Normal Body, Normal Exam

Edited excerpts from our book
A Gynecologist's Second Opinion
by William H. Parker, M.D.

 

The human body is fascinating and complicated. For example, hormonal changes may heighten a woman's sexual desire around the time of ovulation, the most optimal time for fertilization. This increases the odds of conceiving a child by intensifying her desire for sex at the perfect time. Also, the thick mucous produced by the cervix normally hinders the passage of sperm up into the uterus. However, at the time of ovulation the mucous becomes thin and watery and easily allows the sperm entry. It is only over the last 100 years that the functions of a woman's body have begun to be studied and understood. Medical drawings from the 1700's show the anatomy of the female pelvic organs resembling the pelvic organs of farm animals. The ignorance behind this assumption is understandable, since human dissection was prohibited by church law. The anatomists did the best they could based on the animals that were on hand at the time. The medical world spent many years working from these incorrect assumptions.

Before the 1900's, the hormonal processes of a woman's body were not recognized at all. Menstruation was felt to result from irritation to the "fallopian tube nerve", a structure that we now know does not exist. Women were thought to bleed because they had too much blood, more than men had, and more than they needed. When an adolescent girl began to menstruate, she was considered susceptible to weakness, lethargy and disease. The two female hormones, estrogen and progesterone, and the hormonal events that trigger menstruation we were not discovered until the 1920's. The ovaries were thought to be the main influence on a woman's emotions, and disease of the ovaries was felt to cause insanity. "Ovariotomy", removal of the ovaries, was commonly performed for a variety of emotional problems, including overeating and erotic tendencies. The removal of diseased ovaries seemed to produce a "better" woman - more orderly, industrious and clean.

It is no wonder that doctors were rarely able to diagnose true gynecologic diseases. Pelvic examinations were almost never performed, lest the woman and the doctor suffer from embarassment. Often, the doctor made a diagnosis entirely based on reported symptoms sent by the patient via messenger. If an examination was felt to be absolutely necessary, it was performed with the woman covered entirely by drapes, so that the doctor was unable to see anything. Needless to say, a woman's sense of her own ailment or physical condition was rarely respected, and clearly, women were never considered stable enough to be physicians themselves. While medical research sometimes seems annoyingly slow and plodding, there has been a steady march towards our understanding of a woman's reproductive system. With each step, we are able to solve more problems and treat more illness.

In 1597, Francis Bacon said, "Knowledge is power." That statement is particularly true today with regards to your health care. If you understand your own body, you will be in a better position to take care of it in times of sickness as well as health. Staying healthy is always the best medicine. But if you have a medical problem, getting to the right doctor and getting the appropriate treatment all involve decisions. Put some power into your decisions by being well-informed and educated. This book is designed to help you do that.

WHAT DO THE OVARIES LOOK LIKE?

The ovaries are small, walnut - sized lumps of tissue that are about one inch away from the top of the uterus on either side. They are off-white, and, in young girls and adolescents, are smooth. After the onset of menstruation, however, the ovaries begin to go through a series of events that leads to a change in their appearance. Just prior to ovulation, a small (1/2 inch) clear collection of fluid forms around the developing egg and becomes visible below the surface of the ovary. This combination of the fluid, hormone producing cells, and the egg is called a follicle. During ovulation, the surface of the ovary bursts open, and the egg is carried away in a surge of fluid. The surface cells of the ovary heal quickly, leaving behind a yellow-appearing pocket of cells called the corpus luteum. The corpus luteum produces the hormone progesterone until the developing placenta takes over, or will disappear shortly after the menstrual period if no pregnancy has occured. As time goes on, the surface of the ovary becomes pitted and irregular, evidence of many ovulations and subsequent healings. After the menopause, the monthly formation of follicles and ovulation cease. The ovaries decrease in size to that of an almond and become a pale white.

HOW DO THE OVARIES WORK?

