WDH Guide to Your Body

Introduction

No matter your age or career stage in the military, you may push yourself to new limits, facing physical, emotional, and environmental challenges. 

Long shifts, extreme temperatures, limited bathroom access, and wearing protective gear can make it difficult to manage your body’s needs, especially those related to the reproductive and urinary systems of women and diverse members with similar needs.

This guide promotes an inclusive understanding of these health topics while respecting diverse gender experiences.

Terminology

This guide contains inclusive language that cisgender women, transgender persons, intersex persons and gender diverse persons may use to discuss their health. 

Clinical terms are used to explain the external and internal parts of the body which may not reflect your word preferences.

Please share your personal terminology with your health care provider so that you are comfortable when discussing your health.

Basic Body Functions

While everyone is slightly different, you should expect to:

• Urinate 5 to 7 times per day.
• Not leak urine when doing physical exercise.
• Empty your bowels once or twice every one to two days.
• Experience breast changes throughout the menstrual cycle until after menopause.
• Have a regular period of vaginal bleeding, lasting three to eight days and occurring every 21 to 35 days unless:
  • pregnant;
  • taking certain types of hormonal therapy; 
  • underwent removal of the uterus (hysterectomy);
  • perimenopausal; or
  • underwent natural or surgical (removal of the ovaries (oophorectomy)) menopause.

Breasts/Chest

Anatomy

Breasts vary in shape, size and uniformity. Commonly one breast can be slightly larger than the other.

Breasts lie in front of the pectoral muscles on the chest. On the outside is the skin, nipple and areola. The areola is the bumpy area of the skin around the nipple that is darker than the rest of the surrounding skin. On the inside is glandular and fatty tissue, with blood vessels.

The glandular tissue is made-up of lobules, which can produce milk after pregnancy. When a person is breast/chest feeding, this milk passes through the ducts and out through the nipple.

The breasts have very limited supporting structures; only the skin and thin internal fibers known as Cooper’s Ligaments. A properly fitting bra or support clothing will prevent unnecessary soreness of the tissue and nipple.

Changes and Pain (that are common)

Breasts may swell and become tender, or painful (mastalgia) due to hormone changes from hormone therapy, the menstrual cycle, pregnancy, or perimenopause. 

Before a period, some may notice lumps, especially near the armpit, which typically disappear as the cycle progresses. After menopause, breasts may feel softer, less firm, and less lumpy.

Pain may be caused by:

• A lot of tissue movement without enough support;
• Binding too often or the fit is too tight; 
• Injuries or sprains to the neck, shoulder or back.
• Medication such as the contraceptive (birth control) pill and some antidepressants; side effects will be listed in the information leaflet.

Pain can be treated by:

• A new lump, swelling, thickening or bumpy area in one breast/side, the upper chest or armpit that wasn't there before.
• A change in the look or feel of the skin on the breast, such as puckering or dimpling. 
• A change in the colour of the skin that may look red or inflamed. 
• A change in nipple position, for example it has become inverted or is pointing differently.
• A rash or crusting around the nipple. 
• Unusual liquid or blood (discharge) from either nipple. 
• Changes in size or shape of the breast. 
• Pain in the breast or armpit that's there all or almost all the time and is not improving or helped by painkillers. 
• Pain that is accompanied by a very high temperature or feeling hot and chilly.

Genital Area

Anatomy

The outer parts of the genitals are collectively called the vulva. The vulva protects the vagina by helping stop harmful bacteria from getting inside. Pubic hair in the vulvar region also helps by trapping moisture and maintaining a good environment for healthy bacteria. 

The inner parts of the genitals start with the vagina. This is a muscular tube that can expand to accommodate an object such as a penis or sex toy during sexual intercourse or a baby during childbirth. The vagina creates a fluid discharge to get rid of harmful bacteria and replace them with good bacteria. 

Vulvar odour and vaginal discharge can vary greatly among individuals and can be influenced by factors such as diet, the menstrual cycle, and activity (sexual or exercise). Any concerns with stronger odor or abnormal discharge should be discussed with your health care provider.  

The cervix is the opening to the uterus at the top of the vagina. This is normally closed but will open slightly during a period to let blood out or open widely to pass a baby during childbirth.

The uterus is sometimes referred to as the womb. It is a muscular and vascular organ that supports a developing fetus during pregnancy. Its lining changes throughout the menstrual cycle and is shed during a monthly period, passing through the cervix and out of the body via the vagina.

The ovaries secrete hormones and will release an egg, typically every month, unless the person is using certain hormonal contraceptives or other hormone therapy. The fallopian tubes connect the ovaries to the uterus and are where sperm will usually fertilize an egg at the start of a pregnancy.

