Archives of the Vagina: A Journey through Time

by Dr. Margaret Aranda

For my Caring Friends, here's a preview of my newest book, written before the doctor dropped me on the floor in March, 2013. I wrote this book (many of you will understand) because I'm not sure if I'll live long enough to see my daughter live through all the stages of womanhood: the maiden, the mother, and the crone.

                                   Book Cover Photo. Archives of the Vagina: A Journey through Time.

The book starts with my first period, and is very tongue-in-cheek humorous, because we all know where we were when we started our first period. Then I go through history, sociology, anatomy, and the endocrinology of the ovaries.

I discuss what Aristotle thought of menstruation and menopause, how William T. Stead is a hero we never hear about for rescuing children out of prostitution in London's brothels. This book is filled with the sociology of menstruation, including whether women on their periods can fly a plane, and whether women who are camping on their periods attract bear attacks that lead to death.

One of the most surprising statistics that I learned in my research and interviews of women is that in the USA, in women over 45 years old, 40% have had a hysterectomy. Of these, nearly 50% have had normal ovaries removed without proper Informed Consent. I dedicate an entire chapter to "Ovarian Conservation" (i.e., keeping your ovaries), and give you all the risk factors you need to know so you can put yourself on the Chart to see if you are at risk for ovarian cancer, and hence should get them removed. So my next book will be Hysterectomy can be Hell. I hope to get an Army behind me on this one, because it will take a Movement to change our culture. And changing a culture always means that people won't like you. Believe me. I've been there before.

I discuss the HPV vaccination for girls aged 11-12, starting your period, how to put in a tampon, and introduce what most women don't know: the menstrual cup, and the nondisposable pad. I promote a certain program that helps girls in Africa obtain menstrual pads so they don't have to miss school, be drop-outs, get pregnant, contract HIV, attain a lower socioeconomic status, and die earlier than the girls that are more educated. So expect a Movement there, too, ladies and girls.

I go through the Women's Health Initiative and basically tear it to shreds, because it had, in my opinion, no application to women in menopause suffering symptoms of vaginal dryness and hot flashes. I let you skip a very medical chapter if you would like, but I also put it in there for medical personnel to evaluate it for themselves. I dissect menopause and give the man's perspective, too, hopefully leading you to more self-discovery and compassionate understanding. Pretty funny stories there, too, my friend.

The last half of the book is dedicated to such things as Invisible Diseases, the Low Glycemic Diet, Immunonutrition and Fish Oil, Telemeres, Living for not only Health & Wellness but also for Quality of Life, Caregiving (and the effects on women, by ethnicity), Long-Term care, and death and dying. I empower you to ask questions, eat Spoon by Spoon, and Don't Fall when you are elderly. I tired of seeing women come into the Operating Room for hip fractures from a fall. You need to know your bone density, and take your Vitamin D or Calcium. The role of an Endocrinologist in your care can not be underestimated. I also believe that Cenegenics has an excellent program for Concierge Medicine, private pay by cash, that is mostly utilized by Presidents and CEOs of companies. They are mostly men. This needs to change, because there are plenty of millionaire women out there. And women need to stop spending all their time nurturing others, and start spending some time nurturing themselves. So I took all this knowledge in my head and told it to you before my traumatic brain injury and DI occurred; and I thank God that I did it.

There. I said it. My opinion rings throughout this book, and it is backed up by over 200 Stanford-quality references that are NIH-funded. I list them all for you, and many of them are dated in 2012 and 2013. Nothing but the best for you, my friends. Nothing but the best. Be prepared to learn, to grow, and to  ROCK your WORLD. You can PRE-ORDER the book (February launch date perhaps) on The Aranda MD Shoppe. My official site is Coming Soon....and I hope you like it. 

God Bless You in all that you do.

The Ovaries: Reproduction and Endocrine Function

The Ovarian Follicle: Reproductive and Endocrine Organ

The female body is endowed with the uterus and ovaries as reproductive organs.  But having babies is not their only function. Initial breast bud and pubic hair formation occurs because of hormones produced by the ovaries.  Later, a girl will have her first period.

A girl begins to menstruate because her ovaries are producing estrogen and progesterone.  The 28-day menstrual cycle may not begin with the first period.  It may take 2-3 years for a girl to be ‘established’ with monthly periods, as she may have her periods only once or twice in the first year, then more often as time progresses.

Women are born with two ovaries, one on each side of the uterus (See Figure 1).

