Archive for the ‘Women’s Health’ Category.


It’s been known for centuries that women are not fertile throughout the entire menstrual cycle. The awkward term ‘periodic abstinence’ means keeping semen out of the vagina when fertilisation could occur; various methods are used to know when you are fertile so that you will know when to avoid any sexual activity that could result in pregnancy. This is often called ‘natural family planning’ because no chemicals or devices are used and the method involves an understanding of the nature of your reproductive cycle. I don’t believe that it’s really ‘natural’ to avoid sexual intercourse deliberately when there is a possibility you will conceive. Lactation is nature’s only way of delaying the next conception. I prefer the term ‘fertility awareness’.

Over the centuries every part of the cycle has been claimed to be either the fertile or the ‘safe’ time, but because most of these were wrong (as we now know) the method gained a poor reputation for reliability. It is only since the 1950s that there has been convincing evidence, based on sound research, that certain changes in women’s bodies during the menstrual cycle reflect what’s happening in our ovaries, particularly hormone production and ovulation. We can observe and interpret these changes to predict and identify when we are fertile in the cycle. But first we must know some important facts concerning sperm, ova and the effects of ovarian hormones on body temperature, cervical mucus and the cervix.


The quality of sperm vary in regard to the time they will survive, their ability to swim (motility) and their ability to fertilise the ovum. This variation exists between men and between individual sperm within the same man’s semen. From the point of view of preventing pregnancy we must assume that all semen contains some sperm of the ‘very best’ quality.

As you can imagine, it is very difficult to study sperm survival after an ejaculation into a woman’s genital tract. Most of our knowledge comes from post-coital tests and from IVF (in-vitro fertilisation) studies. The important factors that seem to influence sperm survival after ejaculation are:

• the condition of the cervical mucus in the vagina and in the cervical canal

• conditions in the uterus and tubes. Without fertile cervical mucus sperm cannot pass through the cervical canal and die quickly in the vagina. Studies of sperm survival in women wearing cervical barriers (and thus there is no cervical mucus in the vagina) reveal that no live sperm have been found in the vagina three hours after ejaculation and in most cases all were dead after one hour.

Once sperm have entered fertile cervical mucus they can survive on average three to four days. However, the fact that women have conceived when they have had no coitus for seven days (in one case nine days) before the known time of ovulation shows that some vigorous sperm can survive for longer in the right conditions.

Most sperm are motile when they are ejaculated but must undergo further changes before they are able, to fertilise the ovum. These changes normally occur they pass through the cervical, uterine and tubal fluids that have been produced under the influence of oestrogen. Note, however, that in these days of assisted conception technologies, ejaculated sperm are also able to fertilise eggs in the test tube.

In humans it would seem that after ejaculation a reservoir of sperm can remain in fertile cervical mucus for some days, from where they move in relays through the uterus and then on to the tube. This explains how fertilisation can sometimes happen up to a week after the last sexual intercourse. The average ejaculate contains around 200 million sperm. Most of the ejaculate is wasted in the vagina, but if 1 per cent of it enters fertile cervical mucus and if 1 per cent of the sperm in this fraction were и the ‘best quality’, a pregnancy could result up to a week later.



Hormones may be used to prevent ovulation and to cause other changes in the reproductive tract that prevent pregnancy. The hormones may be given by mouth, or may be absorbed from slow-release implants under the skin, injections into muscle or from hormone-containing devices such as vaginal rings and IUDs. To most people, hormonal contraception means ‘the Pill’, so I’ll describe it first.

The oral contraceptive pill – usually called the Pill or ОС – has been used for more than 30 years in Australia. More than 70 million women around the world are now using it to plan their families.

Oral contraceptives contain synthetic hormones that are very similar to the hormones produced naturally by the ovaries. There are probably no other drugs on the market that have been more thoroughly tested, both in the laboratory and by the millions of women who have used them.

There are two main types of oral contraceptive. The most commonly used is called the ‘combined Pill’ and contains both ovarian hormones, an oestrogen and a progestogen. The ‘mini-Pill’ contains only a progestogen, and is also known as the ‘progestogen-only-Pill’ or POP.

The combined Pill

This is what is usually meant when people speak of ‘the Pill’. All combined Pills available in Australia contain one of two types of oestrogen (which have very similar effects) plus one of six types of progestogen.

• Monophasic Pills have the same amount of each hormone in every tablet that is taken throughout the Pill cycle.

• Biphasic Pills have a reduced amount of progestogen in the tablets that are taken for the first half of the cycle.

• Triphasic Pills containing three different combinations of the hormones are taken in three consecutive phases over the cycle.

When oral contraceptives were first introduced, they contained much higher doses of hormones than today’s Pills. All the Pills on the market now are low-dose compared with the early Pills. Some contain less hormones than others. Reducing the dose has reduced or eliminated many of the side-effects of Pills with higher doses.



Most people (including teenagers) expect very different behaviour from boys and girls when it comes to sex. This is called the ‘double standard’.

The double standard

This is the view that says it’s OK for boys to ‘sow their wild oats’ and have sexual adventures when they’re young, but that girls must remain chaste and virginal. Boys who ‘score’ are admired by their mates. Girls can’t win. If they won’t have sex they’re ‘frigid’; if they do they’re ‘sluts’ or ‘tarts’. There are no such terms for boys.

