What’s in it for me? A no-nonsense guide to women’s health.
Are you uncomfortable saying the word “vagina?” How about “vaginal discharge?” Do you know for sure what HPV is, or how likely you are to catch it?
Unfortunately, the majority of sex education comes from rumors, the internet, and magazines – none of which are reliable sources of information. As a result, many women grow up feeling that their bodies are shameful or dirty – something embarrassing to have, let alone talk about. This means that few of us know what is healthy, or when to ask for help.
These blinks will shed light on all the questions you might have had about your body and its functions, but been too afraid to ask. While much of the advice is aimed at cisgender women of reproductive age, everyone can benefit from learning more about anatomy, periods, sexual health, and fertility.
In these blinks, you’ll learn
that “normal” period blood comes in a wide range of colors;
why gynecologists call vaginal discharge a “natural antibiotic”; and
what percent of couples will get pregnant within a year of having regular sex.
An anatomy lesson
Let’s say it all together now: vagina. VAGINA. It’s not a dirty word. Knowing what’s what down there can help you understand what’s normal and what’s not normal, or how to describe what’s going on to your doctor and sexual partners. So, let’s begin with a basic anatomy lesson.
First off, your vulva is on the outside, and your vagina is on the inside. Your vulva is made up of the following components: the mons pubis – that’s the fatty tissue that covers the front of the pubic bone and grows pubic hair; the clitoris – a nerve-packed spongy tissue that fills with blood during arousal; and the urethral opening, which connects your bladder to the world. A bit further back is your vagina – an elastic, muscular tube that connects your vaginal opening to the cervix.
On either side are the labia majora, or skin-covered outer lips, then the labia minora, the fleshy-looking inner lips. It’s common for the labia minora to be asymmetrical, and for them to protrude outside the labia majora. Next up is the perineum, the area between the vaginal opening and the anus. This covers the pelvic floor muscles, which hold your insides in.
OK, now let’s move to the internal anatomy. First up is the uterus, the pear-shaped organ which contracts during labor, menstruation, and orgasm. The endometrium is the lining of your uterus, which thickens every month in preparation for the implantation of a fertilized egg – just in case. Your period happens when your uterus sheds the endometrium.
Connecting your uterus and your vagina is the cervix, through which runs a small canal that stretches during labor. You’ve also got two ovaries, right and left, which store your eggs. Women are born with all the eggs they’ll ever have – between two and four million. When you start menstruating, your ovaries begin releasing eggs for potential fertilization – one every month. Your ovaries also produce female hormones, like estrogen and progesterone.
When your ovary nominates an egg for fertilization, it’s called ovulation. The egg travels through the fallopian tubes to reach the uterus. The fallopian tubes are not connected to the ovaries; they freely rove around, waiting for the signal that an egg is ready.
Now that we’ve got a handle on terminology, let’s move on to what actually goes on in the vagina. Our first stop? The period.
Demystifying your period
According to a recent survey by ActionAID UK, one in four women in the UK don’t understand their periods, and 20 percent feel embarrassed to talk about their period with their friends. This needless dearth of information results in people not knowing what’s normal or abnormal – and a lot of suffering that could be easily avoided. Let’s put an end to this by educating ourselves about periods once and for all.
First, as we learned in the last blink, your period occurs when the lining of the uterus falls away. Your menstrual cycle begins on the first day of your period, and it lasts anywhere between 21 and 35 days.
Your bleeding will typically start off lighter, then get heavier and darker on Day 2. It’s completely normal for the blood to be brown or black, and for it to come out in small clots. Actually, “blood” is a bit of a misnomer: there is blood in there, but there’s also mucus and cells from inside the uterus.
Anytime between Day 12 and 15 of your cycle, your brain secretes hormones to trigger your ovaries to release an egg. About seven days after ovulation, the uterine lining begins to degrade and slowly starts to fall away. You get your period, and the cycle starts all over again.
Your body is sensitive, and your period can be impacted by your lifestyle choices and other health factors. An irregular period is when you absolutely can’t predict when your next period will come – it could be tomorrow, or in three months. There are a few causes for irregular or absent periods.
One is when your body or mind are stressed or overworked – this includes things like overexercising or undereating. Your body would rather you stay alive than have a period, so that's what it focuses its resources on. It’s also common to not have your period for a while after coming off the birth control pill. It could also be the result of a hormonal disorder, like polycystic ovarian syndrome (PCOS). We’ll learn more about this later.
One in five women suffer from heavy or painful periods. Please see a doctor if you’re having to change a pad or tampon every hour for several hours in a row; if you’re bleeding for longer than seven days; or if your period is interfering with your quality of life in any way! There are ways to remedy the causes of these symptoms, and there’s no need to suffer alone.
