Basic Female Reproductive Biology

This is a brief overview, with links to more detailed information, of female reproductive biology and the options girls and women have to deal with it under the current American medical system and law.

Contrary to popular belief, the female reproductive system is not “mysterious” or overly “complicated” as compared to the male. There are – ovaries: two internal organs which produce hormones to regulate the body and eggs that have a possibility of someday growing into a new human being – the uterus, an internal muscular organ lying right next to the bladder – the Fallopian tubes: two ducts leading from the uterus to the ovaries – the cervix: the opening to the uterus which remains closed except in a few special instances – the vagina: a passage from the outside of the female body to the cervix – and the vulva, which consists of the outer, visible reproductive anatomy. The vulva consists of: inner and outer labia, or “lips” – the outer lips, when a female begins to mature, grow a coating of hair (called “pubic hair”) often somewhat darker than the hair that grows on her head; the inner lips are hairless mucous membranes, very soft and sensitive,with a wide natural variation in size from one woman to another – they surround and protect the entrance to the vagina, the urethra, (the opening to the bladder), and the tip of the clitoris, a bodily organ with no purpose other than to create sexual pleasure. The clitoris is made of erectile tissue (just like the penis and the human nipple), and while its visible tip is very small, it extends into the body and has “branches” which reach around the uterus and internally behind the inner labia.

When a girl’s body begins to mature, in addition to breast development and hair growth on various parts of the body, the internal organs – the uterus and ovaries – begin to mature. When a girl is born there are already eggs in her ovaries, but none of them are mature. The brain releases hormones that signal an egg to mature. This process takes a few days – when the egg has matured, it bursts from the ovary, travels through the fallopian tubes and into the uterus, which is busy growing a lining of blood and tissue called the endometrium. If the egg remains unfertilized, about two weeks later the uterus will begin to shed the endometrium and by contracting, and eject it through the cervix into the vagina, where it slowly drains from the body. This process is called menstruation, and for most women, takes place about once a month from their early teens until they are in their fifties. The time from one menstruation to the next is called the menstrual cycle. The first menstruation is called menarche – the ending of menstruation is called menopause.

Pregnancy is the process whereby a woman creates a new human (sometimes more than one) within her body and brings it into the world. Only a female can become pregnant, although not all females may wish to do so or be capable of doing so. To become pregnant, a female’s mature egg must come into contact with a male’s sperm. This usually happens through the process of sexual intercourse – a man releasing sperm (invisible cells that hold half the genetic material necessary to create a new human being) and other fluids (semen) into a woman’s vagina through his penis. Although pregnancy is more likely to occur when sexual intercourse takes place during the middle of the menstrual cycle (when the egg first matures and is released) any number of factors can throw off a woman’s normal cycle and allow an egg to be released at an unusual time – there is no absolutely “safe” time during the menstrual cycle to have sexual intercourse and avoid pregnancy. Also, any contact between a man’s semen and a woman’s vulva can result in pregnancy.

When the sperm reach the egg, usually while it is traveling down a Fallopian tube, they surround it and wait. In time some chemical synthesis may or may not take place, and one sperm is chosen by the egg to enter it. The moment a sperm enters the egg is called conception, and the newly fertilized egg is called a zygote. The cells of the zygote begin to divide as it continues down the Fallopian tube, a journey that takes about three days. When the zygote reaches the uterus, it may implant itself in the endometrium. Sometimes this never happens, and the zygote is simply washed out during the next menstrual period. This is likely a frequent occurrence, and the girl or woman had no way of knowing it ever occurred. But often the zygote will transform into a hollow ball of cells called a blastocyst, and through a chemical process, implant itself in the endometrium. The organism is then called an embryo, and begins to rapidly transform into a new human being. Almost all doctors and scientists consider that this event, the first point at which the fertilized egg becomes attached to the woman’s body, signals the beginning of pregnancy.

All of this generally occurs without any symptoms, or only very slight signs. It is not usually for several weeks that the girl or woman may begin to suspect she is pregnant. Signs of early pregnancy can, but do not always, include:

• Lack of an expected menstrual period
• Soreness in the breasts or a darkening of the nipples
• Extreme fatigue
• Nausea or change of appetite

If you suspect you are pregnant, you can buy a pregnancy test at a store and follow the instructions carefully to detect the presence of pregnancy hormones in your urine, or visit a doctor where they will conduct a similar test but also look for other signs they are trained to recognize, such as feeling the size and location of your uterus, or, in cases where things remain unsure, doing a sonogram or ultrasound to view your uterus and look for signs of a developing embryo.

Unwanted pregnancy

Very often, a girl or woman becomes pregnant when she did not wish to be. If you are experiencing an unwanted pregnancy and live in the United States, you have a number of options. (I am unfamiliar with laws outside of the U.S. and therefore will not address them, but some information may be found here.)

