Down There: Sexual and Reproductive Health the Wise Woman Way
The Vagina – part 1
I am the sheath of the sword. I am toothed, armed, and ready to bite. I have the power to defend, to keep women safe.The Art of Robyn Bellospirito I am not passive, accepting, ready to be filled. I am aware, watchful, ready to reject what I don’t want and to seize what I will.
Listen to me and I will tell you how safe we are, right now, in this moment. When we are secure, I am open and receptive, moist and inviting. When we feel threatened, I become cold and hard, hot and tight, irritated, and inflamed. If the danger goes on and on, I weep, I am overrun.
In health and joy, I am a rich and thriving ecosystem: friendly yeasts, beneficial bacteria, and a generous assortment of slippery, slidey lubricants thrive in my tangy-tasting depths.
I am stretchy. I am expansive. Fill me and I yearn for more. I am yielding; I melt, I surrender. Yet in yielding, I deliver. I am the victor. I clench my fist and grab the prize. Mine.
Do you think that I drool? I do. Do you think that I dribble, leak, and flood? I do. I am messy. I push the boundaries. I am greedy. I am slick. I am sleek.
I lie between what is shown and what is hidden. I am both public and private. I am not visible, yet I am the identity of a woman. By my name is woman named. By my power is woman empowered.
The vagina is a muscular, mucus-lined passage that connects a woman’s outer genitals with her uterus. When we speak of sexual penetration, it is the vagina — not the cervix, the part of the uterus which projects into the vagina, or the uterus itself — that is penetrated. During sexual arousal, the vagina lengthens, opens, and raises a sensitive bump called the G spot.
For thousands of years, men have perpetuated the belief that the vagina is an inert, hollow receptacle which can be penetrated and filled at their will and whim. But tens of thousands of years ago, when women told the stories, the vagina was honored. (And a universe of thanks to Eve Ensler for The Vagina Monologues which has, at least, made it acceptable to say the word “vagina.”)
This vagina, it goes without need of saying one would wish, is alive and sensitive. It is responsive and inherently capable of letting its wishes and desires be known. The vagina, and its health or lack thereof, is deeply connected to a woman’s sense of safety.
Modern women are trained to view their vaginas as dirty and smelly. That’s another misconception. A healthy vagina has a pleasant odor, a slightly sour taste, and is naturally “self-cleaning.” A healthy vagina secretes clear or milky fluids which protect the delicate vaginal tissues. These fluids are heavier and more slippery during ovulation.
The vagina contains health-promoting micro-organisms, as well as microbes that can overgrow and cause symptoms. In the healthy vagina, glucose exuded from the blood serum is eaten by vaginal flora and metabolized into lactic acid. This acidifies the vagina, promoting healthy flora and depressing the disrupters. If there is too much glucose or too few flora, the acidity of the vagina is compromised and infection — from inherent organisms or transmitted organisms — is likely. For health, wash your vaginal area only with plain water, or very dilute vinegar, not soap, which is alkaline.
Antibiotics and antibacterial agents including antibacterial soaps and essential oils kill protective vaginal micro-organisms. Taking antibiotics doubles the risk of developing a vaginal infection.
Celibacy, lesbianism, and double monogamy are life-style choices that cut down on the number of infectious organisms introduced into the vagina. But nuns, lesbians, and monogamous women can still get vaginal infections.
There are at least thirty different bacteria, fungi, and parasites that can cause infections in the vagina. Some live naturally in the vagina, some are introduced through intimate contact, some can be acquired without sexual contact, as well. Many vaginal infections cause discharges, itching, and inflammation. But several are virtually symptomless and can progress to pelvic inflammatory disease (PID), which leaves half of infected women sterile.
The vaginal tissues are sensitive to estrogen and stress hormones. When the estrogen mix changes at puberty, menopause, during pregnancy, and throughout the menstrual cycle, the vagina responds, sometimes with pain, dryness, and eventually, infections.
If the vaginal environment becomes alkaline, or if the tissues receive too much sugar, or if antibiotics kill beneficial flora, then a variety of micro-organisms which live in the vagina, such candida and gardnerella, overgrow and cause an infection. These innate infections make it much easier for other sexually transmitted diseases (STDs) — including gonorrhea, syphilis, trich, and herpes — to take hold. Frequently, several organisms overgrow together, causing multiple concurrent infections. In a European study, thirty percent of the women diagnosed with trich also had a gonorrhea infection.
Things that alkalinize the vagina are listed below, along with remedies to help re-acidify. Vaginal infections generally cause irritation and burning of the vulva as well as the vagina — in some cases, the thighs too. The severe alkalinity and highly increased volume of the vaginal fluids produced during an infection can burn the tissues, like when your nose runs during a cold and leaves the area under it raw and red.
Less common, but more dangerous, is vaginal cancer, of special concern to DES daughters. And a few women will have vaginal ulcers or Bartholin gland cysts, painful blockages at the entrance to the vagina.
These can make the vagina more alkaline and more susceptible to infections
Birth control pills
These restore healthy acidity to the vagina
Yogurt orally and vaginally
The Pap Smear
George Papanicolaou, a pathologist, pioneered this non-invasive screening test in the 1920s. It is not diagnostic. False negative results will occur 10-20 percent of the time.
