foundation, 1997, 600 p.)

Chapter 4: Understanding Our Bodies

This chapter is about the parts of the body that make up a woman’s or a man’s sexual and reproductive system. This information will help you to use the rest of this book.

Figure

In many ways, a woman’s body is no different from a man’s. For example, women and men both have hearts, kidneys, lungs, and other parts that are the same. But one way they are very different is in their sexual or reproductive parts. These are the parts that allow a man and a woman to make a baby. Many of women’s health problems affect these parts of the body.

You can feel your hips bones just below your waist. They are part of the pelvis. The pelvic area is everything between the hips. This is where a woman’s reproductive parts are.

Sometimes talking about the sexual parts of our bodies can be difficult, especially if you are shy, or do not know what different parts of the body are called. In many places, the reproductive parts of the body are considered ‘private’.

¨ No one should feel ashamed of any part of his or her body.

But knowing how our bodies work means we can take better care of them. We can recognize problems and their causes and make better decisions about what to do about them. The more we know, the more we will be able to decide for ourselves if the advice that others give us is helpful or harmful.

¨ The more we know about our bodies, the more we can teach our children how to have better health.

Since different communities sometimes have their own words for parts of the body, in this book we often use medical or scientific names. This way, women from many different regions of the world will be able to understand the words.

A Woman’s Reproductive System

A woman has sexual parts both outside and inside her body. They are called the reproductive organs, or genitals. The outside parts are called the vulva. Sometimes people may use the word vagina for the whole area. But the vagina is the part that begins as an opening in the vulva and leads inside to the womb. The vagina is sometimes called the ‘birth canal’.

Figure

The drawing below shows what the vulva looks like and what the different parts are called. But every woman’s body is different. There are differences in the size, shape, and color of the parts, especially of the outer and inner folds.

The reproductive parts on the outside

Vulva: All the sexual parts you can see between your legs.

The breasts

Breasts come in all shapes and sizes. They start to grow when a girl is between 10 and 15 years old, when she changes from a girl to a woman (puberty). They make milk for babies after pregnancy. When they are touched during sexual relations, a woman’s body responds by making her vagina wet and ready for sex.

Inside the breasts:

Figure

The reproductive parts on the inside

Figure

Figure

A Man’s Reproductive System

A man’s sexual parts are easier to see than a woman’s because they are mostly outside the body. The testicles (balls) make the main hormone in a man’s body, called testosterone. When a boy goes through puberty, his body begins to make more testosterone. It causes the changes that make a boy look like a man.

Figure The testicles also make a man’s sperm. A man begins to produce sperm during puberty, and makes more every day of his life. Sperm travel from the testicles through a tube in the penis where they mix with a liquid produced by special glands. This mixture of liquid and sperm is called semen. The semen comes out of the penis when a man climaxes during sex. Each drop of semen has thousands of sperm which are too small to see. Figure

Having a baby - Will it be a boy or a girl?

About half of a man’s sperm are boy sperm and half are girl sperm. Only one sperm will join with the woman’s egg. If it is a boy sperm, the baby will be a boy. If it is a girl sperm, the baby will be a girl.

Because most communities value men more than women, some families would rather have boys than girls. This is unfair because girls should be valued just as much as boys. It is also unfair because in some places a woman is blamed if she does not have any sons. But it is the man’s sperm that makes a baby either a boy or a girl!

Boy or girl? It is up to chance - much like flipping a coin.

How a Woman’s Body Changes

The Life Cycle

A woman’s body goes though many important changes during her life - at puberty, during pregnancy and breastfeeding, and when she stops being able to have a baby (menopause).

In addition, during the years she can have a baby, her body changes every month - before, during, and after the time of her monthly bleeding. The parts of the body where many of these changes happen are the vagina, womb, ovaries, fallopian tubes, and the breasts, also called the reproductive system. Many of the changes are caused by special chemicals called hormones.

Figure

Hormones

Hormones are chemicals the body makes that control how and when the body grows. A little while before a girl’s monthly bleeding first starts, her body begins to produce more estrogen and progesterone, the main female hormones. These hormones cause the changes in her body known as puberty. During the years when she can have a baby, hormones cause a woman’s body to prepare for possible pregnancy each month. They also tell her ovaries when to release an egg (one egg every month). So hormones determine when a woman can get pregnant. Many family planning methods work to prevent pregnancy by controlling the hormones in a woman’s body. Hormones also cause changes during pregnancy and breastfeeding. For example, hormones keep a pregnant woman from having her monthly bleeding, and after childbirth they also tell the breasts to make milk. When a woman is near the end of her reproductive years, her body slowly stops producing estrogen and progesterone. Her ovaries stop releasing eggs, her body stops preparing for a pregnancy, and her monthly bleeding stops forever. This is called menopause. The amount and kind of hormones produced by a woman’s body can also affect her moods, sexual feelings, weight, body temperature, hunger, and bone strength.

