How To Stay Out of the Gynecologists Office

Things you can do with a speculum

The cervix is the opening to the uterus where menstrual blood, babies, and sperm pass. It is also the opening through which abortions are performed. Spermicide and barrier methods of birth control, like the diaphragm, female condom, and cervical cap, work by covering the cervix and preventing sperm from entering the uterus. Hormonal methods of birth control, including oral contraceptives and Depo Provera, affect the mucus around the cervix and make the opening more resistant to sperm.

· When you use your speculum and flashlight you can see your cervix, the os of the cervical canal, and the vagina walls

· You can know what is normal for this part of your body, and see what secretions are normal and natural and any discharge that may signify infection. If you have an irritation, you can use natural remedies to treat conditions such as yeast, bacterial infection, trichomonas, or cervicitus.

· You can recognize the signs of pregnancy

· You can recognize the changes during your menstrual cycle. You can especially recognize fertile mucus, a sign of ovulation. With a speculum it is no longer necessary to guess when you’re fertil.

· You can understand your doctors instructions so that you can do what he/her advises.

· You can check your health after menopause. SEE "Myths of Menopause" below..

Welcome!...What you see when you use your speculum

Our Normal, Health Cervix & Vagina

Most women’s cervix is a knob-like pink structure about the size of a small plum, but the cervix of women who have never been pregnant may be a little smaller and dark pink, and women who have had children may have a slightly larger cervix of a medium pink. As we get older, the cervix becomes a lighter shade of pink. A healthy cervix is usually smooth and shiny. In the middle is an opening. This is the os; the os may be so small you can hardly see it, however in most women, it is slightly open. The os usually open up (some during the ovulation time of). In some women, especially women who have had several children, the os may be more open.

Squamo-Columnar Juction

Usually the cervix is an even shade of pink, but in some women, you can see a darker almost red ringed area just outside the os (sometimes this ringed area may extend outward on the face of the cervix). This is the “squamo-columnar junction”. Where the column-shaped cells that line the cervical canal meet the flat cells that cover the cervix, it forms a circular line.

When a girl starts to menstruate, the cervix may be almost covered with the reddish “columnar” cells. Each menstrual cycle, the growing columnar cells push forward and become flattened, forming squamous cells. These flat cells are shaped like pancakes and are piled on top of each other to form the outer layer of the cervix. The squamo-columnar junction has gradually receded to the point that it cannot be seen in most adult women’s cervixes.

Secretions, not discharge

Women frequently see some fluid coming out of the os. This fluid is generally a natural secretion. The vaginal is self-cleaning. This fluid, which is clear and odorless, keeps the walls of the vagina moist.

In the middle of our menstrual cycle, our secretions usually change; they become clear and sticky, this is called fertile mucus. These secretions indicate that we’ve ovulated and if a man ejaculates semen containing sperm or if we have sperm inserted into our vaginas for artificial insemination, this fertile mucus and up through the egg tube will draw the sperm up through the cervical canal into the uterus to meet up with the egg. Learning to spot the differences in our secretions by using a speculum can help us to predict ovulation and either prevent pregnancy by avoiding penis-vagina sex or using a condom, or to encourage pregnancy by timing our penis-vagina sexual encounters.

The Vaginal Walls

The walls of vagina are ridged. Very young women tend to have more pronounced ridges. Adult women’s ridges are less so, and older women’s vaginal walls become somewhat flattened out. Sometimes, the vaginal wall becomes clear as glass and the red blood cells can be seen. If the woman has regular penis-vagina sex, the walls stay thicker and more rugged. If a woman resumes having penis-vagina sex after not having had it for awhile or infrequently, sexual intercourse can be painful at first. (See dry vagina to learn self-help tips to reverse this process). If a woman is not having regular penis-vagina sex, the thickness of the vaginal walls is not important

Discharge

There are a variety of types of fluids that come out of the cervix that may indicate an infection. You can spot these fluids before they mix in with the vaginal secretions and decide if you have a problem. (see yeast condition)

Menstrual Cycle

During menstruation, the menstrual blood which is made up of the cells that lined the uterus that are no longer necessary because we didn’t conceive during ovulation, trickles out. It is bright red and odorless. It is only when the menstrual blood is exposed to oxygen that it becomes a rusty color and has an odor.

