Healthy sexual and reproductive organs are vital to a woman's sexual health. Learning about the functions of each organ and how these organs work together allows you to be aware of your body and of any changes that might indicate a problem. This information can also help you choose a method of birth control or determine when is the best time to try and get pregnant.

Learning about a woman's sexual responses may also make you more comfortable with your body. If you understand what happens to your body when you are sexually excited, you may be able to improve your sexual experiences.

A woman's sexual responses change throughout her life cycle. In part, this is due to her changing levels of experience and self-knowledge, but there are also physical changes as her body matures. Pregnancy and childbirth may have an impact on a woman's sexual responses. Dealing with the physical and emotional changes associated with menopause is also an important part of a woman's sexual health.

The reproductive and sexual organs | The menstrual cycle | Female sexual response

The reproductive and sexual organs

The internal organs

The largest organ in the female reproductive system is the uterus. Most of the time it is relatively small, about the size of your fist. In a normal pregnancy, the fetus develops within the uterus, stretching it to many times its normal size. Visit the pregnancy virtual health centre to learn more about this topic.

On both sides of the uterus are pouches called ovaries. The ovaries contain unfertilized eggs or ova. When one of these ova (called an ovum) unites with a man's sperm, it is fertilized and may eventually produce a child.

A girl's ovaries begin releasing ova at puberty prompting the start of her menstrual cycles.

When the ovaries stop producing ova, a woman has reached menopause. Tubes attached to the ovaries called Fallopian tubes allowing the ovum to travel to the uterus.

The vagina connects the uterus to the outside of the body. This passage has several important functions for women:

• a man's penis may enter a woman's vagina during sex (Vaginal penetration by a penis is called intercourse. Intercourse is the most probable way for a woman to become pregnant. Fingers or other clean objects may also enter the vagina during sexual play. Each woman is unique in her enjoyment of sexual intercourse. Deciding what gives us pleasure is an important part of learning about our sexual selves).
• menstrual blood is carried out of the body through the vagina
• when a baby is delivered normally, it passes through the vagina

When the vagina of an adult woman is healthy, it contains many types of harmless bacteria. Some of these bacteria are similar to those found on the skin, but other bacteria called lactobacilli are found mainly in the vagina. These bacteria help protect the vagina from infections with yeast and other bacteria.

The connection between the uterus and the vagina is called the cervix. This is a narrow opening, which helps protect the uterus from outside contaminants.

The external organs

The clitoris is the reproductive organ most involved in sexual pleasure. The top part of the clitoris is a short protrusion above the vaginal opening. However, most of the clitoris is inside the body. Its tip is very sensitive, so the clitoris is protected by a flap of skin called the hood. Blood rushes to the clitoris when a woman is sexually aroused, making it the most important organ for female sexual response.

Between the clitoris and the vagina is the tiny opening connected to the urethra. A woman urinates from this opening.

Folds of skin called the labia protect the clitoris and the vaginal opening.

The menstrual cycle

Changes in a woman's hormones that happen every month direct her body to release a tiny egg or ovum. The different stages in the production of this ovum are used to describe a woman's menstrual cycle. On average, the body produces an ovum once every 28 days and this is the average length of a menstrual cycle. Some women have longer or shorter cycles.

A woman's menstrual cycle begins with her period. To measure your own menstrual cycle, record the date of the first day you see blood during your period. The time from the first bleeding day of one period to the first bleeding day of the next period is the length of your menstrual cycle.

Women usually begin having periods in their early teens, but a woman's periods can start as early as age 9 or as late as 16 or 17. Having a period means that a woman's menstrual cycles have begun and that she can become pregnant if the ovum she releases combines with a man's sperm.

Changes in your cycle

Sometimes a woman's cycles are irregular, which means they come at a different time every month. This is particularly common for teenagers, however, most women miss a period or experience other variations in their cycle at some point in their lives. You might miss a period because:

• you are pregnant
• your body is still maturing
• you are under stress at work, home or school
• you are approaching menopause
• you've been exercising vigorously
• you've lost a lot of weight in a short period of time
• you have a hormone disorder
• you've been using prescription or street drugs

Although some of these changes are part of a woman's natural life cycle it is always wise to discuss changes in your menstrual cycle with your doctor.