At the start of a normal menstrual cycle, the pituitary gland, situated at the base of the brain, releases a hormone called follicle stimulating hormone (FSH) into the bloodstream. When the FSH reaches the ovary, it stimulates an egg and the cells around the egg (the follicle) to develop. The follicular cells surrounding the egg then begin to produce estrogen, the main female hormone.

Around the middle of the cycle, the pituitary gland produces another hormone, called luteinizing hormone (LH). LH causes the cells on the surface of the ovary to break open and release the egg. After the egg is released, the ovary begins to produce progesterone, the other main female hormone, in addition to estrogen. If you become pregnant, the ovary continues to make these hormones for about three months, until the placenta is able to take over hormone production for both itself and the developing fetus.

If you don't become pregnant, the ovary stops making both estrogen and progesterone about two weeks after ovulation. Without these hormones, the uterine lining cells can't survive; they die and are shed as the menstrual flow. Then the cycle starts all over again. These finely balanced hormonal events are crucial to controlling the changes you associate with your menstrual cycle and the normal pattern of bleeding that you expect.

WHAT DOES THE DOCTOR FEEL WHEN YOUR PELVIC EXAMINATION IS PERFORMED?

The manual part of the pelvic examination allows the doctor to feel the size and shape of the uterus, tubes and ovaries. During this part of the examination, the doctor pushes the cervix upward from the inside of the vagina. This moves the top of the uterus closer to your abdominal wall, where the size and shape of the uterus can be felt between the doctor's two hands. Thus, the doctor should be able to detect conditions that increase the size of the uterus, such as fibroids.

The ovaries are normally about the size of a small walnut and can be felt on either side of the uterus. Abnormally large ovaries usually indicate the presence of cysts, benign tumors or, very rarely, cancer. The fallopian tubes are so soft and mobile that they are normally not able to be felt during the examination. Tenderness in the area of the tube sometimes indicates infection. If endometriosis or scar tissue from previous infection or surgery is present near the tubes, tenderness may also be present during the examination.

The following questions and answers can be found in our book

  • NORMAL BODY
    • WHAT DOES THE UTERUS LOOK LIKE?
    • HOW DOES THE UTERUS WORK?
    • WHAT DOES THE CERVIX LOOK LIKE?
    • HOW DOES THE CERVIX WORK?
    • WHAT DO THE FALLOPIAN TUBES LOOK LIKE?
    • HOW DO THE FALLOPIAN TUBES WORK?
    • WHAT DO THE OVARIES LOOK LIKE?
    • HOW DO THE OVARIES WORK?
  • NORMAL EXAM
    • WHAT DOES THE DOCTOR FEEL WHEN YOUR PELVIC EXAMINATION IS PERFORMED?
    • HOW OFTEN SHOULD YOU HAVE A PELVIC EXAMINATION?
    • HOW IS THE PAP SMEAR PERFORMED?
    • HOW OFTEN SHOULD YOU HAVE A PAP SMEAR?
    • CAN THE PAP SMEAR DETECT OVARIAN CANCER OR UTERINE CANCER?
    • HOW IS THE BREAST EXAMINATION PERFORMED?
    • WHAT DOES BREAST CANCER FEEL LIKE?
    • SHOULD YOU PERFORM A MONTHLY BREAST SELF-EXAMINATION?
    • WHEN AND HOW SHOULD YOU DO A BREAST SELF-EXAMINATION?
    • HOW OFTEN SHOULD YOU HAVE A MAMMOGRAM?
    • WHAT HAPPENS IF A SUSPICIOUS BREAST LUMP IS DETECTED?
    • DO YOU REALLY NEED A RECTAL EXAMINATION?
    • HOW OFTEN SHOULD YOU HAVE A SIGMOIDOSCOPY?
    • HOW OFTEN SHOULD YOU HAVE A PELVIC SONOGRAM?
    • HOW OFTEN SHOULD YOU HAVE YOUR BLOOD TESTED?
    • WHAT ELSE CAN YOU DO FOR YOUR HEALTH?

 

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Disclaimer: The ideas, procedures and suggestions contained on this web site are not intended as a substitute for consulting with your physician. All matters regarding your health require medical supervision.