The pelvic floor includes all the muscles that support the bladder, uterus, and bowels. Imagine a hammock of muscles that support your core during exercise, sexual activity, childbirth, and toileting activities. Pelvic floor dysfunction is when the muscles become weak, tight or damaged which can occur during childbirth or menopause and may cause urine to leak among other issues. This can be managed by seeing a physiotherapist qualified in pelvic floor rehabilitation.

Genital Care

Proper care and hygiene in the lower body is important for maintaining overall health and well-being. It is recommended to cleanse the external genital area with warm water daily. When washing, focus on the external area, without inserting soap into the vagina, as the vagina is self-cleaning and does not require internal cleansing. 

A person should wipe or wash themselves clean starting from the front or top of the genitals to the back towards the anus, to avoid getting harmful bacteria into the vulvar area, which increases the risk of getting an infection. Wash hands afterwards when possible.

Regular changing of hygiene products during menstruation and practicing safer sex by using condoms are also important aspects of self-care. 

Pubic Hair Removal

There is no medical or hygienic reason to remove pubic hair. However, some will prefer to remove all or some of their pubic hair using any of the following methods:

• Shaving. 
• Waxing.
• Laser hair removal.
• Creams. 
• Trimming. 

Removing pubic hair can cause complications such as ingrown hairs, severe itching as the hair returns, waxing burns, cuts or abrasions and skin infections. Trimming the hair shorter with scissors or a trimmer with a guard is recommended over completely removing pubic hair.

Genital Health Concerns

Yeast Infections

Yeast infections are common. They can happen in any damp, moist area, including under folds of skin, under breasts, in the armpits, between fingers and toes, in the groin area, under the foreskin of a penis or inside the vagina. It is usually harmless but can be very uncomfortable and may keep coming back (although it is not a sexually transmitted infection). Cleaning the body regularly and keeping the skin as dry as possible are important prevention measures.

Symptoms of vaginal yeast infection can include:

• A thick, white clumpy discharge (sometimes described like cottage cheese) which does not usually smell. 
• Itching or irritation in the affected area. 
• Soreness or stinging when urinating or having sex.

A vaginal exam by your health care provider is an important part of the diagnosis of a yeast infection. There are some vulva skin conditions like lichen sclerosus (that cause a need to scratch, little cuts, pain, and pale or crinkly skin) that come and go. People often think they have a yeast infection, but it could be lichen sclerosus, which can be easily treated by topical steroid ointment when it flares up.  

If you suffer from recurrent yeast infections, your health care provider may be able to help you prevent infections by checking for diabetes and prescribing medications for a longer period of time.

Female Genital Mutilation

Female genital mutilation (FGM) is any procedure that involves partial or total removal of, or injury to, the outer parts of a person's genitals for non-medical reasons. FGM is performed in some cultures, but it is illegal under Canadian law. There can be complications following FGM, both immediately and in the longer term. If you have been affected and have complications or concerns with urination, leakage, abnormal discharge, menstruation, intimacy, or childbirth, a health care professional can help.

Urinary Tract Infections

Urinary tract infections (UTIs) are usually caused by harmful bacteria getting into the urinary tract and can affect the urethra, bladder, ureters, or kidneys. They are very common for the female genital anatomy because the tube that carries urine (urethra) is short, and the openings of the anus and urethra are closer together. This closeness makes it easier for harmful bacteria to enter the urinary tract, increasing the risk of developing a UTI.

Symptoms of a UTI include:

• Pain or burning when urinating (dysuria). 
• Needing to urinate more often than usual (urinary frequency).
• Urinating more during the night (nocturia). 
• Needing to urinate suddenly (urgency). 
• Having blood in the urine or its colour turning darker and cloudier. 
• The urine having a strong smell.

If symptoms develop, contact your healthcare provider as soon as possible for treatment with a short course of antibiotics. A sample of urine will need to be tested to confirm an infection, although treatment may be provided based on the symptoms alone. The antibiotics usually work within 48 hours of starting treatment and symptoms usually disappear by the end of day 3 if taken as prescribed. 

THIS MAY HELP

While the evidence may be limited or under research, there are some widely accepted practices that may help avoid UTIs:

• Keeping the vulva area clean. 
• Wiping or cleaning from front to back. 
• Drinking fluids and urinating regularly. 
• Urinating shortly after sexual activity. 
• Taking pure cranberry juice or extracts regularly, if prone to frequent UTIs.

For more information see the Urinary Health Guide.