The stages of the menstrual cycle

Two important hormones govern the menstrual cycle:

• estrogen
• progesterone

Hormones are chemical messengers, which the body uses to send instructions from one part of the body to another. The levels of estrogen and progesterone signal the changes that happen during the menstrual cycle. It is important to remember that these hormones also influence other parts of the body. For example, estrogen helps a woman retain calcium in her bones. The influence of these hormones is also thought to cause many of the symptoms of premenstrual syndrome.

A woman's menstrual cycle is said to begin on the first day of her bleeding. A woman's menstrual cycle only occurs if she is not pregnant.

Day 1

• estrogen and progesterone levels are at their lowest level
• the inner lining of the uterus, or endometrium is discharged as menstrual blood
• the unfertilized ovum produced in the last cycle is also discharged

Day 2-12

• menstruation continues for three to six days for most women
• when menstruation begins, a new ovum begins to mature in the ovaries
• the sac around the maturing ovum produces estrogen, increasing the levels in the body
• increasing estrogen levels prompt the uterine lining to thicken beginning around day nine. If a woman becomes pregnant this nutrient-rich lining supports the developing embryo.

Ovulation

• estrogen levels peek
• around Day 14 the sac containing the mature ovum, splits open releasing it from the ovary
  This is called ovulation. Some women feel a slight pain when this occurs. This is called a mittelschmerz. Some women also have spotting (light bleeding) at this time.
• the endometrium continues to thicken

Days 15-22

• the empty sac left in the ovary begins to produce both estrogen and progesterone
  This sac is called the corpus leuteum.
• the uterine lining continues to thicken thanks to estrogen produced in the ovary
• the ovum travels from the ovary down the fallopian tube
  If the egg is going to be fertilized (unite with a sperm) it is likely to happen now. When a fertilized egg reaches the uterus, high levels of estrogen and progesterone signal the uterine lining to allow it to implant on the wall of the uterus.

Day 22 - Day 1 of next cycle

• around this time the corpus luteum stops producing estrogen and progesterone
  If the egg has not been fertilized, levels of both estrogen and progesterone will begin to drop.
• blood vessels in the uterine wall contract and spasm due to the lack of estrogen and progesterone
• the uterine lining is shed as menstrual blood beginning the first day of the new cycle

Premenstrual syndrome (PMS)

Premenstrual syndrome (PMS) is a poorly defined condition used to describe symptoms, which occur after ovulation and before a woman's period. They are usually most intense in the week just before a woman's period when the levels of estrogen and progesterone are the lowest. Symptoms include:

• abdominal bloating
• irritability
• mood swings
• headache
• weight gain
• fatigue
• food cravings
• tension
• breast swelling
• backache

Many women experience some of these symptoms.

Some illnesses may become worse during the two weeks before a woman's period. This is known as 'menstrual magnification.' Illnesses where this occurs include:

• depression
• migraine headaches
• seizure disorders
• irritable bowel syndrome
• asthma
• chronic fatigue syndrome
• allergies

These conditions should be ruled out before a diagnosis of PMS is made. If PMS-like symptoms occur outside of the two-weeks before your period, you doctor should check for other illnesses.

Treatment

Changes in a woman's diet and lifestyle may help relieve the symptoms of PMS. Here are some things that research has shown may improve PMS symptoms:

• aerobic exercise
• a complex carbohydrate diet that involves whole grains like brown flour and rice
• vitamin supplements of calcium, magnesium and/or vitamin E

Other changes in a woman's diet may help, such as eating more fruits and vegetables or eating less:

• fat
• sugar
• salt
• caffeine
• alcohol

Some women have found herbs such as evening primrose oil or chasteberry helpful.

For women with serious symptoms, particularly mood changes, a group of antidepressant drugs known as SSRIs may be useful.

Birth-control pills are sometimes prescribed to treat PMS to increase hormone levels. This is for women with primarily physical symptoms. There is little evidence to support this approach.

More about periods

Menstrual periods usually last from three to five days, but periods as short as two days or as long as seven may be normal for you. Menstrual flow is usually heaviest in the first two days. It is not unusual for menstrual fluid to contain small clots.

Most women have some occasional pain or discomfort during their period. Typical symptoms include:

• cramps
• backache
• headache
• nausea
• fatigue
• diarrhea

Of these symptoms, cramps are the most common, particularly for young women. Cramps are most often felt in the lower abdomen but may also occur in the lower back or spread down the legs. The medical term for menstrual cramps is dysmenorrhea.

