Female Friday is BACK this week, with a couple of hot links! Lately I’ve been trying new things – like golf! I can hit a ball past the 50 – and as someone who is not particularly skilled in sports, seems like a huge achievement for me!

Here’s what you should be reading

The future effects of stress during pregnancy (link)

“Children of mothers who experienced a death in the family during their pregnancy are more likely to be diagnosed with anxiety, depression, and attention deficit hyperactivity disorder. It is one of the first studies to show the impact of in-utero stress on mental health later in life.”

While family deaths may not be able to be avoided, this study makes the case for taking care of mental health during pregnancy – especially if you hope to avoid mood disorders in children. A mother’s mental health is important during and after pregnancy, and seeking support should not be avoided. 

Reducing menstrual cramps (link)

There is value knowing what is available to you for those painful periods, but I can’t say I agree with this entire article. Here’s my take:

• To calm inflammation, avoid inflammatory foods. If you’re eating a pint of ice cream before and during your period, know that it can lead to more inflammation (and more pain!). Investigate your food choices and your stress levels around the time your cycle begins. 

• Birth control will not ‘fix’ your period. Birth control acts as a temporary bandage for your period problems, and once you go off it, those symptoms are likely to come back. Investigate it further. Plus, if you have debilitating cramps, it might be endometriosis. 

• Stay active. Certain yoga poses have been shown to be helpful for period pain. On a personal note, I save high intensity workouts after my period is over because I do believe in rest and relaxation during bleed days. It also fits in with the yin/yang perspective as the beginning of the cycle is more yin-based. 

• External heat on the abdominal area. Agree!

• Talk to your gyno. Or your ND to figure out how to relieve the pain from a holistic perspective.  

Best Menstrual Cups (link)

Are any of your favourite menstrual cups on this list? I’ve only tried the DivaCup. PS. If you do use a menstrual cup, be sure to use it safely!

Experiencing a period as a trans man (link)

An illuminating read with an accompanying video, about a menstruating man. 

“In one scene, Bliss changes their pad in a men’s restroom and then has to roll it up and put it in their pocket because there aren’t trash cans inside the stalls. And in another, they walk down an aisle full of pink and purple period products, lamenting how everyone who makes and markets pads and tampons assume that only women use them.”

Endometriosis and birth control (link)

“In a 2017 study “Progestin-only pills may be a better first-line treatment for endometriosis than combined estrogen-progestin contraceptive pills” Dr. Robert Casper also praised progestin-only birth control pills as a viable option for endo women.”

I would add a caution about progestin-only birth control methods, because there have been studies linking them to depression and lowered feelings on quality of life. 

Here’s something almost nobody wants to discuss – painful sex. Yes, this is a symptom otherwise known as dyspareunia. In fact, 3 out of 4 women will experience painful sex during some point in their lives. It may be temporary, or it may be a long-term problem. 

Why does dyspareunia happen?

According to the experts, dyspareunia is not its own health condition. It’s a symptom that occurs alongside something else. There can be many reasons why someone may experience painful sex.

They include:

• Vaginismus

• Vulvodynia

• Inadequate lubrication

• Postpartum dyspareunia

• Vaginal atrophy

• Endometriosis

• Infections

• Psychosexual causes

• Interstitial cystitis

• Pelvic adhesions

• Retroverted uterus

• Uterine myomas

• Irritable bowel syndrome

• Pelvic floor issues

• & more

Risk Factors for dyspareunia

• Young age

• Education below a college/university degree

• Urinary tract symptoms

• Poor to fair health

• Emotional distress

• Stress

• Decrease in household income

Where does dyspareunia happen?

Pain might be felt in the vulva, vaginal opening (known as the vestibule), within the vagina itself, or perineum. It can also be felt in the lower back, uterus, or bladder as well. 

Quick anatomy lesson (mostly because I love this image):

• VULVA: Is the external genitalia, surrounding the opening to the vagina. It includes the prepuce, clitoris, urethral opening, vulval vestibule, labia majora, labia minora, and the vaginal opening. 

• VULVAL VESTIBULE: part of the vulva between the labia minora into which the urethral opening and the vaginal opening open.

• VAGINAL OPENING: Is the opening to the vaginal canal. 

• PERINEUM: Not shown in this image, but it is the area between the vulva and anus. 

Superficial or insertional dyspareunia

Sharp, burning or stinging pain at or near the vaginal opening, experienced on penetration. This can happen with vulvodynia, vaginismus, infections, and more! 

Deep dyspareunia

This pain is felt within the pelvis, and is associated with deep penetration into the vagina. It can be due to endometriosis, surgery, pelvic tumours or inflammatory diseases, and more. Certain sex positions may also elicit pain, especially if the penis makes contact with the cervix. 

Classification of dyspareunia

PRIMARY You’ve experienced pain the first time you’ve had sex and it has continued each time after.

SECONDARY: You’ve had sex before and it wasn’t painful. But you are now experiencing pain during sex. May be due to an underlying condition.

Naturopathic approach to dyspareunia

Because dyspareunia is a symptom and not a disease, Naturopathic Doctors will aim to discover the root cause of this symptom. This usually involves a:

• Detailed health history

• Examination – abdominal and vaginal

• Blood work (if necessary)

NDs will create a treatment plan based on their findings. For example: if yeast infections are found to be the root cause, then that treatment plan will commence. This will be different if endometriosis is found to be the the reason why painful sex keeps happening.  

