Taking Charge of Your Fertility

by Toni Weschler

  Although the use of ultrasound would eliminate this confusion, there are many women who would prefer to avoid such procedures, but regardless, pregnancy wheels should not be considered definitive. Indeed, such miscalculations can lead and have led to the induced labor of many a premature baby.

  FERTILITY AWARENESS FOR DETECTING GYNECOLOGICAL PROBLEMS AND UNDERSTANDING THE HEALTHY BODY

  How often have you felt a sudden sharp pain in your side, noticed spotting at odd times, or even felt a breast lump that caused you to panic? While all of these experiences may seem confusing, they can be normal occurrences if they take place at the appropriate time in your cycle.

  The benefits of charting extend far beyond knowing when a woman can and cannot get pregnant. There are many gynecological conditions that can be identified through observing your fertility signs. Women who chart can determine whether they are experiencing something normal for them or something that might be a true gynecological problem, such as a vaginal or urinary tract infection or cervical anomaly. Those who chart are so aware of what is normal for themselves that they can help their clinician determine irregularities based on their individual symptoms rather than on the average woman’s symptoms.

  This awareness has tremendous advantages, as seen in the classic example of women who have occasional midcycle spotting, which is usually harmless and often referred to as “ovulatory bleeding.” But because spotting can be an indication of other potentially serious problems (such as cervical cancer), clinicians often feel obligated to pursue unnecessary testing, needlessly worrying and inconveniencing their patients. A woman who charts would know whether this type of bleeding is normal for her, and thus wouldn’t seek medical attention unless she felt she really needed it.

  Of course, certain unpleasant medical procedures will always be necessary. Most women would say that an annual pelvic exam is hardly their idea of a good time. The average woman would probably rather be scrubbing a toilet than lying on the exam table, her legs in stirrups, trying to maintain a semblance of dignity. Especially when the doctor walks in, smiling and acting as if there’s nothing the least bit awkward about her lying there stark naked under a skimpy paper gown.

  And what is the first thing that physicians say when they sit down at the foot of the exam table? “Scoot down, please.” It’s hardly a coincidence that doctors must always request that of their patients. After all, how many women of their own volition would choose to have their derriere hanging off the table if they didn’t have to?!

  Now, granted, no amount of fertility consciousness will free you from this unpleasant experience. But taking responsibility for your own health care will at least give you some integrity and a sense of control often lost in a typical office visit. Charting the menstrual cycle allows a woman and her health care practitioner to work together as a team, with the patient contributing to her own well-being. In addition, FAM will put you so in tune with the normal occurrences of your cycle that it will greatly reduce the number of times you feel a need to consult with your doctor in the first place. For example, how many times have you gone to your gynecologist complaining of an infection only to be assured you were fine? As you know, information about women’s fertility signs is not typically taught in school; therefore, many girls and young women grow up thinking they are unhealthy or even dirty. What they really are is simply uninformed.

  So That’s What It Is!

  There is nothing more confusing than sitting in the library studying for finals in your master’s program when you feel a sudden, slippery, wet sensation (and you know that physics has never excited you that much). So, what’s going on? You run to the bathroom, thinking you may have started your period, only to find no blood on your underwear. In reality, you are no doubt experiencing what is commonly referred to as “eggwhite quality” cervical fluid, an extremely slippery and fertile secretion that is released as you approach ovulation. As you will learn, such secretions are healthy, and most important, they’re predictable.

  The first time Barbara ever noticed fertile cervical fluid as a young teenager, she was horrified. She couldn’t imagine what was hanging from her vagina when she went to urinate. The only thing she could think to do in order to remove it was wad up balls of toilet paper and hurl them at this seemingly foreign blob. Barbara grew up to become a FAM instructor!

  Many women today refuse to remain ignorant. They are beginning to actively participate in all facets of their health care, enhancing their understanding of their fertility in the process. FAM gives women these opportunities. Most women are thrilled with the sense of control they feel after spending just a couple of minutes a day charting their cycle, cherishing the privilege of finally understanding their bodies.

  Fertility Awareness as Basic Education

  To be sure, Fertility Awareness is not the best choice of birth control for all women. Indeed, given the realities of AIDS and other sexually transmitted infections (STIs), FAM as contraception is recommended only for monogamous couples with the maturity and discipline to follow the method correctly. However, even if a woman never uses it for contraceptive purposes, this book will clearly show that the biological principles that form the foundation for FAM should be part of every woman’s basic education. If this came to pass, women would be far less dependent on doctors for answers that should be a part of their own fundamental knowledge and understanding.

  Alicia, one of my clients, had been charting her cycles for several years when she volunteered to be a control for an ultrasound study in abnormal ovulation. Over five months, her ovaries were monitored to determine if she was releasing an egg. Every time she went in, she would announce confidently that she was about to ovulate, and as usual the technician would raise her eyebrows in surprise. “Oh, really?” she would say. She would then check the monitor and say, “Oh, it looks like you’re about to ovulate.” “I know, that’s what I just told you.” And sure enough, the following day, Alicia would indeed ovulate.

