Self-Help: Key to Understanding the Changes Our Bodies Go Through During Pregnancy

Excerpt from Chapter 1 of Woman-Centered Pregnancy and Birth by Ginny Cassidy-Brinn, R.N., Francie Hornstein, and Carol Downer
Federation of Feminist Women's Health Centers
Illustrations by Suzann Gage

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To actually see your cervix and the opening to the uterus-the opening that will dilate to allow the baby's head to come out-can be one of the most exciting moments in your pregnancy. Suddenly, all of the diagrams and drawings that you have been looking at to try to understand what is happening, make perfect sense. And, just as when a woman is not pregnant, being able to look at the cervix makes it easier to ward off or alleviate common problems such as vaginal infections or urinary tract infections.

It is not essential to do vaginal self-examination in order to understand the processes of pregnancy and birth or in order to stay healthy. Any woman can carry out all of the suggestions in this book without ever seeing her cervix. Self-examination of the vagina and cervix using a plastic vaginal speculum is, however, very simple to learn, requires a minimum of equipment and is a common-sense health routine equivalent to standing in front of a mirror, opening your mouth and saying, "Ah."

Self-examination can be done by yourself or in a self-help group. The Self-Help Clinic started out in April, 1971, as a type of consciousness-raising group. The Self-Help Clinic is a meeting where women learn to do self-examination of the vagina, the cervix and discuss their health experiences. Depending on the age, sexual orientation, and wishes of the participants, the topic may be birth control, menopause, sexuality, childbirth, vaginal infections or feelings about our bodies.

The equipment needed for self-examination is a vaginal speculum, a light and mirror. Most women prefer a semi-sitting position on a bed, table or the floor, usually with a pillow behind them. Water soluble jelly can be used to moisten the bills of the speculum. The speculum is inserted with the bills closed, handle up. Many women are pleasantly surprised to find that, since they are in control, the procedure is not painful. You open the speculum by pushing down the front of the handle while simultaneously pulling up on the back. As the speculum opens, you will hear three clicks. You can lock the speculum into place at whichever notch is comfortable. Speculum's come in three sizes, narrow, medium and long. Most women use a medium. Many women who usually used a narrow speculum found it was easier to insert a medium size speculum during pregnancy. Many women have noticed that their cervixes moved further back in the vagina during pregnancy and found it necessary to switch from their usual medium size speculum to a long one.

The light, generally a flashlight or a high-intensity lamp, is reflected off the mirror so that the vaginal walls and cervix are illuminated. Magnifying mirrors can help you to see details.

Often, women need several attempts to bring the cervix into view. But, with practice it becomes much easier. No one who has tried persistently has failed to use the speculum successfully. As your abdomen gets larger with pregnancy it becomes more difficult to see your cervix. By lying flat, self-examination can be made easier with the help of one other person holding a large mirror over your cervix. As pregnancy progresses, the cervix grows along with the rest of the uterus. Some women's cervices get so large that it is possible to see only a portion of the cervix at any one time. By pointing the speculum in different directions, you can eventually see the entire cervix.

You can safely do vaginal self-examination throughout pregnancy as long as the bag of waters hasn't broken and you are having no signs of miscarriage. These guidelines are the same as the guidelines for deciding when it is safe to have coitus (see p. 61)

Two customs are observed in the Self-Help Clinic. A woman does self-examination if and when she feels comfortable doing so, and she gets to look at her cervix fist. Many women want to do self-examination at the first meeting; others take their speculum's home to have their first look in privacy. Initially, a woman may feel reluctant to do self-examination if she is menstruating of has a bad-smelling vaginal infection. When she finds out that the other women are eager to learn about menstruation or vaginal infections, she is generally happy to give them a chance to learn. Embarrassment is replaced by curiosity; some have called it "show and tell time."

The distinctive sounds of a Self-Help Clinic are the clicking of speculums, the buzzing of several conversations and intermittent choruses of laughter. An air of discovery and adventure exhilarate most women in the Self-Help Clinic.

Another important part of the Self-Help Clinic is the uterine size check. A member of the group can feel your uterus by inserting two fingers of a gloved hand into the vagina pressing with the flat of the fingers of the other hand just above the pubic mound. After the first three months of pregnancy it is not necessary to insert the fingers into the vagina. While lying flat, the uterus can be felt by pressing down under the ribs, with the flat of the fingers, and gradually moving the fingers down toward the pelvis until a hard muscular ball is felt. This is the top of the uterus which get approximately one inch higher per month during pregnancy. The purpose of the uterine size check is to learn the size, shape and position of the uterus. Its growth can be recorded by periodically measuring the distance from the top of the uterus to the pubic bone with a tape measure laid flat on the uterus. A uterine size check can also be done to see if the uterus is larger or softer than usual, indicating pregnancy.