The Art of Suzanne GrayA Pap smear is a sample of the tissues of the cervix (and sometimes vagina). In order to collect this sample, women are asked to lay back and put their feet up in stirrups. If this position makes you uncomfortable in any way, tell the examiner you want to put your feet on the examining table. With your knees spread, a speculum is gently fitted into your vagina and opened, making the cervix visible. Breathing deeply and relaxing will make any strange sensations easier to bear.
A small implement and a tiny brush are used to collect cells from the outside of the cervix and from inside the cervical os, like using your fingernail to scrape cells from the inside of your cheek, it is not painful, and there is rarely any bleeding.
The collected cells are either preserved in liquid (best) or smeared directly on a slide. Liquid preservation is required for HPV-DNA testing. Pathologists "read" Pap smears with a microscope, looking for cellular changes, such as cells with large black nuclei (cancer).
The vagina is best kept in its natural state for at least 24 hours prior to the Pap smear: avoid douching, intercourse, spermicides, vaginal hygiene products and sprays, and the insertion of boluses, pessaries, or hormonal creams. For the best results, keep it totally natural for three days before your Pap. Cancel your Pap smear if you are menstruating or have had vigorous sex the night before, as it won’t be accurate.
The original classification of Pap smear results - into four broad categories - created confusion on the part of patients and doctors, and resulted in hundreds of thousands of women being frightened into harsh treatments.
Since 1988, a clearer system, the Bethesda, has been used. It was hoped that expanding the categories and giving more specific information about the cells in the smear would limit the amount of over-treatment. Unfortunately, the new classifications have doubled the number of women with abnormal results, so, instead of fewer needless hysterectomies and drug prescriptions, twice as many women are told they need treatment.
"Unfortunately, informed consent rarely enters the Pap test equation. … The need to be fully informed about the risks as well as benefits is even stronger for anyone undergoing a screening test, which by definition is given to healthy people without symptoms."
There are at least 30 different variations in the spectrum from healthy to cancerous cervical cells. The Bethesda system shows these:
Negative for lesions
There is controversy about what level of abnormality requires further tests or treatment, and how often women need to have a Pap smear done.
PAP ABNORMALITIES - WHAT TO DO?
• Conservative guidelines send women with ASC-US for a colposcopy. Liberal practitioners rely on DNA testing along with repeat Pap smears to follow women who are HPV-DNA free (99.5 percent of women negative for HPV-DNA are cancer free ). At CIN II/ III they schedule a colposcopy. Only half of women with CIN III will progress to cervical cancer in five years.
• If you have a "bad" Pap report, redo the smear in 3-6 months before you agree to any treatment or even any further diagnosis.
"For every person who benefits from early detection, many more are diagnosed with a cancer they did not need to know about."
PAP SMEAR - HOW OFTEN?
• A visit to the gynecologist for a first Pap smear is a worthwhile part of any young woman’s puberty (menarche) ceremony. Remember, it is not necessary to have sex to be infected with HPV.
• The American Cancer Society says all women under the age of 65 should have a yearly Pap smear. This includes women without a uterus (in one-third of hysterectomies done in the USA the cervix is left) and even those without a cervix (as smears from the vagina can reveal vaginal cancer).
• In countries with socialized health care, Pap smears are done every third year since cervical cancer grows so slowly.
• However, Pap test results are notoriously inaccurate, with a false negative rate of 10-60 percent. Yearly testing is thought to make up for this deficiency.
• Computerized screening (PAPNET) promised to correct false results from human-read Pap smears, but has actually increased ambiguous findings and over-treatment.
• The safest course for sexually active women who are under the age of 25, sexually active women of any age who have multiple partners, and any woman whose sole partner has other partners, is to have a yearly Pap smear. However, given that women who have annual Pap smears are the most likely to be over-treated, that may not be the healthiest thing to do! Protect yourself by refusing invasive tests or treatment until two or even three more Pap tests, taken at least three months apart, show abnormalities.
"Based on solid evidence, regular screening with the Pap test leads to additional diagnostic procedures (e.g. colposcopy) and [surgical] treatment for low-grade squamous intraepithelial lesions (LSIL), with uncertain long-term consequences on fertility and pregnancy. These harms are greatest for younger women, who have a higher prevalence of LSIL, lesions that often regress without treatment.
"Additional diagnostic procedures were performed in 50% of women undergoing regular Pap testing. Approximately 5% were treated for LSIL. The number with impaired fertility and pregnancy complications is unknown." National Cancer Institute website, 2006
The Art of Suzanne GrayFor those, like myself, who prefer to avoid doctor visits, a visual exame is as good, and may be better. Nurse-midwives in Zimbabwe were asked to take a Pap smear, then to swab the cervix with a mild vinegar solution and (with the aid of a flashlight) to check for white areas that signal abnormal cells. While 77 percent of the positive vinegar tests were accurate, only 44 percent of the positive Pap smears were correct.
To check yourself, you’ll need only a speculum, a mirror, a flashlight, white vinegar, and cotton swabs.
A study of 2,763 postmenopausal women who had Pap smears annually for four years found 110 women with abnormal results, but only one woman who actually had cervical cancer.
"Even in the context of a major clinical trial, which would presumably employ the most skilled pathologists, these specialists disagreed with one another’s diagnosis [of Pap smears] at an alarmingly high rate."