Preventing – or facilitating – pregnancy
Blood isn’t the only fluid that comes out of your vagina. There’s also vaginal discharge! Let’s say it again: vaginal discharge. You might cringe at the word, but actually, discharge is perfectly healthy. What’s more, it’s packed with what gynecologists refer to as “natural antibiotics,” which protect you against sexually transmitted infections.
Your vagina discharges fluid when you’re sexually aroused and when you’re ovulating – but also just as part of its normal duties to keep itself clean. Healthy vaginal discharge comes in a variety of colors: white, yellowish, gray, and clear.
Abnormal vaginal discharge is something to look out for. If you have white, yellow, or green discharge with the consistency of cottage cheese, you may have a case of thrush, also known as a yeast infection, which is due to an imbalance in the vagina’s natural yeasts. You can treat a yeast infection with over-the-counter medication, but if it doesn’t get better you should see a doctor.
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Another job of vaginal discharge is to help sperm get to the egg. If you are sexually active and would like to avoid this, you should use contraceptives. There are plenty of options for contraception, usually divided into hormonal and nonhormonal categories.
Hormonal contraceptives work by releasing hormones that prevent ovulation. The most popular hormonal contraceptive in the UK is the birth control pill, which can cause lighter periods and reduce the risk of some types of cancer. Other hormonal options include the contraceptive ring, implants, and a hormonal coil inserted into the cervix.
Nonhormonal options work by creating a physical barrier between sperm and egg. The most common of these is, of course, the condom. A longer-term option is a copper coil inserted into the cervix which kills any sperm that dare to enter.
If you get pregnant and don’t want to have a child right now, termination is an option, depending on the law where you live. About 20 percent of pregnancies in England and Wales end in abortion. Half of these are what are called medical abortions, where the pregnancy is terminated using medication. The rest are surgical abortions, where a suction tube is inserted into the cervix to remove pregnancy tissue.
But contraceptives aren’t just important for preventing pregnancy. Sexually transmitted infections, or STIs, are something you should be thinking about if you are sexually active. We’ll find out more in the next blink.
Preventing STIs
Sexually transmitted infections are alive and well in the community of sexually active people. The bottom line is: if you are having sex without a condom, and either you or your partner has not been recently tested for STIs, you are at risk of giving or receiving one. No contraceptive except condoms protects you from STIs. Women should be especially concerned with catching one because they experience the greatest health consequences. The general advice for sexually active people is to get screened yearly, or every time you change sexual partners.
The most common STI in the UK is chlamydia. Chlamydia is a bacterial infection that shows no symptoms in the majority of women. If you do experience symptoms, they can be hard to recognize: a bit of pain or bleeding with sex or during urination. Gonorrhea is less common, but it often comes along with chlamydia. Antibiotics effectively treat both infections.
But if left untreated, chlamydia, gonorrhea, and other STIs can cause Pelvic Inflammatory Disease. That’s the inflammation of the upper female reproductive tract, which eventually leads to the formation of scar tissue and, in some cases, chronic pelvic pain and infertility. This might sound a little dramatic, but it’s only to reinforce the necessity of getting tested regularly.
Herpes, another common STI, can cause cold sores and is unfortunately incurable – though easily treatable. Another STI to be extra careful about is, of course, HIV. HIV still has the reputation of being a gay man’s disease, but almost half of new cases diagnosed in the UK each year are in heterosexual men and women. HIV can eventually cause AIDS, but antiviral medication is improving every year. Nowadays, people diagnosed with HIV have near-normal life expectancy.
Another incredibly common STI is the human papilloma virus, or HPV. There are hundreds of kinds of HPV, at least 15 of which are known to cause cervical cancer. Almost everyone gets HPV, and normally it clears up on its own relatively quickly. Pap smears, or smear tests, are the only way to detect abnormal cells so they can be treated before they turn into cancer. During a pap smear, your gynecologist will insert a soft brush into your cervical canal to collect cells for analysis. Women between the ages of 25 and 50 should have one every three years – and every five years after age 50.
There’s now a vaccine which protects against two strains of HPV that cause cervical cancer, and two strains that cause genital warts. But even if you’ve been vaccinated, you still need to be screened regularly for the hundreds of other kinds of HPV out there.
Planning for fertility
Maybe you’re thinking about having a baby in the next few years. Maybe you’ve never even considered the possibility. Either way, it’s important to be aware of how fertility functions. Someday your situation and priorities may change. And in any case, you should have a plan regarding it.
Many women experience a lot of fear around the idea of pregnancy. They may spend the first decade or more of their sexual lives doing everything they can to avoid getting pregnant. And then when they do decide they want to tap into their fertility, there’s fear that it’s too late.
The fact is, 84 percent of couples will get pregnant within one year of having unprotected sex two or three times per week. If you want to get a fertility check before trying for a year, that’s your prerogative, but it might just end up making you experience needless anxiety. And don’t assume that problems with getting pregnant come down to the woman’s fertility. At least 30 percent of fertility-related problems are due to male factors.