At the first Self-Help Clinic we learned to do self-examination of the cervix and vagina. As woman after woman inserted her speculum, looked at her cervix, then passed around the flashlight so that others could look, we exclaimed over the different characteristics of each women. It soon became obvious that the so-called "disease" of yeast overgrowth is a common and generally harmless condition. In an era of tight jeans, nylon pantyhose, the Pill, and high sugar diets, we have varying amounts of yeast in our vaginas. We were struck by the absurdity of having made numerous trips to the doctor to deal with this everyday common problem. All but one of us had "tipped uterus," which merely means that is was angled wither toward the back or front instead of the classic, textbook angle. One women recalled that her doctor said her tipped uterus accounted for her problems in getting pregnant. Another said that her doctor had blamed her tipped uterus for her many pregnancies. Just by talking to each other and comparing notes, we could see how we had been made to feel like there was something wrong when, in fact, we were quite healthy.

That very first evening of self-help, like all those that have followed, liberated us from many of the myths and notions that had driven us to the gynecologist. We found that irregular menstrual cycles are not uncommon; very few of us fit the 28-day cycle model. Our normal secretions varied throughout our cycle, becoming very heavy around the time of ovulation. This "discharge" had caused many of us great concern.

Menstrual Extraction is an early accomplishment of the Self-Help movement. Lorraine Rothman invented the Del-Em, a device used by groups of women to suction out the uterine contents on or near to the time of the expected menstrual period. This technique, which shortens the menstrual period, lightens the flow, or terminates an early pregnancy, has been used by women for ten years with outstanding safety and success. If this technology were widely available to women, the dark ages of state control of women's reproduction would be over. We would cease to worry about what the predominately male Supreme Court or legislature dictate.

The concepts of Self-Help have had a tremendous impact on the women's health movement. Lorraine Rothman and Carol Downer, members of the first Self-Help Clinic, travelled around the country in the fall of 1971, visiting women's groups to lecture on abortion and to hold Self-Help Clinics. Many women's health groups had reached an impasse at that time. They were counseling and referring women to abortion facilities on the East and West coasts and they had read Women and Their Bodies, the predecessor to Our Bodies, Ourselves. But they felt unable to proceed further due to lack of funds and the lack of cooperation of the medical profession in their communities. Self-Help gave them the ability to directly learn well-woman health care. They were able to do independent research, to compile information and finally, to set up women-controlled clinics.

The women in a Self-Help group in Santa Cruz, California taught themselves to be midwives and later formed the United States' first birth center, the Santa Cruz Birth Center. The concept of a community center where women having home births could come for prenatal care and meet other pregnant women has since become very popular. One of the midwives in this group, Raven Lang, wrote the first and for several years the only book on home birth, The Birth Book. This book inspired many mothers to have home births and many women to become midwives.

Woman-Centered Pregnancy and Birth focuses on information that enables you to make important decisions about your pregnancy and birth. Learning self-examination is an important first step, and a self-help group is the best setting in which to learn it.

You can order a plastic speculum from the Feminist Women's Health Center or the Women's Health Specialists

Also, visit "Our Anatomy" webpage for further information.

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Woman-Centered Pregnancy and Birth published in 1984 - we encourage comments, insights and suggestions; please write whwh@womenshealthinwomenshands.org

Self-Help for Sex

CAROL DOWNER

What would happen if groups of laypeople examined each other's bodies and talked about their health-related experiences? What if they were all women and the part of the body they were examining was their genitals? Shocking? Dangerous? Frivolous? Or a totally new approach to the understanding of female sexuality and reproduction?

In 1971 in Los Angeles, several women, in turn, removed their pants, lay down and inserted a plastic vaginal speculum, looked at themselves with a mirror, and then allowed others in the group to look at their vaginal walls and uterine cervices using a flashlight. Throughout the evening, they freely shared experiences with one another. This type of session, which we named the self-help clinic, has been repeated by many groups of women throughout the United States and abroad. Meetings like this continued and, in the next few years, became the basis for the Federation of Feminist Women's Health Centers, which includes centers in Los Angeles, Orange County, San Diego, and Chico, California, and in Atlanta, Georgia, and Tallahassee, Florida.