Some women may decide to have a baby even though their circumstances may be difficult and they did not intend to become pregnant. This is a difficult decision to make and only you can decide for yourself if you are prepared to deal with such a life-changing event. Or you may not be able to decide what you want to do immediately after you discover you are pregnant. This is perfectly normal. In either case, you should see a doctor as soon as possible after discovering you are pregnant, for the sake of your health and to discuss what might be best for you.

Abortion is an option a woman has of dealing with an unwanted pregnancy. Is is used by women all over the world with frequency, whether or not it is safe or legal in the place she lives, and has been around in various forms for thousands of years. Women have always had unwanted pregnancies and have throughout history and pre-history sought to end them. Medical developments have now made abortion a very safe and relatively minor medical procedure, especially when (as most are) it is performed very early in pregnancy. There are a range of abortion options a woman may have depending on how far along she is in her pregnancy. Contact an abortion provider to see what is available in your area. Be certain before you give out any personal information or go to their address that they are an actual service provider and not anti-abortion “crisis pregnancy center“meant to talk you out of your decision.

Abortion is legal in all 50 U.S. States by order of the U.S. Supreme Court, which, in their 1973 Roe vs. Wade decision, ruled that a woman has a constitutional right to abortion – however, states are allowed to put restrictions on abortion and all of them do. An abortion obtained in the early part of pregnancy has the least number of restrictions in any state. As of this time, it is not illegal to travel to a different state to get around an abortion restriction in your own, with a possible exception in some places of further travel restrictions on girls under 18. Various states in the U.S. have the following restrictions on even early abortions: requirements to inform parents for minors; requirements to obtain permission of at least one parent for minors; a 24 hour waiting period after your first appointment with the doctor who will perform your abortion; and required “counseling” that uses slanted materials meant to convince you that you are making a bad decision by choosing abortion. For abortions which take place later in pregnancy there can be additional restrictions, although at no stage can an abortion be completely forbidden to a woman, although in late pregnancy a state may choose to limit abortion availability to a woman only to protect her life or health. This does not affect most women seeking abortion, however, since virtually all abortions take place in early pregnancy. Check with your abortion provider on legal restrictions in your state when making an appointment to avoid delays and stress when you arrive.

Some women may be uncomfortable morally or ethically with abortion, but may still not wish to be a mother. Placing a child for adoption is a good option for some women coping with an unplanned pregnancy. The wisest thing to do if you wish to pursue this option is to obtain a lawyer who will make sure the rights of all parties are protected, including/especially your own.

Preventing pregnancy

The best way to avoid dealing with raising an unwanted child, having an abortion, or giving a child up for adoption after going through pregnancy and giving birth is to avoid becoming pregnant in the first place. Avoiding pregnancy can be done with a fair degree of success through practicing contraception, aka birth control.

Some of the more commonly used and effective forms of birth control are:

• Condoms
• Spermicide
• “The Pill” – Birth control pills
• IUD - Intrauterine Device
• Diaphragms
• Depo-Provera (”the shot”)
• Ortho-Evra (”the patch“)
• Emergency contraception
• Sterilization
• Abstinence – abstaining from sexual intercourse with men
  

There are several classes of birth control methods.

Barrier methods of contraception work by preventing sperm from being able to reach the egg.  They are easy to use, inexpensive, and have the fewest side effects.  Unfortunately, most barrier methods require the cooperation of the male partner to use them, and many men are reluctant to participate in sharing any responsibility for preventing pregnancy.  However, since the most commonly used barrier method – the condom – also helps both partners avoid sexually transmitted diseases, more reasonable men will agree to use one, for their own well being if for nothing else.  Other barrier methods include the diaphragm (use of which requires a woman make a doctor’s appointment to be fitted properly) cervical caps, and the female condom.

Hormonal birth control uses medicines that affect a woman’s hormones to prevent eggs from ripening and thus from being fertilized or to prevent a fertilized egg from ever implanting in the uterine wall, thus preventing pregnancy.  The Pill, Depo-Provera, “the patch” and emergency contraception are all methods of hormonal birth control commonly used by women.  Some IUDs also contain hormones to help prevent pregnancy.  Some women enjoy the effects of hormonal birth control, which can sometimes be prescribed for reasons other than contraception.  These effects can include cessation of menstruation or less painful menstruation for women who have such a problem, a more regular menstrual cycle, and other benefits from having a regulated hormonal cycle.  Other women find the side effects too difficult to deal with and for some women they can be outright dangerous.  For this reason, hormonal methods of birth control are not available without a doctor’s prescription.  Your doctor can monitor your health to see if you should or should not be using one of these methods.

