Our Bodies, Ourselves (8 page)

• The time from a woman's period until ovulation varies, but it is often about two weeks.

• Sperm can live in fertile-quality cervical fluid for up to five days, though typically they live only about two days.

WAKING OR BASAL BODY TEMPERATURE (BBT) Before ovulation, early morning temperatures typically range from about 97° to 97.5°F (36.11° to 36.38°C), and after ovulation, they usually rise to about 97.6° to 98.6°F (36.44° to 37°C). It's helpful to use a special basal or digital thermometer to get readings that are precise enough to track such small changes. After ovulation, your temperature usually remains elevated until your next period, about two weeks later. But if you become pregnant, it remains high for more than eighteen days.

The important concept to understand is your
pattern
of low and high temperatures. Your temperatures before ovulation fluctuate in a low range, and the temperatures after ovulation fluctuate in a higher range. The trick is to see the whole and not to focus so much on the day-to-day changes. Temperatures typically rise within a day or so after ovulation, indicating that ovulation has already occurred.

A sustained rise in waking temperature almost always indicates that ovulation has occurred. It does not reveal impending ovulation, though, as do the other two fertility signs (cervical fluid and cervical position). After charting a few cycles, if your cycles are consistent, you should be able to see how these three signs interact. It is often believed that most women ovulate at the lowest point of the temperature graph, but this is true for only a minority of women. It's more common for ovulation to occur the day before the temperature rises.

Factors that may disrupt your morning temperature:

• Fever

• Alcohol consumption the night before

• Fewer than three consecutive hours of sleep before taking temperature

• Eating or drinking before taking an oral temperature

• Taking temperature at a substantially different time than usual

• Heating your body, as with an electric blanket

• Thyroid conditions

CERVICAL FLUID (CF)

Cervical fluid is the secretion produced around ovulation that allows sperm to reach the egg. In essence, fertile cervical fluid functions like seminal fluid: It provides an alkaline medium to protect the sperm in an otherwise acidic vagina. In addition, it provides nourishment for the sperm, acts as a filtering mechanism, and functions as a medium in which to move. Cervical fluid also capacitates the sperm; this process removes the tip of the head, preparing it to fertilize the egg.

After your period and directly under the influence of rising estrogen, your cervical fluid typically starts to become wetter as you approach ovulation. After your period ends, you may have several days of nothing, followed by cervical fluid that evolves from sticky to creamy and finally to clear, slippery, and stretchy (also known as spinnbarkeit), similar to raw egg white. The most noticeable feature of this fertile cervical fluid is its lubricating quality.

After estrogen has peaked and dropped, the cervical fluid abruptly dries, often within a few hours. This is due to the surge of progesterone following ovulation. The absence of wet cervical fluid usually lasts the duration of the cycle.

A trick to help you identify the quality of the cervical fluid at your vaginal opening is to notice what it feels like to run a tissue (or your finger) across your vaginal lips. Does it feel dry? Is it smooth? Does it glide across? When you are dry, the tissue won't pass smoothly across your vaginal lips. But as you approach ovulation, your cervical fluid gets progressively wetter, and the tissue or your finger should glide easily.

As with temperature, certain factors may mask or interfere with cervical fluid:

• Vaginal infection

• Semen (from recent sexual intercourse)

• Arousal fluid

• Spermicides and lubricants

• Antihistamines (which can dry out or decrease fluid)

• Guaifenesin cough medicine (which can increase fluid)

In addition, if you have recently stopped taking birth control pills, you may notice one of two very different patterns: Either you may not produce much cervical fluid at all, or you may tend to have what appears to be continuous creamy cervical fluid for several months.

CERVICAL POSITION

In addition to emitting cervical fluid, your cervix goes through changes throughout your cycle. These changes can sometimes be felt by inserting a clean finger into your vagina (your middle finger is usually easiest, since it's the longest).

The cervix is normally firm, like the tip of your nose, and becomes soft and rather mushy, like your lips, as you approach ovulation. In addition, it is normally fairly low and closed, and rises and opens only in response to the high levels of estrogen around ovulation. The angle of the cervix also changes around ovulation, becoming straighter when estrogen levels are high. (For
more on the cervix
)

Secondary fertility signs around ovulation may include pain or achiness near an ovary, increased sexual feelings, and abdominal bloating. Secondary fertility signs do not occur in all women, or in every cycle in individual women. Still, these signs, when apparent, can offer additional information to help identify fertile and infertile phases.

CHAPTER 2
Intro to sexual Health

A
woman's body and her sexuality have traditionally been understood and presented as the property and business of everyone but the woman herself. Many of us have been made to feel that knowledge about and care for our bodies—particularly those parts considered primarily sexual—are unnecessary, maybe even inappropriate. Yet learning how to take care of ourselves frees us to feel more comfortable in our bodies and with our sexuality, and enables us to take a more active role in monitoring and maintaining our health.

This chapter covers some steps you can take to protect your sexual and reproductive health, including what you can do for yourself and when to see a health care provider. It also describes what to expect at a gynecological visit and exam and
how to advocate for the respectful, compassionate, individualized, and comprehensive care you deserve. Many of the topics addressed briefly in this chapter are covered in more depth in other chapters.

For the most part, the vulva and vagina need only basic care to stay healthy. Here are some tips to keep your vulva healthy and happy:

• Lay the groundwork.
Eat well, get adequate sleep, and exercise regularly to help keep all parts of your body healthy.

• Have smart sex.
Learn the sexual history of your partners and practice safer sex. (See
Chapter 10
, “Safer Sex”; and
Chapter 11
, “Sexually Transmitted Infections.”)

• Loosen up.
Thongs can rub back and forth, and tight-fitting pants, spandex, and synthetic underwear can trap heat and moisture and cause irritation. Wear looser clothing and natural-fiber underwear such as cotton. Sleeping without underwear or anything tight allows some air to get to the vulvar area and helps keep the vulvar tissues healthy.

• Don't douche.
The vagina is a self-cleaning organ, so there is no need to wash inside or douche. In fact, douching can create unhealthy changes in the pH (acidity) and the balance of normal vaginal bacteria.

• Keep clean.
To help prevent the spread of bacteria that could cause a urinary tract infection, wipe from front to back, reaching from behind, after a bowel movement.

• Use tampons wisely.
Choose the right absorbency and change tampons every two to eight hours. (See
“Common Questions About Tampons,”
)

• Don't overdo.
To clean your vulva, use just warm water or a gentle, unscented soap applied with your fingers—don't scrub. Avoid lengthy soaks in very hot water, which can dry and irritate the skin.

• Avoid common irritants.
Skip the scented soaps, body deodorants, and perfumes. These can lead to irritation in some women. If you have sensitive skin, stick to unscented white toilet paper, use a hypoallergenic clothing detergent, and avoid fabric softener/dryer sheets when you dry your underwear or bed sheets.