The double standard is unfair and absurd these days, but it started off as protection for girls, who had a great deal to lose if they became pregnant. For this reason most parents (especially fathers, remembering what they got up to in their teens) still put a lot more restrictions on the comings and goings of their daughters than they do on their sons. Though some parents warn their sons to protect themselves from STD with condoms, few mention this to their daughters or advise them about contraception.

There is also the belief that boys have much stronger sex drives than girls (I don’t think this is true: how could it be measured?). It’s thought that their raging drives might make them get into fights or other mischief if they’re not released. The double standard doesn’t tell us who, if girls should be chaste, the boys are going to have sex with to relieve their pent-up drives!

If you’re a teenage girl today, you’ll get a lot of mixed messages about sexuality:

• you’ll be bombarded with sexual images and innuendoes from every type of media

• you’ll be encouraged to be sexually attractive

• you’ll be under a lot of pressure from boys to have sex.

In spite of all this, you’ll sense (though perhaps nobody ever tells you directly) that you’re expected to remain pure and chaste, with a strict obligation not to become pregnant.

Some girls are still subtly discouraged from being well informed about sexuality and contraception. Finding out about these things is considered premeditated and rather nasty – certainly something that nice girls don’t do’. Fortunately this attitude is disappearing as everyone realizes that the more you know, the less likely you are to have problems.

Sexual morality

People have strong beliefs about what’s right and wrong in sexual behaviour. Some believe that sex is a sacred act blessed by God as part of the sacrament of marriage. For others it’s a source of pleasure to be: enjoyed when you feel like it with whomever is available.

For many religious and ethnic groups premarital chastity is very important for both women and men (and in some, for women only), but in most of Western society, the ideal of the virgin bride has been abandoned. For most young people sexual values and morality are strongly influenced by their parents’ attitudes.

Talking about sex

Most of you will have talked about I among your friends, and many schools now deal with the subject (this was out of’ the question 30 years ago). More parents these days are discussing sex with their adolescent children, but there are still families where it remains unmentionable. This is a pity, because I believe it makes things easier for everyone if it comes out; in the open; many surveys have shown that adolescents get along better with their parents and take more responsibility for their sexuality if sex is discussed at home.

You could try bringing it up (only you can know whether this is possible or wise). Your parents might be grateful. If they seem embarrassed, remember how different things were in their youth, and be gentle with them. It can be hard to find the right words to use when talking about sex.



Breast development is the most obvious outward sign of puberty. Changes in the breast are also the first thing you’ll notice that will let you know your ovaries have started producing the hormones that will transform you into a woman.

Most girls notice something happening in their breasts between the ages of 10 and 12, though a couple of years earlier or later is within the normal range. Months before anyone else can detect the change, you’ll notice increased sensitivity and slight enlargement and puffiness of the nipple and areola. This is called breast budding. You’ll be more aware of your clothes brushing against your nipples, which may become itchy or a bit tender. You’ll discover that touching your nipples may stimulate some sexual feeling. This is normal.

Your breasts will enlarge beneath and around the nipple as the milk glands develop and fat accumulates around them. They may feel tender from time to time as they grow, including the ‘tail’ that extends up into your armpit.

Breast size and shape

Breast growth, like many of the other changes of puberty, doesn’t always happen at a steady rate. There may be spurts of rapid enlargement that can play havoc with your wardrobe, such as going through three increases in shirt sizes in six months. After some months of rapid growth (which

often happens between the ages of 13 and 15), your breasts may not enlarge much more, just changing shape as you move through your teens. Breasts usually have reached their adult form by about the age of 18, and there are as many variations in size, shape and appearance as there are women in the world.

If your breasts develop earlier than most of your classmates’ it is often an embarrassment. If breast growth is late it can also be a worry. Then there are the breasts themselves. Are they the right size (it is often said that breasts come in two sizes -too large and too small!) and the right shape? Are the nipples too protruding? not protruding enough? too dark? too pale? Why are your breasts different from the pictures and the other girls you have seen? We have all inherited different genes; it is these that determine our characteristics, including those of our breasts.

Attitudes to breasts

In our society breasts have become such sex symbols that little attention is given to their physiological purpose of feeding babies. The ‘sexy’ attitude to breasts is emphasized in the media and in advertising – think of the printed photographs of ample-bosomed beach belles bulging out of their (too small) bikini tops; the ‘topless’ craze; advertisements for beer featuring scantily clad women and publicity about implants and creams to enlarge the breasts. No wonder many of us become anxious about the development of our breasts and their size and appearance.

Should you wear a bra?

From the early twentieth century until recently, bras had been a necessary part of every woman’s underwear. They were recommended as a support to prevent the breast’s weight from stretching the fibrous ligaments that hold it in place on the chest wall. When these ligaments become stretched, the breasts sag.

Bras also served the purpose of moulding the breasts into the fashionable shape of the time, for example flat in the 1920s and fiercely pointed cones in the 40s and ’50s. When I was in my teens it was considered an outrageous breach of decent for any hint of the nipple shape to be detectable through the clothes.

There is usually no real need for the support of a bra during the teen years un less your breasts are growing very rapid or have become large and heavy. However you may feel more comfortable wearing one for sport and if your breasts are tender.