Figure 1.  The female pelvis.  The uterus is behind the urinary bladder.  1 = Fallopian tube; 2 = urinary bladder; 3 = pubic symphesis; 4 = vagina; 5 = clitoris; 6 = urethral opening; 7 = vagina; 8 = ovary; 9 = fascia; 10 = uterus; 11 = posterior cervix; 12 = cervix; 13 = colon; 14 = rectum.

It is important to understand that the human ovary serves two functions:  reproduction and endocrine.  Both of these functions are tightly coupled, as the release of hormones makes the uterus ready for fertilization of an oocyte that comes from the ovarian follicles (See Figure 2).

Figure 2.  Reproduction:  The Ovarian Follicle and the Cycles of Menstruation.  With the monthly cycle, the ovarian follicle prepares an oocyte for maturation and release to the Fallopian tube, with the possibility of fertilization and reproduction. 

There are three types of cells in the human ovary:  the oocyte or mature egg, the granulosa cells, and the external thecal layers.  The follicle houses the oocyte that is maturing to the time of release.  The granulosa cells are in the follicle, and they surround the oocyte.

Hormone production dictates what happens to the follicle. When testosterone increases, the number of granulosa cells decrease.  When gonadotropins (i.e., protein hormones produced by the anterior pituitary gland) increase, the granulosa cells increase in number, not size.  Pituitary gonadotropins include:  follicle-stimulating hormone (FSH) and lutenizing hormone (LH).  FSH tells the granulosa cells to make LH receptors on the cell surface so that when LH is produced and binds to the receptors, the end of the cycle proliferation occurs.  This makes the period stop (see Figure 3).

Figure 3.  Endocrine:  The Ovarian Follicle and Hormone Production.  The human ovarian follicle produces estrogen and progesterone during the Follicular Phase and Luteal Phase, respectfully.  At the time of the early menstrual period, estrogen dominates.  Once the egg is released and there is no fertilization, progesterone dominates.

Another human gonadotropin is produced by the placenta, and this is known as human chorionic gonadotropin (hCG).  The hCG is the hormone test for pregnancy that is commonly used on pregnancy strips.  If hCG is present, placenta is making it.  As the placenta increases in size during the early stages of pregnancy, the hCG also increases in number.  During pregnancy, the placenta also produces estrogen.

During the nonpregnancy state, the human female ovaries produce estrogen, progesterone, and testosterone.  Granulosa cells in the ovarian follicles and the surrounding corpora lutea make estrogen.  Other organ cells participate in estrogen production, but to a lessor extent:  the fat or adipose, liver, breasts, and the adrenal gland.  Postmenopausal estrogen production can still occurs from these extra-ovarian sources, but a woman's individual blood levels must be measured to know what phase her ovaries are in.  In the nonpregnant female, the highest levels of estrogen occur just prior to ovulation, near the end of the Follicular Phase (see Figure 3). 

Figure 4. The metabolism of cholesterol.  A variety of biochemical reactions exist whereby cholesterol is metabolized to progesterone, then on to dehydroepiandrosterone, testosterone, dihydrotestosterone, or estradiol.  Cholesterol is not all bad, and our bodies must produce cholesterol not just in order to procreate, but to develop neurologically. Cholesterol is important to the structure of cells, as well as being a precursor of oxysterols, bile acids, and steroid hormones.  

Cholesterol is the "Mother Molecule" of androgen and estrogen steroids (See Figure 4). Actually, you may be surprised to learn that the cholesterol molecule is a major part of the human brain, and there is no organ in the human body that contains more cholesterol than the human brain (Orth, 2012).  In fact, about 20% of the body’s cholesterol is contained in the brain.  The brain does not have the same metabolic pathway as other organs, and the brain is responsible for what is called de novo synthesis of cholesterol.  This means that the brain makes it freshly. It was Couerbe who, in 1836, described the cholesterol molecule as being “un element principal”, meaning ‘a key element’ in the central nervous system (Couerbe, 1834).

It is important to note that the ovary is uniquely tied into the hormones that they produce.  The ovaries are an organ, and they synthesize and coordinate the lifecycle of a girl and a woman. In old age, the same ovaries dictate how menopause is approached.  

If a woman undergoes a hysterectomy and the surgeon also removes the ovaries, this is 'surgical menopause'. A woman undergoing a hysterectomy gets a 'crash course' in menopause if the ovaries are removed, and she should be offered a discussion of whether or not she should be placed on hormone replacement therapy (HRT).  Backing up for a moment, wait just one moment.  Actually, we must first question whether the ovaries should be removed at all.  Stay tuned for the next article, which will address this issue.