  When she returned the next day, she would say, “By the way, I think you’ll find that I’ve already ovulated.” “Oh, really?” the technician would say, scratching her head. She would then check the monitor and say, “Oh, it looks like you already ovulated.” “I know, that’s what I just told you,” Alicia would reply, feeling a real sense of confidence about her ability to interpret her fertility signs.

  Given the few pages you’ve read so far, you may be starting to question why Fertility Awareness is not routinely taught as early as high school. And when you are done reading this book, you too will undoubtedly have the same reaction that so many women have upon learning this vital information: “How is it possible that I have gotten to this age without knowing such practical information about my own body?”

  So let me ask you a seemingly off-the-wall question: What is the definition of “literate”? If you answered something to the effect of “being well versed in literature or creative writing” you wouldn’t be wrong, of course. But many dictionaries list “to be educated” as the first definition. I, for one, love the idea of being literate, especially in the context of body-literacy—being able to read my own body to tell me the crucial information I need to take control of my reproductive and general health.

  Indeed, it’s worth noting that renowned scientist Dr. Carl Djerassi, often honored as the father of the pill, acknowledged that women should be privy to such basic biological occurrences. “Eventually,” he wrote, “many a woman in our affluent society may conclude that the determination of when and whether she is ovulating should be a routine item of personal health information to which she is entitled as a matter of course.”

  CHAPTER 3

  There’s More to Your Reproductive Anatomy Than Your Vagina

  What woman doesn’t remember awkwardly gathering with other fifth-grade girls to learn about the mysteries of their bodies and the fascinating world of sanitary napkins they were soon to embark upon? The funny thing is, when all was said and done, most of us came away from the uninspired inst
ruction with hardly a clue as to what was really about to happen to us. We proceeded to grow up with the menstrual cycle still cloaked in mystery, the subject of numerous myths.

  We were all led to believe that the main event of every cycle was menstruation, and the primary lesson was proper tampon and sanitary pad etiquette. I can still remember giggling in the corner with my friends as we whispered the joke that was pathetically transformed from one of Stevie Wonder’s most popular songs: “What’s all right, uptight, and outta sight?” Tampons, of course. We were so mature now. We fifth-graders could joke about these sorts of things—things the fourth-graders surely would just not get. We were so cool.

  So it should come as no surprise that after spending hours in the “feminine hygiene” aisle of the drugstore, most of us find that we still know basically nothing about our bodies, but can tell you pretty much anything you ever wanted to know about mini- versus maxipads, napkins with wings versus those with super-duper adhesive strips, extra-wide versus extra-long panty shields, and super-absorbent versus regular tampons.

  This is where Fertility Awareness comes in. It’s about so much more than merely understanding female hygiene and menstruation. At its core it’s a philosophy of taking control of, understanding, and demystifying the menstrual cycle and all its effects on you. This is because sexuality, fertility, childbirth, and menopause are all facets of being female, and charting is the edifying window into these aspects of a woman’s life. The self-knowledge available from Fertility Awareness is a valuable resource for all kinds of personal decision-making. Perhaps most important, it encourages women to value and trust knowledge provided by their own bodies.

  Gynecologists are experts in women’s physiology, so it only makes sense that women tend to turn to doctors rather than themselves to interpret their bodies. Reliance on physicians would be understandable if the knowledge doctors possessed about women’s cycles was incomprehensible to the general public. But this is basic fertility, not brain surgery. In reality this information is quite simple, and not the mystery so many people believe it is.

  To understand your cycle, though, you should first have a general knowledge of human reproductive biology. The following pages should familiarize you with both female and male anatomy.

  INTERNAL FEMALE REPRODUCTIVE ANATOMY

  Do you realize that a part of every single one of us resided inside our maternal grandmother’s uterus, even before our own mothers were born? Unlike male fetuses, which contain no sperm, female fetuses already possess all the eggs that the newborn child will ever have. What that means, practically speaking, is that when your mother was just a fetus inside her mother, she already had developed all of her eggs, and one of them eventually became you! And if one day you are lucky enough to get pregnant with a girl, imagine being able to look down at your belly and ponder the fact that you are carrying a physical part of your future grandchildren inside of you. (see Where do I come from? on the last page of the color insert.)

  One of the major differences between male and female anatomy pertains to when the sex cells (or gametes) are developed. As mentioned above, girls are born with all the eggs they will ever have. The eggs start to mature and be released at puberty, continuing usually to expel one egg per cycle until menopause. Boys, on the other hand, don’t develop sperm until adolescence, but then continually produce sperm every day until they die. The box below reflects the three major differences between male and female fertility.

  The Woman’s internal reproductive organs. Note that for most women, the uterus typically tilts forward.

  Uterus: The womb. A hollow, muscular, pear-shaped organ (about the size of a small lemon) that builds up and releases a blood-rich lining every cycle and acts as an “incubator” for the developing fetus if conception occurs. In most women, the uterus curves forward.

  Vagina: The elastic 4- to 6-inch-long muscular passage between the vulva and cervix through which menstrual blood flows from the uterus. During sexual arousal, the vagina expands to receive the penis during intercourse and stretches to become the birth canal during childbirth.