Monthly Bleeding

About once each month during her reproductive years, a woman has a few days when a bloody fluid leaves her womb and passes through her vagina and out of her body. This is called ‘monthly bleeding’, the ‘monthly period’ or ‘menstruation’. It is a healthy process and is part of the way the body gets ready for pregnancy.

Around the world, women have many different names for their monthly bleeding.

Most women think of their monthly bleeding as a normal part of their lives. But often they do not know why it happens or why it sometimes changes.

The monthly cycle (menstrual cycle)

The monthly cycle is different for each woman. It begins on the first day of a woman’s monthly bleeding. Most women bleed every 28 days. But some bleed as often as every 20 days or as little as every 45 days.

The amount of the hormones estrogen and progesterone produced in the ovaries changes throughout the monthly cycle. During the first half of the cycle, the ovaries make mostly estrogen, which causes a thick lining of blood and tissue to grow in the womb. The body makes the lining so a baby would have a soft nest to grow in if the woman became pregnant that month.

In the middle of the cycle, when the soft lining is ready, an egg is released from one of the ovaries. This is called ovulation. The egg then travels down a tube into the womb. At this time a woman is fertile and she can become pregnant. If the woman has had sex recently, the man’s sperm may join with her egg. This is called fertilization and is the beginning of pregnancy.

During the second half of the cycle - until her next monthly bleeding starts - a woman also produces progesterone. Progesterone causes the lining of the womb to prepare for pregnancy.

¨ A woman may find that the time between each monthly bleeding changes as she grows older, after she gives birth, or because of stress.

Most months, the egg is not fertilized, so the lining inside the womb is not needed. The ovaries stop producing estrogen and progesterone, and the lining begins to break down. When the lining inside the womb leaves the body during the monthly bleeding, the egg comes out too. This is the start of a new monthly cycle. After the monthly bleeding, the ovaries start to make more estrogen again, and another lining begins to grow.

The monthly cycle

Problems with monthly bleeding

If you have problems with your monthly bleeding, try to talk with your mother, sisters or friends. You may find that they have them too and they may be able to help you.

Changes in bleeding

Sometimes the ovary does not release an egg. When this happens, the body makes less progesterone, which can cause changes in how often and how much a woman bleeds. Girls whose monthly bleeding has just begun - or women who have recently stopped breastfeeding - may only bleed every few months, or have very little bleeding, or too much bleeding. Their cycles usually become more regular with time.

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Women who use hormonal family planning methods sometimes have bleeding in the middle of the month. See Hormonal Methods of Family Planning for more information about changes in bleeding caused by hormonal family planning methods.

Older women who have not yet gone through menopause may have heavier bleeding or bleed more often than when they were younger. As they get closer to menopause, they may stop having monthly bleeding for a few months and then have it again.

Pain with monthly bleeding

During monthly bleeding the womb squeezes in order to push out the lining. The squeezing can cause pain in the lower belly or lower back, sometimes called cramps. The pain may begin before bleeding starts or just after it starts.

Pressing hard on the tender place between your thumb and first finger can ease many kinds of pain. For other places where pressure can ease pain from monthly bleeding see Acupressure Massage

What to do:

· Rub your lower belly. This helps the tight muscles relax.

· Fill a plastic bottle or some other container with hot water and place it on your lower belly or lower back. Or use a thick cloth you have soaked in hot water.

· Drink tea made from raspberry leaves, ginger, or chamomile. Women in your community may know of other teas or remedies that work for this kind of pain.

· Keep doing your daily work.

· Try to exercise and walk.

· Take a mild pain medicine. Ibuprofen works very well for the pain that comes with monthly bleeding.

· If you also have heavy bleeding and nothing else works, taking a low-dose birth control pill for 6 to 12 months may help.

Pre-menstrual syndrome (PMS)

Some women and girls feel uncomfortable a few days before their monthly bleeding begins. They may have one or more of a group of signs that are known as pre-menstrual syndrome (PMS). Women who have PMS may notice:

· sore breasts
· a full feeling in the lower belly
· constipation (when you cannot pass stool)
· feeling extra tired
· sore muscles, especially in the lower back or belly
· a change in the wetness of the vagina
· oiliness or spots (pimples) on the face
· feelings that are especially strong or harder to control

Figure

Many women have at least one of these signs each month and some women may have all of them. A woman may have different signs from one month to the next. For many women, the days before their monthly bleeding starts are a time of unrest. But some women say they feel more creative and better able to get things done.

What to do:

What helps with PMS is different for each woman. To find out what will help, a woman should try different things and notice what makes her feel better. First, try following the suggestions for pain with monthly bleeding.

These ideas may also help:

· Eat less salt. Salt makes your body keep extra water inside, which makes the full feeling in your lower belly worse.

· Try to avoid caffeine (found in coffee, tea and some soft drinks like cola).

· Try eating whole grains, peanuts, fresh fish, meat and milk, or other foods that are high in protein. When your body uses these foods, it also gets rid of any extra water, so your belly feels less full and tight.

· Try plant medicines. Ask the older women in your community which ones work.

Exercise can sometimes help with the signs of PMS.