References:

Couerbe JP. Du cerveau, considere sous le point du vue chimique et physiologique. Annales De Chimie Ed De Physique. 1834;56:160-193.

Orth M., and Bellosta S.  Cholesterol: its regulation and role in central nervous system disorders.  Cholesterol, 2012;2012:292598, doi:10.1155/2012/292598. Epub 2012 Oct 17.  http://www.ncbi.nlm.nih.gov/pubmed/23119149

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Additional Articles by Dr. Margaret Aranda

Menopause and Painful Intercourse

The Cochran Report

What Aristotle Thought of Menstruation

From Menarche through Menopause

The History of Menopause

The Different Types of Hysterectomies
Low Sexual Desire: Is It HSDD?

Surgical Menopause and Testosterone Therapy

Bears Can Smell the Menstruation: Or Can They?

The Ovaries: Reproduction and Endocrine Function

Bears Can Smell the Menstruation: Or Can They?

by Dr. Margaret Aranda

The question arises as to whether bears attack women who are on their periods, due to the attraction of the menstrual blood.  In 1983, Cushing presented his findings at the International Conference on Bear Research and Management, documenting the responses of polar bears to menstrual odors.  This spearheaded the future work in this area, which continues to this day.  Stay with me as we explore the fascinating issues surrounding this issue. 

The Grizzly Bear.

Yellowstone National Park (YNP) has been tabulating interactions between bears and humans in their district, which includes parks in Wyoming, Montana, and Idaho.  Data analyzed in 2012 by Kerry A. Gunther, bear biologist and expert at YNP’s Bear Management Program. He showed that the overall risk of human injury (for any reason) by a bear in YNP, men and women inclusive, is 1 in 2.1 million.  But the interest and fascination with this subject continues.

Kerry A. Gunther.

Perhaps the biggest outburst public scrutiny on bears attacking menstruating occurred after the night of August 13, 1967 in Glacier National Park.  The Park is located in northwestern Montana, along the Rocky Mountains.  In a situation that was later determined to be unrelated and coincidental, two women on their periods were killed by Grizzly bears on this night.  The National Park Service (NPS) subsequently put out a bulletin that menstruating women could be attacked by the Black Grizzly bear, perhaps spurring that speculation had turned into a scientific notion that the two were actually scientifically related.  The official statement was, “..women should stay out of bear country during their menstrual period.”  Years of belief ensued, wherein it was thought that camping or hiking women on their periods were attractants to killings by bears.

In his 1983 study on captive Polar Bears and the odor of menstrual blood, Cushing studied a series of different odors and their effect on bears.   Scents included seal scent, food, used tampons, and non-menstrual human blood.  There was a strong response to seal scent and used tampons.  Cushing also studied wild Polar Bears, who were attracted to and ate food and used tampons, perpetuating the observation that bears are attracted to menstrual blood.

In 1985, Herrero studied Grizzly bears and human attacks, including the two women attacked in 1967.  He concluded that there was no relationship.

In 1988, Byrd revisited the unsettled issue, trying to answer this question on his Thesis for his Master’s in Science.  He found that there was no evidence that the Black Grizzly bear preferred menstrual odors over other odors, and there was no scientific evidence that hundreds of bear attacks were related to women on their periods (Byrd 1988).

In 1991, Rogers et al studied how 26 wild Black Bears reacted to used tampons from 26 women.   In a novel design, he also studied 20 wild Black Bears’ response to 4 women’s menstrual blood at different times of their menstrual cycle.  The bears ignored the menstrual odors.

From 1980 through 2002, YNP had over 62,000,000 visitors spending over 15,400,000 nights at the main campgrounds and 956,000 nights in the backcountry.  No one kept track of statistics on the proportion of menstruating women.  There were 32 people injured by bears, coming to 1.2 injuries per year. Gunther and Hoekstra evaluated 1970 - 1994 statistics, citing that no bear injuries to humans were caused by menstruating women.  

Official word came out on August 9, 2012 from Kerry A. Gunther, who categorically stated that bears are not attracted to menstruating women. We can rest assured that if we keep the safety measures cited above, the risk would be so small as to be unproven.  So hat's away to camping, and be careful in the backwoods. 

References:

Byrd, C.P.  Of bears and women: Investigating the hypothesis that menstruation attracts bears.  M.S. Thesis, Univ. Montana, Missoula.  129 pp, 1988.