  Fallopian tubes: The 4- to 5-inch-long narrow tubes in which fertilization occurs, and through which the fertilized egg is transported from the ovary to the uterus. The fringed end is called the fimbria.

  Ova (ovum): Granule-sized eggs stored in the ovaries, only one of which is usually released each cycle. The ovulated ova may unite with sperm during fertilization to form the eventual fetus.

  Ovaries: Two almond-sized primary sex glands that contain up to a million immature eggs at birth. Each egg (or ovum) is surrounded by a group of cells called a follicle. These follicles produce estrogen and progesterone during the reproductive years.

  Endometrium: Lining of the uterus that builds up in preparation for a potential pregnancy and is shed every cycle in the form of menstruation.

  Cervix: The lower opening of the uterus. The only part of the uterus that can be felt protruding into the upper vagina. Lined with channels called cervical crypts that cyclically develop cervical fluid in which sperm thrive.

  Cervical os: The small opening of the cervix that becomes larger around ovulation and which expands up to four inches during childbirth to allow the baby to emerge.

  EXTERNAL FEMALE REPRODUCTIVE ANATOMY

  It is amazing how few women really know what their external anatomy looks like. Sadly, most girls are led to believe that they are “dirty down there,” and are therefore reluctant to even examine themselves. Boys, however, are usually socialized to believe that they possess a treasure in which to take pride.

  Although the illustration of External Female Reproductive Anatomy on the next page should be self-explanatory, there are several points worth mentioning regarding external anatomy. One thing is that there are probably as many variations in size and shape of vaginal lips as there are women. The six sample drawings in The Spice of Life: Variations in Female Anatomy section of the color insert represent but a tiny fraction of the diversity. The variation between women’s vaginas and vaginal lips merely adds spice and uniqueness.

  Aside from the obvious external differences between men and women, they also differ both sexually and in terms of certain potential physical problems. Women, for example, tend to be more prone to urinary tract infections (UTIs). This is because a woman’s urethra is shorter, so bacteria have less distance to travel from its opening to the bladder. In addition, its location so close to the anus makes it more vulnerable to external bacteria, while its location so close to the vagina can lead to occasional irritation during intercourse. Finally, a contraceptive diaphragm can obstruct the flow of urine by pressing against the urethra, creating a perfect medium for bacterial growth.

  In addition to UTIs, women may develop occasional vaginal infections due to the delicate pH balance in the vagina. As you know, discharge from infections should not to be confused with healthy cervical fluid, which women usually produce every cycle around ovulation. (True vaginal infections are discussed in Chapter 18.)

  Differences in anatomy affect the way men and women experience sexuality. This seems obvious on the surface, but there are so many subtle distinctions in this area that I have devoted much of Chapter 20 to discussing it. Still, one difference is certainly worth mentioning in this context: orgasms.

  Women do not achieve orgasms the way men do. They’re simply not built the same. A man’s most sensitive nerves are just below the tip of the penis, which is the part most stimulated during sexual intercourse. It should come as no surprise that men achieve orgasm fairly easily due to the physical nature of intercourse.

  Why do women not achieve orgasms during intercourse the same way men do? The answer is straightforward. The most sensitive sexual nerves in women are in the clitoris, which is outside and above the vagina. So, during traditional intercourse (with the couple face-to-face in the missionary position), while the man is having a grand ol’ time, the woman may be compiling a grocery list for dinner that night.

  It’s not tha
t the sensation of intercourse isn’t wonderful for most women. And for the lucky 25% or so who can achieve orgasms from intercourse, the experience can be fantastic. But the point is that women are built differently than men, plain and simple.

  The most graphic way to explain this is by illustrating how a human being develops while in the uterus. Before a fetus evolves into a boy or girl, the exact same cells that would become the tip of the penis in the boy become the clitoris in the girl. And the same cells that would become the scrotum in the boy become the vulva in the girl. Perhaps the best way to help men understand women’s sexuality would be to ask them whether they would be able to achieve an orgasm from merely being stroked on the scrotum. Who knows? Maybe, maybe not. Or maybe after, say, two hours! Yet high expectations cause men and women alike to get frustrated when women don’t have orgasms as readily as men do.

  How embryonic development determines pleasure during intercourse. The clitoris and the tip of the penis evolve from the same sensitive cells. The vulva and the scrotum evolve from less-sensitive cells. The vagina, however, is comprised of cells of very low sensitivity, and has no analog in the male. Thus, during sexual intercourse, a man’s most sensitive area (the glans) is directly stimulated, while a woman’s (the clitoris) is not.

  If you could be a fly on the wall of bedrooms throughout the world, I think you’d be amused to discover how often women blame their partners for “lousy technique,” which prevents them from having orgasms during intercourse. Meanwhile, men blame their partners for not being responsive enough to automatically have orgasms. Needless to say, this often leads to conflict between the genders.

  Sex between men and women can be extremely sensual and gratifying if both partners learn about each other’s bodies and needs. Satisfying your partner means taking the time to ask questions and being willing to be vulnerable. Chapter 20 further discusses how to enrich your sex life by charting.