Signs of Pregnancy

When we are pregnant, even a few days pregnant, the cervix softens, and our os begins to open up a little; frequently a drop or two of clear mucus will be at the opening of the os. If we have been looking at our cervix and know how it generally looks, this opening-up is very noticeable. If we do self-examination with other women who have seen different cervixes, they can usually spot this right away.

Possible Problems of the Cervix

Usually the Cervix is an even color and has no blotches or inflammation, but sometimes you may see imperfections which may indicate an infection or you may see a bruise which might have resulted from the banging of the penis.

Cervical Erosion or Cervicitis

This term, which does not mean that the surface of the cervix is eroding or wearing away, indicates that there’s a reddish irritation on the cervix. This may be the result of a tampon rubbing against the cervix, an infection, abrasion or trauma, or an IUD string lying on the cervix. These irritations can last awhile. It’s a good idea to keep doing self-examination every week to see if it will go away. Doctors usually like to treat these irritated areas because they want to be sure that the irritation is dealt with while the woman is in the office. When you go for a check-up, the doctor may cauterize the irritation by blowing very cold air on it to freeze the outer cells. These cells will die and be cast off and new cells will grow to replace them. For further information, see Cervicitis.

Cysts and Polyps

Women doing self-examination often see a cyst on their cervix, which looks like a pimple or blister on the surface of the cervix. Some cysts are white, and can be tinged with a reddish-blue color; others are grayish white with a red rim. They vary in size from a pinhead to a small pea. These usually cause no problems, but do change in size and appearance during the menstrual cycle.

Polyps look like soft, bright red, stalk-like growths. Polyps are not as usual, but they are nearly always benign growths. (see Polyps)

Common Problems and Remedies

Vaginal Infection: When an infection erupts, the vagina is often red and swollen and very tender; the vulva and inner lips can also become swollen and irritated and itch intensely. With your speculum and mirror, you can nearly always distinguish between a yeast condition, a bacterial vaginal infection, trichomonas, and these can be dealt with by using over-the-counter remedies or home remedies. Once you know the signs and symptoms of these common problems, you will be more likely to spot the symptoms of conditions that require medical treatment.

Symptoms of conditions that Require Medical Treatment

Gonorrhea, unfortunately, often is difficult to detect except with a laboratory test, however, you may see a thick, yellow-greenish discharge which could be gonorrhea. Or, if in addition to irritation and discharge, you also have burning on urination, a yellowish discharge directly from the cervix, or pain the pelvic area, you may have chlamydia, which can be detected by taking a culture of the vaginal secretions. If you see lesions on the cervix or vulva along with symtoms of general ill health, you may have an infection of the Herpes virus and you need medical attention.

Yeast Condition

Sometimes, you can see a whitish secretions, sometimes cottage-cheesy or clumpy, on YOUR cervix and when the speculum is in place for a minute or two, it will form a pool under the cervix. You may or may not experience an irritation on the inner lips and the vaginal opening. If this is a Yeast Condition, it will probably have a yeasty odor (like fresh-baked bread). Yeast is a one-celled plant (candida albicans or monilia), and it is normally present in our vaginas. It only becomes a problem when it overgrows. Other than intense irritation and itching, there are no serious health consequences of this condition. Please Note: some women get intense irritation and itching without seeing even a speck of Yeast, but doing a treatment for Yeast Condition gets rid of the problem.

Treatment of Yeast Condition

Women have used a variety of ways to clear up a Yeast Condition. There are over-the-counter medications, such as Moni-Stat or homeopathic remedies, that some women swear by. Or, many women have used home remedies, such as taking a vaginal douche, with either clear water or water with a couple of tablespoons of vinegar to flush out the excessive amounts of Yeast. Be sure to wash the douche bag with soap and water and dry thoroughly to prevent reinfection.