Final Thoughts

A woman’s mental and physical health can be negatively impacted by dyspareunia. Not to mention the effects on her body image, relationship with her partner and desire to conceive. It may lead to sexual dysfunction disorders down the line as well. If you are experiencing pain with sex, now is the time to find out why it’s happening, and work on getting this symptom to go away for good. If you’re looking for a holistic approach, consider working with a Naturopathic Doctor.  

If you found this information helpful, please sign up for my monthly newsletter called The Flow for great and informative content like this!

References

Seehusen D, Baird D, Bode D. Dyspareunia in Women. Am Fam Physician. 2014;90(7):465-470.

Cassis C, Mukhopadhyay S, Morris E. Dyspareunia: a difficult symptom in gynaecological practice. Obstetrics, Gynaecology & Reproductive Medicine. 2018;28(1):1-6. doi:10.1016/j.ogrm.2017.10.006.

Fertility awareness methods allow the opportunity for people to track their cycle, with the goal of knowing when ovulation occurs. There are a variety of methods (as listed below) and are about 76-88% effective, with a possible increase in effectiveness if you use multiple methods together. 

With most of these methods, it’s wise to track your period and these particular signs for at least 3 months (6 months for calendar methods) to get an idea of your body’s rhythms before you use any of the methods for contraception. 

The Temperature Method

If you’ve been following my blog for a while, you might remember a blog post discussing basal body temperature and fertility.

A quick recap: body temperature changes throughout the menstrual cycle. It’s lower in the follicular phase and slightly higher in the luteal phase. This slight rise in temperature occurs after ovulation, and happens after the formation of the corpus luteum which releases progesterone (the hormone responsible for the temperature change). 

By following this method, you would measure your basal body temperature everyday and chart it (on an app or on paper).  

Days are considered safe once 3 days has passed since the initial rise of temperature, as well as a drop in temperature before the onset of the next menstrual cycle. This is an opportune time to have unprotected vaginal sex (with or without ejaculation). 

During your fertile days, you can avoid sex or use another birth control method. 

The Cervical Fluid Method (The Billings Method)

This method is based on cervical fluid changes, another topic I covered a while back. 

A quick recap: During the follicular phase, increasing estrogen levels will lead to the production of cervical fluid. Cervical fluid will change in colour, texture, and amount during the period, and is considered especially fertile around ovulation. 

Similar to the Temperature Method, cervical fluid needs to be charted everyday, starting from the end of the menstrual cycle. The changes that you may see will give you an idea of when ovulation may occur – which is great if you are hoping for pregnancy (unlike temperature, where it tells you that ovulation has passed).  Record everything daily: your period days, dry days, wet days, sticky days, cloudy days, and slippery days.

There are 3 ways to check your cervical fluid: (1) Before urination, wipe the opening of your vagina with white toilet paper or tissue. Observe the colour and feel of the fluid. (2) Look at your underwear for any discharge – note the colour and texture. (3) Insert your clean fingers into your vagina, and note the colour and texture of cervical fluid on your fingers. The best way to feel the consistency of your fluid is to rub it and stretch it between your thumb and index finger.

This fertility awareness method may not be best for people who don’t generally produce any cervical fluid. 

The Symptothermal Method

This method combines cervical fluid, cervix changes, basal body temperature, and calculation to determine the beginning and the end of the fertile period. At the very least, you should be tracking cervical fluid and basal body temperature to determine when to avoid or engage in sex (depending on your goals, obviously). 

The Calendar Method (The Rhythm Method)

This is one of the methods that need at least 6 months of charting your period. 

Mark the first day of your cycle on an app or on a calendar. Remember, the first day is when you notice significant bleeding – not spotting. Mark the first day of your next cycle. Count the number of days in between your period. You’ll find the fertile part of your cycle, once you subtract 18-21 days from the shortest cycle (of the 6 cycles that you have tracked). You would find the end of the fertile part of your cycle by subtracting 9-11 days from your longest menstrual cycle. 

A real life example:

Dec – Jan = 30 days
Jan – Feb = 33 days
Feb – Mar = 28 days
Mar – April = 26 days
April – May = 32 days
May – June = 27 days

My shortest cycle was 26 days 
My longest cycle was 33 days

Start of my fertile phase is (26 days – 21 days) and (26 days – 18 days) = Days 5 to 8
End of my fertile phase is (33 days – 11 days) and (33 days – 9 days) = Days 22 to 24

Therefore, I would be considered fertile between days 5 to 24 of my period. Many couples may find this way a bit constricting, and may need to have another means of contraception if they still want to engage in vaginal sex. 

This method may be unreliable if you experience irregular menstrual cycles. 

The Standard Days Method

This fertility awareness method identifies a standard window in which someone may be fertile. You can only use this method if your cycle is really regular and is never shorter than 26 days and never longer than 32 days. You must also be cool with not having vaginal sex or using another contraceptive method between days 8 and 19 of your cycle – as they are considered the most fertile. 

Final Thoughts

There are at least 5 ways of practicing fertility awareness. Your best bet is paying attention to your basal body temperature and cervical mucus, and doing so for at least 3 cycles if you’re choosing this as your primary method of birth control. Speak to your Naturopathic or Medical Doctor to determine if these methods are right for you.