You might have heard the proverb, ‘health is wealth’, which suggests that being in good physical, physiological and psychological shape is vital for a long and healthy life. But there’s more to this proverb, as the COVID-19 pandemic has clearly highlighted in 2020-21. Like wealth, good health cannot be generated overnight. Sure, some hacks, tricks, and shortcuts can help you in the short term. But for lifelong health, you have to put in the effort every day, and it all begins with getting educated about your body and best practices to follow.
For women, sexual and reproductive health (SRH) education plays a central role in building this wealth of health. This is not just because women are biologically equipped to bear and nurture future generations, but also for their own longevity and a disease-free life. However, the fact remains that SRH education is considered to be taboo in most low- to middle-income countries, including India. The stigma attached to SRH education leaves women of all ages, from all socio-economic backgrounds, ill-equipped to handle all the issues that arise throughout their lives, leaving them more susceptible to a low quality of life and health.
We talked to Dr Asha Dalal, the director of the department of obstetrics and gynaecology, Sir HN Reliance Foundation Hospital and Research Centre, Mumbai, about the need for SRH education among women. Here’s what she had to say.
The need for an early start
When it comes to SRH education, learning from an early age is the best way to go. This means that girls should be taught the basics of sexual health during adolescence so that they can not only deal with menarche (the age at which you get your first period) but also grasp the importance of maintaining SRH during other important stages like pregnancy and menopause. A 2021 study published in the Journal of Family Medicine and Primary Care, titled Empowering adolescent girls, is sexual and reproductive health education a solution?, explains this need for an early start very well.
The study explains that during adolescence, growth and development occur rapidly. If adolescent girls aren’t provided with proper SRH knowledge at this age, their risk of succumbing to various problems—like unhealthy menstrual hygiene practices, unwanted sex, teenage pregnancy, unsafe abortions, reproductive tract infections (RTIs), or sexually transmitted infections (STIs)—increases manifold. Being at risk of these problems can also affect a girl’s mental health, and impair her development as fully functioning members of society.
The right source of information matters
But while getting SRH education is crucial for adolescent girls, Dr Dalal explains that getting the right information from the right sources matters even more. “Ideally the discussion of sexual and reproductive health should begin in childhood with parents,” she says. “Most schools offer it in the Class 5 to 6 and above, with teachers trained in making children comfortable to ask any questions.” But apart from learning from teachers and parents, there are other resources Dr Dalal believes you should try accessing too. “Several professional organisations of obstetricians and gynaecologists are going to all schools and colleges to impart this knowledge,” she explains, so you could look out for such workshops or training programmes. “Due to the current situation, the knowledge of this is disseminated by webinars which are interactive. There are teaching videos made accessible to all schools,” Dr Dalal says, highlighting the fact that simply because there’s a pandemic outside doesn’t mean you can’t learn more about SRH while at home. “It is best to go to a school teacher or a parent when in doubt rather than look for help online or in unreliable friends or magazines,” she adds.
The other vital part of this process is to consult with a gynaecologist, not once or twice in your lifetime, but regularly. “People often see a gynaecologist when there is a problem like irregular periods, dysmenorrhea or heavy bleeding,” Dr Dalal says, adding that consulting a gynaecologist should be normalised early on. “It is always a good idea to visit a gynaecologist at least once after menarche. Ask about all your doubts about menstruation, or other issues like acne,” she says. It’s also important for young women to consult a gynaecologist regularly to get proper counselling about the HPV (human papillomavirus) vaccine, and also be reassured that all is well.
Let’s get the basics right
Understanding how the female reproductive system works can help you a long way in understanding the changes that happen in your body during menarche, after it, during pregnancy and during and after menopause. This is extremely important for adolescent girls, who can easily get scared when the first bleeding occurs, if things haven’t been explained to them properly. Now, in case you find the language of textbooks too heavy to comprehend, Dr Dalal provides you with an easier approach to understanding the female genital tract:
All girls have a uterus, which is a pear shaped organ in the pelvis. It is the lining of this which is shed at intervals—thereby the bleeding which occurs when you’re on your period. Attached to the uterus on either side are two tubes, called the fallopian tubes, and two ovaries. The ovaries produce the female eggs called ova. These eggs are carried by the tubes to reach the uterus. If the egg meets a sperm (which is the male gamete) then a pregnancy results. This forms an embryo. This mostly happens in the tube. If a pregnancy results then the embryo gets attached to the lining of the uterus.
If there is no pregnancy the lining of the uterus is shed through the mouth of the uterus, called the cervix, via the passage called the vagina. This cyclical bleeding due to the shedding is known as menstruation, which is also referred to as periods. The first bleeding or period experienced by a girl is called menarche. This usually starts by the age of 12-13 years, but it may start earlier by 10 years or later by 16 years of age.
Don’t worry, it’s normal
Once you get these basics right, you need to know what’s normal and what’s not within the framework of your SRH. For example, most textbooks suggest that a normal menstrual cycle is of 28-30 days. But Dr Dalal explains that cycles which are 21 to 45 days long are also normal. It’s only if you get a period with a gap of less than 21 days and more than 90 days that you should see a doctor. The other confusion people always have is about the correct age of menarche, but here again, it differs from woman to woman. The only way to map this progress is by evaluating a girl child’s overall development. “A period usually starts about two years after breast development is seen,” Dr Dalal explains. “Before or around this time, you will see secondary sexual characters develop, like pubic and axillary hair. You may also get a whitish discharge. Don’t worry. It is normal.”
And so, Dr Dalal says, are irregular menstrual cycles during adolescence. “Very often, for the first few years, cycles are very irregular and may come anywhere from 15 days to more than three months,” she explains. “This is normal and does not require any treatment unless the bleeding is very heavy, in which case you may have to consult a doctor.” Beyond adolescence, however, irregular periods can have a number of implications, including polycystic ovarian syndrome (PCOS) and thyroid hormone problems. To detect which problem is causing irregular periods, you must consult a gynaecologist, who will recommend a pelvic ultrasound and blood tests to evaluate the issue. It’s very important to remember that stress can also cause irregular periods, so you might want to keep it in check too.
Another aspect you should monitor regularly is pain. While some pain, discomfort and mood swings are normal before or during your period, excessive pain and heavy bleeding are not. “There can be other causes of pain, like bleeding in an ovarian cyst, or rarely, endometriosis,” she adds. “If you do not have pain normally, or if your pain starts few days before your periods, or it does not go away with simple pain relief medications, do visit a doctor. Never ignore a pain which happens suddenly or a long-standing pain.”