Inserting plain, non-sweetened yogurt into the vagina and leaving it in can clear up a Yeast Condition. Be sure the yogurt is not pasteurized, because it is the live bacteria in the yogurt culture (lactobacillus acidophilus) that do the work, restoring the healthy balance in the vagina.

Bacterial Vaginal Infection

Bacterial Vaginal Infection results when there is a change in the normal bacteria of the vagina that causes harmful bacteria to overgrow. A runny discharge of a brownish color and a foul or fetid odor may indicate a bacterial infection. This discharge may keep the inner lips moist, while the vagina is usually dry, remaining so even during sexual excitement.

Fortunately, there are a number of home treatments for bacterial vaginal infections. Getting relief from responsibilities and getting plenty of rest is important. Douching for one to four days with water and vinegar, herbal tea or Betadine (povidone-iodine) are effective treatment for Bacterial Vaginal Infection. Some women who have repeated bouts of Bacterial Vaginal Infection have found that it helps, in addition to using the self-help remedies,to have their male partner wash his genitals and hands before sexual intercourse.

Trichomonas infection

Trichomonas can be treated at home, avoiding the anti-fungal drugs that are usually prescribed which have side-effects.

Whatever treatment a woman chooses, it is very important that her male partners either get treatment or use condoms for two or three months afterwards. Otherwise, the infection is passed right back.

Douching with full-strength povidone-iodine (Betadine) has been successful in getting rid of Trichomonas or bacterial infections. Women have reported the greatest success in curing Trichomonas if douching is continued for a week following a menstrual period, particularly since the condition has a tendency to recur during this time. (Pregnant women are cautioned not to use Betadine).

“Sucking Air” is the most effective way to be sure that the povidone-iodine, which kills the Trichomonads on contact, reaches every wrinkle and crevice of the vagina. Some women fill a douche bag with the undiluted povidone-iodine and hang it high. Others pour from the bottle. You lie on your back in the bathtub facing away from the faucet with your legs resting on the back wall of the tub or against the wall. The higher your hips are, the better. Some women can raise their hips and stand on their shoulders, so that the vagina is upside-down and balloons so that it has no creases or crevices. Relax the muscles in your abdomen, buttocks, and anus so that the organs fall away from the vagina. Next, spread the vaginal open either with two fingers or the speculum. The Betadine is poured from the bottle or douche bag until it overflows. Leave the solution in for several minutes. As you come to a seated position, the solution runs out. This procedure seems messy, but povidone-iodone is easily washed off and doesn't stain.

Douching with herbal teas can often clear up a vaginal trichomonas infection. Those teas have antiseptic properties and relieve inflammation. They are: bayberry, goldenseal, and slippery elm. Brews of these teas can be prepared by steeping one ounce of cut or powdered herb in a pint of boiling water for 15 to 20 minutes and used after the liquid has cooled to a lukewarm temperature.

For additional Home Remedies please check-out the Women Health Specialists Website. Thank You!


This 21-year-old woman is on day 25 of her menstrual cycle. Although she thought she probably ovulated on her day 20, her os is still open and clear mucus can be seen in it. She also has a very noticeable squamocolumnar junction. She has had no births or abortions. The white, creamy pool of secretions under her cervix is partly from a slight bacterial infection. (Please select image to enlarge.)	This woman is 23 years old and has had three abortions, one of which was done two-and-a-half weeks before this picture was taken. Her cervix does not look any different because of her recent abortion. Her cervix faces upward, indicating that her uterus is tilted backward, a perfectly normal position. This is called a “retroverted” uterus. She has some irritation on the cervix which does not bother her. (Please select image to enlarge.)

This woman is 28 years old and sexually active. She has had two children, which probably accounts for the shape of her os, and two miscarriages. (Please select image to enlarge.)	This woman’s cervix has a few small red blotches near the os and you can see a clear mucus secretion coming out. Her vagina walls, right next to the cervix, has a ripply texture. She is six weeks pregnant. (Please select image to enlarge.)