By breaking the societal taboo of letting our genitals be viewed outside a medical or sexual setting, we have been able to let the feelings of shame (Greek for the genital area is pudendum, meaning "shame") fall away and to learn directly about our own bodies.

Since 1971, through participating in self-help clinics, writing and distributing health pamphlets and books, and establishing feminist women's health centers and women's clinics, self-helpers have amassed a new body of knowledge about the healthy functioning of woman's body, including improved fertility-detection methods, new and safer birth-control methods, natural home remedies for common problems of well women, and healthy alternatives to estrogen-replacement therapy in menopause.

The women's health movement, for which the self-help clinic is the training ground, has exposed many medical myths perpetrated by male physicians whose only knowledge of women's bodies is derived from medical textbooks, their clinical practices, or personal sexual contact. But of all aspects of women's health, certainly women's sexuality has been the most neglected and misunderstood by the male dominated medical profession and the related fields of psychotherapy and psychology. Despite some substantial contributions made by William Masters and Virginia Johnson and by Mary Jane Sherfey, whose book, The Nature and Evolution of Female Sexuality (1972), is based largely upon Masters and Johnson's work, the first reliable glimpse of women's sexuality in today's society has come from Shere Hit. In the Hite Report (1976), which consists of over 1000 responses to a lengthy questionnaire, Hite argued persuasively that women are "sexual slaves," habitually satisfying men's needs during sex and ignoring their own:

The fact is that the role of women in sex, as in every aspect of life, has been to serve the needs of others-men and children. And just as women did not recognize their oppression in a general sense until recently, just so sexual slavery has been an almost unconscious way of life for most women-based on what was said to be an eternally unchanging biological impulse. . . . Women are sexual slaves insofar as they are (justifiably) afraid to "come out" with their own sexuality, and forced to satisfy others' needs and ignore their own . . . The truth is that almost everything in our society pushes women toward defining their sexuality only as intercourse with men, and toward not defining themselves as full persons in sex with men. Lack of sexual satisfaction is another sign of oppression of women.

At first, self-help clinics concentrated on the urgent topics of birth control, breast surgery, and alternatives to steroid hormones. But in 1976, in conjunction with writing a book on women's health care, a group of six women in Los Angeles were selected by the Federation of Feminist Women's Health Centers to spend several months studying the female sexual response and the structure and function of the sexual organ. Suzann Gage, an anatomical illustrator and member of the health center staff, brought in thick anatomy books in various languages for the group to consult. We sat on the floor and, using mirrors and flashlights, each carefully examined our genitals and compared them to the illustrations. First we found that although all of us had most of the structures pictured, the variation in size, proportion, coloration, texture, and shape of each component part gave each woman's genitals a markedly different appearance-different from one another, but especially different from the standard drawing. Among other differences, the drawings always show the opening that leads to the vagina as a gaping hole rather than the neatly closed opening that may or may not be visible, depending on the shape (or existence!) of the fourchette, a membranous fold of skin that stretches across the lower part of the opening. (See Figure 1, 2, and 3.)



As part of the study, some of the women masturbated to orgasm while being photographed so that the changes in the sexual organs during the sexual response cycle could be observed. These changes, while not as obvious as those that occur in the penis, are nevertheless pronounced and quite identifiable. Women at the Orange County FWHC also made motion pictures of sexual response. In some instances, the speculum was inserted and kept open throughout so that the changes in the vaginal walls and in the cervix could be seen during the phases of excitement, plateau, orgasm, and resolution.

Careful comparison of living genitals to drawings largely based on dissections of dead tissues, combined with our observations of the sexual response cycle, enabled us to piece together a full description of the clitoris, the female organ. We learned that the clitoris is an intricate organ located in the crotch below the ischium bones (the bones we sit on), which flare out, forming a triangular space. It consists not only of the hooded glans, the shaft, and the crura, as generally believed, but also of the ligament that suspends these structures from the symphysis (or midline) of the pubic bone; the muscles that bound the triangle; the networks of nerves and blood vessels that branch into the clitoral structures; the spongy erectile bodies, such as the urethral sponge, the clitoral bulbs, and the perineal sponge; and the inner lips, which extend from the hood until they again join and form the fourchette just above the perineum between the clitoral opening to the vagina and the anus. (See Figures 4, 5, and 6.)



In self-examination, the clitoris can be distinguished from the surrounding vulva (the pubic mound and the outer lips) by the fact that it has no hair. The inner part of the clitoris extends to the depth of the hymen, which separates it from the vagina, except along the roof, where a pad of spongy erectile tissue, the urethral sponge, extends back into the vagina. By inserting the index finger and pressing against the ischium bones, the crura (or legs) and the clitoral muscles that extend from the shaft and the pubic bone can be felt as thick rubber bands. By inserting the finger a little deeper and pressing sideways, the soft clitoral bulbs can be felt.