If you are a menstruating person seeking to get pregnant, you can increase your odds by organizing intercourse around your ovulation. Track your ovulation via an app like Clue, and time your sex to fall in the span of five days before you release an egg and one day after.
Another factor affecting fertility is diet. Getting pregnant requires a lot of nutrients, vitamins, and minerals. One recent study showed that women who frequently eat fast food take longer to get pregnant, and women who eat a lot of fruit get pregnant faster.
And finally, if you are trying to get pregnant, or find yourself accidentally pregnant, it’s recommended that you take a folic acid supplement. This helps the body with rapid cell production.
More and more people these days are starting families later. Because female fertility naturally declines with age starting at about 32 years old, many women are considering egg freezing. By freezing your eggs, you stop the egg-aging clock at the moment those eggs go into the freezer. It may sound great, but there are a few things to remember before rushing off to the doctor.
First, there’s no guaranteed success. Not every egg will survive or create a good-quality embryo. Next, your eggs might not be aging – but your body is, which increases the chances of a complicated pregnancy. And finally, it’s an invasive, expensive procedure that isn’t usually covered by insurance.
That being said, egg freezing is an incredibly empowering fertility advancement, and it brings us closer to equality between the genders when it comes to fertility.
Your lifestyle, your body
You probably know that many diseases have a lifestyle component. You might not know that the same is true for gynecological conditions, including cancer. Actually, 34 percent of cases of endometrial cancer, the most common gynecological cancer in the UK, could be prevented with lifestyle modifications.
What are the most common lifestyle factors impacting gynecological health? Many of them are the same factors affecting overall health. Stress is the most common one. You might feel stress from a looming deadline or a fight with a partner or friend. But medical stress stems more frequently from lack of sleep, overexercising, too much caffeine, and unhealthy food choices – which includes undereating.
Stressors like these stimulate your brain to release cortisol, a stress hormone, which tells your body to prepare to either run from or face down danger. Having too much cortisol and other stress hormones can stop your period or cause it to be more painful. If you’re not ovulating, you won’t be able to get pregnant either. And finally, stress can change your vagina’s flora, triggering a yeast infection or other bacterial infections.
Diet is another factor that impacts our gynecological health. You should focus on getting the right number of nutrients and vitamins rather than weighing a certain number of pounds. This means eating a plant-based diet of colorful, minimally processed foods. You should also be eating healthy fats, like olive oil, nuts, and flaxseeds, which help stimulate the production of female hormones. And despite what you might see on social media, dairy is also an integral part of a healthy diet. There may be ethical and environmental issues surrounding dairy, but studies show that dairy is consistently associated with better health.
Exercise is important too. It’s been shown to reduce the risk of endometrial and ovarian cancers. Loading up with muscle is also important to prevent osteoporosis – or thin, brittle bones – which women are especially prone to. If you’re new to exercise, start small. Maybe go for a lunchtime walk, or try yoga. Eventually you can turn to what doctors call muscle-strengthening activities, like high-intensity interval training (HIIT) or even weight lifting.
Finally, sleep is one of the most undervalued medicines out there – and it’s free. Put plainly, a lack of sleep causes chronic health problems and early death. While you sleep, your body works on repairing tissue damage, producing hormones, and even making memories. To get better sleep, cut down on caffeine and alcohol, and reduce screen time before bed.
You’ve only got one body, so it’s never too early to start taking better care of it!
Final summary
The key message in these blinks:
Female health has been mysterious for a long time, locked away behind layers of shame and misinformation. But there’s nothing shameful about knowing what’s normal for your body – actually, knowing yourself and your vagina better can help you avoid needless pain and anxiety, and can set you up for a longer, healthier life.
Actionable advice:
Strengthen your pelvic floor muscles with Kegel exercises.
Kegels are highly recommended exercises to strengthen the pelvic floor muscles. They’re great for preventing incontinence, and can also enhance the quality of your orgasms. To find the right muscles, pretend that you’re tightening your vaginal muscles around a tampon. Contract these muscles for five seconds, then relax for five seconds. Repeat this cycle ten times. An added bonus is that – unlike dead lifts or burpees – Kegel exercises can be done nearly anytime, anywhere! Go ahead, try one now. Nobody will know!
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What to read next: In the FLO, by Alisa Vitti
You’ve just had a whistle-stop tour of women’s health. You’ve learned the difference between the vulva and the vagina, and you’re now clear on how often you need to go in for a pap smear (reminder: every three years). You’ve also gotten a good primer on periods, from what’s a normal cycle length to when it’s time to ask for help.
If you want an even deeper dive into menstruation and menstrual health, check out our blinks to In The FLO. You’ll learn how to put your cycle to work for you, improving health, relationships, and career in the process.