The secretion covering the cervix in this picture is white and clumpy. This woman typically has a lot of secretions and this secretion, a mixture of mucus and cast-off cells, is completely healthy. In appearance, it could be mistaken for a yeast condition, but it lacks the other characteristics of yeast, a yeasty odor or irritation of the vagina or clitoris. This photo was taken the day before her period was due. Note how dark the cervix is. Also, her cervix was cauterized by cryosurgery a year before and has had this irregular texture ever since. (Please select image to enlarge.)	In this photo, (taken in the mid-1970's) an IUD string can be seen coming out of the os. The whitish part of the string at the os is where bacteria have gathered, like pus of an infection. This woman’s IUD is a Dalkon Shield, a type that has been removed from the market in the U.S. because of the number of deaths and severe infections associated with it. (It is now recommended that every woman who has a Dalkon Shield have it removed.) She is 31 years old. The red spots above her os is an irritation commonly seen on the cervixes of women who have IUDs. (Please select image to enlarge.)

MYTHS OF MENOPAUSE

After our period have stopped coming regularly, our regular doctor's visit can turn into a prescribing opportunity for the physician or nurse-practitioner. We may complaint to the doctor that we have experienced less lubrication when a penis is inserted into the vagina, or we may feel an itching and irritation at the vaginal opening. Then, when the speculum is inserted, it may be painful. Voila! "Here's a prescription for some cream that's going to make it all better" or "Here's some pills to take daily".

Even though the reason we had less lubrication might be that our partner hasn't waited for us to get sufficiently "wet" or that we have douched excessively or that we haven't had much penis-vagina sex lately, it is assumed that we are deficient in hormones because we no longer have a regular menstrual cycle. If we allow ourselves more time to get fully lubricated, or if we stop douching, or if we stimulate the vaginal walls with a dildo or a speculum, the problem of "dryness" may disappear.

But, the irony is that if we do use the cream or take the pills, the dryness does go away. Doesn't that prove that we needed the drug?

No. The way that hormone-like drugs work is the stimulate our cells to work harder to do whatever each type of cell is supposed to do. The cells of the vaginal lining are supposed to proliferate, that is, reproduce themselves rapidly, so the drugs cause our cells to grow rapidly, causing a thicker vaginal lining. A thicker vaginal lining has more cells to push out fluid when we're sexually stimulated, so therefore, more moisture.

Very often, we have no complaints at all, but when the speculum is put in, it hurts. Lorraine Rothman and Marcia Wexler have written an excellent small book to explode all those "Myths of Menopause". The myths are stated here with a summary of the Facts, but if you are having any problems after menopause, this whole book is a must-read!

MYTH 1: Science has all the answers.

FACT: They don't. Faulty studies are accepted by the medical community and are absorbed into the broader culture.

MYTH 2: Menopause is a time of biologic imbalance that is best managed by medical professionals.

FACT: Menopause is a natural transition that most women pass through with little of any discomfort.

MYTH 3: There are male hormones and female hormones.

FACT: All people make the same sex hormones.

MYTH 4: Our ovaries are our only source of estrogen and progesterone.

FACT: Estrogen and progesteron are not made only in our ovaries but also in our adrenal glands and body fat. We need these hormones throughout our lives for healthy normal body function.

MYTH 5: Post-menopausal women have estrogen levels that are either very low or non-existent.

FACT: Our bodies make sufficient estrogen from the time we're embryos until the day we die.

MYTH 6: At menopause women's ovaries shut down and doctors are correct in caling this "ovarian failure".

FACT: Healthy women's ovaries do not cease to function after menopause.

MYTH 7: Estrogen levels always go down at menopause.

FACT: Because of liver damage and/or exposure to certain chemicals, estrogen levels can go up in menopausal and aging women. High levels of estrogen can stimulate cancer cells.

MYTH 8: Studies show that menopause is a disease.

FACT: For many years, menopause studies focused on women with illnesses or unusual health conditions, wich gave normal menopause an incorrect and disease-oriented definition.

MYTH 9: Decades of research into menopause support the importance of giving Hormone Replacement Therapy to aging women.

FACT: Research has not been able to show that hormone drugs protect women against the degenerative diseases of aging, nor has research shown that taking the drugs is safe.