Long term methods of birth control include IUDs and sterilization.  An IUD is a small device which a doctor can implant during a short visit.  The device is inserted through the cervix into the uterus, and generally while it is implanted prevents pregnancy.  It is intended for long term use, is highly effective, and completely reversible.  It requires a doctor visit to remove if you decide it is not for you.  Sterilization is a surgical procedure done to end a person’s fertility.  Either men or women can choose sterilization, although the procedure is much safer, cheaper and easier for a man to do.  If you are a woman who is not in a long term monogamous relationship with a man who is willing to be sterilized, however, and you are completely certain you do not want to become pregnant again (or at all), it would make more sense for you to consider the operation yourself.  While there are some doctors who will try to reverse sterilization procedures later in life for those who change their minds, this has a low chance of success, and therefore sterilization should be considered a permanent and irreversible form of birth control.  Sterilization, for women, is when the Fallopian tubes are cut, banded shut, or cauterized, so that mature eggs cannot reach the uterus and sperm cannot reach the egg.  A few new techniques are being developed that are changing the way female sterilization is performed, but currently this is usually done through abdominal surgery, and thus, should not be undertaken lightly.

There is a final class of birth control which is widely variable in its effectiveness.  These methods all center around human decision not to complete sexual intercourse (”withdrawal” or “coitus interruptus”), not to complete it at a certain time of the menstrual cycle (”the rhythm method” or “natural family planning“, or not to engage in it at all (abstinence”).   These methods are not very effective, although they are more effective than not doing anything at all.

Withdrawal is commonly used by those with no access to or knowledge of other birth control methods.  In this method, a man stops sexual intercourse before his orgasm, thus preventing much of his sperm from being released inside a woman’s vagina.  However, continuously during sexual excitement, a man’s penis emits small drops of semen which do contain sperm, so even when used perfectly this method may be ineffective.  Also, a man may be unwilling to stop due to sexual excitement – he may lie to his partner about his willingness to stop – or his body may surprise him so that he has an orgasm before he is fully able to withdraw.  Many men find this practice frustrating and diminishing to sexual pleasure even when they are willing and able to do it, and a woman has to put total trust in her partner for this form of birth control.

“Natural family planning” is also very ineffective.  This is the practice of trying to guess which days during the month a woman is not fertile and only having sexual intercourse on those days.  This method is typically used by people who believe other forms of birth control are morally wrong and who are in a long term commitment such as marriage.  This method does not work at all if a woman has an irregular menstrual cycle or if either partner is unwilling to go without having sexual intercourse for the length of time they determine the woman is fertile.  Even for couples who are committed to using this method and when the woman has a regular cycle, the variability of when eggs can be released from the ovaries make it difficult or impossible to truly know if she is fertile at any given time – so while such couples will have the highest success rate, even then it is not a sure thing.

Abstinence is voluntarily not having sexual intercourse.  Many very young teens of both sexes choose not to have sexual intercourse for any number of reasons, which are commonly summed up as “I’m not ready”.  Not engaging in any sexual contact at all with another person will, of course, prevent pregnancy.  Some people feel sexual contact should be reserved strictly to heterosexual marriages, and that abstinence should be the only option for contraception outside of marriage.  A brief look at society, however, shows most people do not feel capable of living that way.  Some people do, however, feel comfortable with practicing abstinence.  There are various methods of abstinence, when practiced for reasons of contraception, that can be effective. Total abstinence would be refraining from any sexual contact. There are other methods of affection and sexual sharing which can, however, be enjoyed without fear of pregnancy. These include: kissing; hugging; touching any part of a partner’s body with your hands, including the genitals; oral sex; or any sexual contact at all between partners of the same sex. So long as the man’s semen does not come in contact with the vulva there is no risk of pregnancy.  These methods do require a commitment to not having intercourse, however, which some couples find it hard to avoid doing in the heat of the moment.

A final note on birth control

As seen above and discussed briefly, most forms of birth control rely on the woman to change something about her body.  Since women are the ones directly impacted by pregnancy, they have a greater stake in preventing it.  Men may wish to prevent pregnancy for their own reasons, such as not wishing the economic burden of children,  not wishing to have children for emotional reasons, or not wishing to have children just yet.  For some men these concerns are serious enough to make them take contraception seriously, however, many men consider it a woman’s problem only and thus will not take responsibility for preventing unwanted pregnancy.  Another issue to consider when planning birth control methods and the larger social issue of birth control is the extremely high incidence of men raping women or otherwise coercing or “seducing” them into having sex they do not want or are not entirely sure they want.  A woman who lives in a home where a male is forcing her to have sex, a young woman who is exploring the dating scene, or any woman in a relationship with a man she does not entirely trust should avoid using a birth control method which requires any cooperation of or trust in a man.

It is best to decide before intercourse which option is best for you. (Emergency contraception, of course, is for incidents in this was not possible or a contraceptive method failed during sexual intercourse.)

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