Mild menstrual cramps can be treated in a number of ways. Here are some possibilities:

• carefully use a hot water bottle or heating pad on the area where you feel the cramp
• exercise may increase blood flow and help release natural painkillers
• reducing the salt in your diet may decrease water retention and bloating
• non-prescription painkillers may help
• over-the-counter medications specifically for menstrual cramps may help

There are many over-the-counter drugs sold for menstrual cramps. The drugs used in each formula vary so read the label carefully and try to find the product that best matches your symptoms. Some women find that non-specific painkillers such as acetaminophen and ibuprofen are just as effective and are cheaper.

If you have serious cramps that interrupt your life on a regular basis you should see a doctor. Severe menstrual cramps may be a sign of more serious conditions like endometriosis (particularly if they start after you are 25). If there is no problem other than cramping, your doctor can prescribe painkillers or birth control pills that may relieve your symptoms.

Either pads or tampons can be used to capture the menstrual blood. Some women choose to use menstrual sponges, or menstrual cups, which are made of rubber. Both of these products can be inserted like tampons and removed and rinsed every four to six hours. Menstrual sponges should be boiled for five to ten minutes between each period. You should use whatever method is most comfortable and convenient for you.

Toxic shock syndrome

Women who use tampons may be at increased risk of a rare but serious illness called toxic shock syndrome (TSS). This syndrome is caused by a bacterial infection. If you experience symptoms of toxic shock during your period or in the few days immediately afterward, remove your tampon and visit a doctor or emergency room immediately. Symptoms include:

• sudden high fever--39 degrees Celsius(102 F) or higher
• vomiting
• diarrhea
• muscle aches
• dizziness, fainting, or near fainting when standing up
• a rash that looks like a sunburn

You can reduce your risk of toxic shock syndrome by doing the following:

• use the lowest absorbency tampon possible
• change your tampon every 6-8 hours
• alternate between pads and tampons
• wash your hands before changing your tampon

Female sexual response

Four stages are used to describe the physical changes that happen when a woman is sexually excited. These changes may occur when a woman masturbates or when she is sexually active with another person. What is exciting is unique to each woman. Some women are aroused when their breasts are fondled; other women hate this kind of touching. Learning what kind of physical contact you enjoy is an important part of learning about your sexual self. When you have sex with another person, there are also many emotional and social factors that will affect your physical experience.

You may not experience all four stages every time you are sexually active. Most women find there are many times when sexual play involves only the first one or two stages. Some women never or rarely have orgasms. Both physical and social/emotional issues can be barriers to a woman's sexual response.

Stage one: excitement
This stage can last anywhere from a few minutes to several hours. Sexual activity during this stage is often called foreplay. Extending foreplay can sometimes make the other stages more intense. During this stage:

• the blood flow to the genitals increases
• the clitoris swells
• the vagina begins to lubricate (get wet and slippery)
• blood flow to a woman's breasts increases and her nipples may get hard
• heart rate and blood pressure increase
• breathing may speed up

Stage two: plateau
During this stage:

• due to increased blood flow, the outer third of the vagina swells and the genitals appear darker
• the clitoris is very sensitive and retracts beneath its hood
• heart rate, blood pressure and breathing continue to increase
• muscle tension increases and spasms may occur in the feet, face and hands

Stage three: orgasm
This stage is also called the climax. During this stage:

• muscles in the outer third of the vagina contract in a rapid series of pulses
• the first contractions are the most intense and the closest together
• the muscles in the uterus also contract
• heart rate, blood pressure and breathing are at their highest rate
• the skin may appear red or flushed (this may begin in earlier stages)

Orgasm is the shortest of the four stages, usually measured in seconds.

Just before or during orgasm, some women release a clear fluid from their urethra. This is now commonly called female ejaculation. Most researchers (and women!) believe that this is not urine, but instead a clear fluid similar to the fluid containing a man's sperm. Ejaculation is most likely to occur when a woman is being penetrated vaginally and pressure is being applied to the top wall of the vagina. This is where the back of the clitoris meets the wall of the vagina and is sometimes called the G-spot.

Stage four: resolution
During this stage:

• a woman's clitoris and nipples get soft
• the vagina and genitals return to their normal size and colour
• breathing, heart rate and blood pressure decreases

This process typically takes longer for women than men, although some women may be able to return to the plateau stage at this point.