MYTH 10:Hormone Replacement Therapy is a must for aging women.

FACT: 75% of aging women do not take Hormone Replacement Therapy, do not want to take these drugs, and, if they do start, generally stop taking them within a year.

MYTH 11: Severe physical symptoms at menopause are due to low estrogen levels and require Hormone Replacement Therapy.

FACT: Metabolic and chemical changes at menopause can exacerbate hidden health problems. Doctors attribute many symptoms to menopause and don't look for the underlying causes..

MYTH l2:Estrogen drugs can be taken in different ways; each tailored to fit the woman.

FACT: Women can take the hormone drugs in different ways--pills, shots, vaginal creams, skin patches--but al have the same risks to life and health.

MYTH 13: Lowering the dosage decreases the risk associated with hormone drugs.

FACT: High or low dosage, the risks remain the same.

MYTH 14:Most of the estrogen replacement hormones are natural hormones; those that are synthetic act as natural hormones.

FACT: Estrogen replacement hormones are not natural to women's bodies. So-called natural hormones are not part of the body's process of making hormones and have not had long-term large-scale studies to determine safety.

MYTH 15: To counter progesterone deficiency at menopause, natural progesterone, developed from a wild yam, is like our body's hormone and therefore, safe and useful.

FACT: Menopause does not cause a progesterone deficiency. Furthermore, the wild yam does not contain progesterone; it has to undergo chemical alteration in the laboratory before its molecules are exactly like our own progesterone.

MYTH 16: Drugs are the only choice to help a woman through the discomforts of menopause.

FACT: If a woman is otherwise healthy, yet wants some help through her menopause, she can pick from a variety of choices that do not depend on drugs.

MYTH 17:Hot flashes are inevitable at menopause, due to estrogen insufficiency, and are relieved with Hormone Replacement Therapy.

FACT: Hot flashes are related more closely to lifestyle issues than to estrogen levels. Although many women get relief when they take HRT, hot flashes often return once the drugs are stopped.

MYTH 18:Vaginal dryness is very common at menopause, due to estrogen deficiency, and is relieved with estrogen cream.

FACT: Sensations characterized as "vaginal dryness" can occur at any stages of a woman's life. More atention has been placed around it around the menopause. Although estrogen creams do relieve vaginal itching and the sensation of dryness, the synthetic hormone is absorbed into the blood stream and carries the same risks to health as pills and patches.

MYTH 19: Taking HRT for depression and anxiety around the time of menopause solves the problems.

FACT: Menopause has the knack of showing up at the worst time in a woman's life. The loss of a job, loss of a spouse, caring for aging relatives, children leaving home, or worse, moving back in, and the perceived loss of youthfulness are problems that cannot be treated with HRT.

MYTH 20: Heart disease increases dramatically after menopause and women with heart disease catch up to their male counterparts.

FACT: Heart disease is a degenerative condition of aging aggravated by western lifestyles. Menopause does not increase a woman's susceptibility.

MYTH 21: Mild bone loss in menopausal women indicates the onset of osteoporosis, which inevitably leads to fractures and death. Mild bone loss should be treated immediately with estrogen to prevent further loss.

FACT: Menopause does not cause osteoporosis.

MYTH 22: Vitamins can't hurt but they aren't going to help much either.

FACT: Hormones and vitamins act interdependently, meaning that hormones need vitamins to carry out their functions.

MYTH 23:Doctors take lab tests to improve care.

FACT: Doctors often request tests to satisfy themselves and the patient pays for it.

MYTH 24: Laboratory tests can accurately measure a woman's hormone levels to determine if she is in menopause.

FACT: We can't rely on laboratory tests to predict menopause.

MYTH 25: The FDA oversees the safety of our food and drugs.

FACT: The FDA has over bowed to the needs of corporations.

MYTH 26:To date, there is no evidence that food additives and pesticides do any harm, and their benefits fr our food supply outweigh the risks.

FACT: Exposure to chemicals aggravate an already over-burdened body. Some of these chemicals are also estrogen-imitators.

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See Your Cervix!