Cushing, B. 1983. Responses of polar bears to human menstrual odors. International Conference on Bear Research and Management 5:270-274.

Gunther K.A. and H.L. Hoekstra.  Bear-inflicted human injuries in Yellowstone, 1970 – 1994, a cautionary and instructive guide to who gets hurt and why.   Yellowstone Science 4(1):2-9. 1997.

Herrero, S.M.  Bear attacks – their causes and avoidance.  Winchester Press, New Century Publishers, Inc.  Piscataway, New Jersey, 287 pp, 1985.

Nelson, Brian. Mother Nature Network.  Mentruating women do not attract bear attacks.  August 9, 2012.  http://www.mnn.com/earth-matters/wilderness-resources/stories/menstruating-women-do-not-attract-bear-attacks

_____.  Yellowstone National Park website.  National Park Service. Bears and Menstruating Women. http://www.nps.gov/yell/naturescience/bears_women.htm

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Other Articles by Dr. Margaret Aranda

Menopause and Painful Intercourse

The Cochran Report

What Aristotle Thought of Menstruation

From Menarche through Menopause

The History of Menopause

The Different Types of Hysterectomies

Low Sexual Desire: Is It HSDD?

Surgical Menopause and Testosterone Therapy

Bears Can Smell the Menstruation: Or Can They?

The Ovaries: Reproduction and Endocrine Function

What Aristotle Thought about Menstruation

A student of Plato, Aristotle (384 BC – 322 BC) had a view of women that would be viewed as rather peculiar today.  He considered women to be unfinished males, ‘deformed’.  

In his Treatise On the Generation of Animals, he viewed menstrual blood as being a lesser sort of semen, writing on male and female secretions: 

“…This much is evident: the menstrual fluid is a residue, and it is the analogous thing in females to the semen in males.  Its behavior shows that this statement is correct.  At the same time of life that semen begins to appear in males and is emitted, the menstrual discharge begins to flow in females, their voice changes and their breasts begin to become conspicuous; and similarly, in the decline of life the power to generate ceases in males and the menstrual discharge ceases in females…”

A novel invention by the Ancient Greeks was a tampon make from a piece of wood entwined with lint wrapped around it; based on written records, these were believed to be used primarily for contraception.  I don’t know, but it sounds like those would hurt.  No wonder they were used for contraception, as the woman was probably injured afterwards and could not have sexual intercourse, I thought.

The Ancient Egyptians are credited with the invention of disposable tampons made from papyrus that were softened (The Period Blog; Utian, 2008).  Tampons were also used by the Byzantine women, who made them out of wool that was softened.  I can’t help but wonder if they knew when to pull them out.  Did they get toxic shock syndrome back then, from keeping them in too long and acquiring bacteria and then sepsis and then death?

Jump to the 1700’s, where the French considered menstrual blood to be seductive, and also a measure of female fertility (Corbin, 1986).  In 1986, Corbin writes:

 “…in 18^th century France, menses was considered to be ‘impregnated with subtle vapors transmitted by the essence of life.  These were particularly seducing, as a woman was ‘dispersing seductive effluvia’ and ‘making an appeal for fertilization.’  Thus societies have celebrated the seductive aroma of menstruation, rather than stifled (it).”

In the early 1800’s, remember that women probably menstruated for less of their lifetime versus now.  Menarche started later, at 17 years of age, and women breastfed much longer, they were pregnant more often, menopause started earlier, and they were more likely to be ill or malnourished.   Today, the age for a girl’s first period is now 13 years old.  The common notion during the 1800's was that menstruation was controlled by lunar phases of the moon (Covington, 2007). 

References:

The Period Blog: View The Period Blog here

Alain Corbin.  The Foul and the Fragrant: Odor and the French Social Imagination. Cambridge, Mass.: Harvard University Press, 1986.

Covington, Sharon N.  Infertility Counseling.  A Comprehensive Handbook for Clinicians, 2^nd Edition.  Georgetown University School of Medicine, Washington DV.  Linda Hammer Burns. View Book Here

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Other Articles by Dr. Margaret Aranda

Menopause and Painful Intercourse

The Cochran Report

What Aristotle Thought of Menstruation

From Menarche through Menopause

The History of Menopause

The Different Types of Hysterectomies

Low Sexual Desire: Is It HSDD?

Surgical Menopause and Testosterone Therapy

Bears Can Smell the Menstruation: Or Can They?

The Ovaries: Reproduction and Endocrine Function