The vagina & vaginal environment

The Vagina

In popular speech the vagina is the entire area of the vagina and vulva: everything pink and soft (mucous tissue) so also the labia (the "lips") majora (outer) and minora (inner). The inside of the labia majora and all of the labia minora carry many small glands. The secretions of those glands (different from those of the skin) "coat" this area and form a thin protective layer against urine, bacteria and menstrual blood. On both sides of the vestibulum (the entrance into the vagina) are 2 glands that produce a fluid during sexual excitement and lubricate the vestibulum in preparation of sexual intercourse. The vagina itself is an 8cm tube which extends from the vestibulum to the cervix (the opening to the womb).

On both sides of the cervix the vagina bulges out into a pocket which is called a fornix. In these fornices, especially the one on the back part of the vagina, secretion of the cervix and some cell-debris may collect.

The vagina itself has no glands but is lubricated by the secretion of the cervix. Normal vaginal discharge has a pleasant, mild smell and looks like a milky white cream or a clear eggwhite, depending on the moment of the menstrual cycle.

Vaginal mucous tissue

The vagina is covered with a mucous tissue, which is protective and rather strong. The thickness of this tissue is determined by the balance of the sex hormones. This balance changes during the menstrual cycle, during pregnancy and with age. In young girls and older women the mucous tissue is very thin, this tissue is therefore quite vulnerable and the balance of the vaginal environment can easily be disturbed.

The vaginal flora

In the vagina (as well as e.g. in the mouth and the bowels) a great many micro-organisms are living in balance with each other and their hostess. This is called the "vaginal flora". It is important to know that the vagina usually has an acidic environment (a low pH).

Lactobacilli (lactic acid bacteria) are named after their function of producing lactic acid. They are largely responsible for determining the acidity of the vaginal environment. In some women we observe too many lactobacilli. When this condition is accompanied by complaints that resemble those caused by candidiasis the diagnosis is called "Lactobacillosis".

Typically these women are constantly - and of course without result - treated for candidiasis. Next to lactobacilli other bacteria are often present, the cocci, that belong to the bowel flora. These are certainly not useful but the presence of a certain number of these cocci is acceptable in a "healthy vaginal environment" (the mixed flora). When lactobacilli are absent the protective acidity of the vagina disappears. In this case, the vaginal environment becomes alkaline (as opposed to acid). This environment promotes overgrowth of coccoid bacteria, often resulting in an infection called bacterial vaginosis (BV).

To summarize, the natural protection of the vagina is determined by several factors; the cell layers of the vaginal membrane, the acidity of the vagina (pH), the balance between the micro-organisms present and the state of general health of the woman. Disturbing the balances in the vagina has some consequences, in the worst cases it can result in infections and inflammations. The disturbances can be caused by external factors as well as internal factors - or by a combination of both.

Making Sense of Your Cycle

The female menstrual cycle always seems to be a point of confusion and discussion among women, "When can I get pregnant?" being one of the most pertinent questions.

The menstrual cycle actually begins on the first day of menstruation and ends the day before the next period starts. For most women the cycle lasts between 21 and 35 days, commonly 28 days.

Phases of the Menstrual Cycle

There are 3 phases in the menstrual cycle - the follicular phase, ovulation and the luteal phase.

The follicular phase can vary in length, which means that it is difficult to predict ovulation by counting forward from the beginning of the menstrual cycle. The luteal phase, which is after ovulation, is always 14 days.

The phases explained:

Follicular Phase

this is when a follicle containing an egg develops in the ovary

Ovulation

this is when the follicle bursts and releases the egg (ovum)

Luteal Phase

the remains of the non-fertilised egg shrink and vanish

The Cycle in More Detail

The average woman has 400 menstrual cycles in her lifetime, yet many of us aren't aware what happens during our menstrual cycle. The typical 28-day cycle is as follows, however this will vary from woman to woman.

Days 1-5 Menstruation

Menstruation starts when the lining of the uterus - called the endometrium - is shed, which causes the bleeding that lasts from two to eight days. This happens because in the absence of a pregnancy, women stop producing oestrogen and progesterone. Meanwhile small amounts of follicle-stimulating hormone (FSH) are being secreted, which stimulates the egg follicles to start growing in one of the ovaries. As the follicles grow, they release small amounts of oestrogen into the bloodstream.

Women who suffer with PMS will feel a release as soon as their period starts. This is because oestrogen and progesterone levels are low, making you feel more cheerful and energetic than the previous week.

It's not all good news though. According to studies, over 70% of women suffer from painful periods with symptoms including stomach cramps, lower back ache, headaches and nausea.

Days 6-10 Post-menstruation

During this phase, the pituitary is still producing FSH, which continues to stimulate the follicles to grow, which means more oestrogen is being produced too. This is when energy levels will peak and women will feel the best in their cycle.

Days 11-14 Pre-ovulation

The oestrogen levels peak around now usually around days 12 or 13. The developing follicles move towards the surface of the ovary, but only one keeps growing (the others break down). Due to the high levels of oestrogen, the endometrium thickens in preparation for a fertilised egg. At the same time the cervical mucous starts to thin out, making the way for sperm to pass through to the uterus.

At this time the body is getting ready for pregnancy and produces higher amounts of testosterone, which could lead to feeling more confident and assertive.

Days 15-17 Ovulation

Ovulation is when the egg moves out of its follicle and into the fallopian tubes. Most experts believe this is caused by a surge of lutenizing hormone (LH) that happens between 36 and 48 hours before ovulation. Then, once the egg has been released, the empty follicle transforms into what is technically known as corpus luteum. This, in turn, starts secreting progesterone, the main role of which is to sustain pregnancy. Women are now at their most fertile.

Days 18-23 Post-ovulation

During this phase, the corpus luteum keeps pumping out progesterone, making the endometrium thicken even further, while the egg travels down the fallopian tube towards the uterus.

Now is the time when women experience PMS symptoms, such as headaches, abdominal and back pain, depression, irritability and anxiety.

Days 24-28 Premenstruation

This is the cycle coming to an end. Unless it has been fertilised, the egg dissolves and the corpus luteum breaks down, which in turn means oestrogen and progesterone production ceases. Once that happens, the endometrium starts breaking down too, resulting in a period.

Irregular Cycles

Many women suffer with irregular cycles on a regular basis. All women are likely to experience an irregular cycle at some point in their lives. There are many reasons why the menstrual cycle is irregular and this could be due to problems with the thyroid, ovaries or uterus, among others.

It is sensible to consult a GP if suffering from an irregular cycle or bleeding in between periods.