During sexual excitement, the suspensory ligament shortens, pulling the glans and the shaft up under the hood and into the groove of the symphysis. The erectile tissue of the shaft and the crura (corpus cavernosum) fills with blood and becomes bone-hard. As stimulation continues, the muscles begin to tighten, and the soft erectile tissues (corpus spongiosum) of the urethral sponge, the perineal sponge, and the clitoral bulbs swell with blood, causing the vaginal opening to become smaller and to "sweat" and become very moist. (See Figure 7.)
During the plateau phase, erection and muscular tension increase and the inner lips often become bright red or wine-colored from vasocongestion. (See Figure 8.) At orgasm, the mucles (ischiocavernosus, bulbocavernosus, and transverse perineal) contract rhythmically four to eight times at four-fifths of a second. The whole clitoral pulsates as it muscles force the blood from its engorged tissues back into the body. (See Figure 9.) During resolution, the ligament stretches, the shaft returns to its usual position, and muscle tension gradually subsides. This sequence of events closely parallels those that occur in the penis, with its comparable but somewhat differently arranged structures.



In our study, we observed that Masters and Johnson's extremely important discovery, that the male and the female sexual responses are similar instead of complementary, applies to the structure and the function of the sex organs as well as to the generalized body responses of systemic changes, such as increasing heart rate, rise in blood pressure and respiration, nervous excitation, vasocongestion, and muscle tension. 1

Since the women participating in this project had no access to dissection rooms, they were forced to rely on Masters and Johnson, Sherfey, anatomy texts, the drawings of Robert Latou Dickinson (an artist-physician who interviewed and sketched thousands of his patients in the 1920s and 1930s), and the observation of their own bodies. Some people may quibble with the claim that the women discovered "something new" in this study, since all of the structures they identified as being part of the clitoris can be found described in one anatomy book or another, especially if one searches back over the last 75 years. In defense of Masters and Johnson, who failed to describe the clitoris fully and who instead designated most clitoral structures as being, somehow an extension of the vagina called the "orgasmic platform" and located in the "outer third of the vagina," the functional unity of the clitoris is totally obscured by the literally fragmented approach that anatomists use. (Feminists will be forever grateful, however, to Masters and Johnson's recognition of the vital role that the glans and the shaft play in orgasm.)

Anatomical artists, first of all, cut out and study sections of tissue and, unless they conceptualize structures as belonging to a unit, do not see them as a unit. Second, for purposes of illustrating certain parts, the artist omits others; therefore, anatomical drawings of cross sections of the body seldom show all of the structures. Certainly, no one illustration or set of illustrations we found included all of the clitoral structures. For example, the urethral sponge was missing from all illustrations and descriptions except in three texts: Testut (1931), Toldt (1928), and Netter (1970). The perineal sponge is never pictured; it is merely alluded to in Kinsey's Sexual Behavior in the Human Female (1965). (See Figure 10.)

In any inquiry, the best test of theory is how well it fits the facts. As we described our understanding of how the sex organs work in self-help clinics, woman after woman has commented matter-of-factly, "Yes, that's how it is with me," not realizing how ignorant the medical profession has been of this simple truth: that the clitoris is an organ as complex and active as the penis. Also, another test is usefulness. After demonstrating self-examination and showing the parts of the clitoris and how it functions, discussions of our sexual experiences become much more concrete and specific. We now have a vocabulary and a conceptual framework to communicate with.

One of the major accomplishments of this group self-study project is to put to rest forever the controversy over clitoral or vaginal orgasms. Now that it is understood that the clitoral structures surround and extend into the vagina, the fact that women report pleasurable feelings deep in the vagina in no way contradicts Masters and Johnson's correct if inadequately pursued finding that all orgasms are of clitoral origin. The vagina is involved passively in the orgasm, and the pleasure that women receive from the thrusting of the penis comes from the sensations of the penis rubbing against the erect clitoris.

As part of our research, we gathered accounts of individual experiences. We were more interested in the actual sexual experiences than in feelings about sexuality. We found that some women experience the entire sexual response cycle from the time that they are toddlers. On the other hand, it became clear that many women do not experience orgasm until they are in their 20s or 30s or even later, or never. We found few women who experience orgasm regularly and dependably during coitus. Women agreed with the subjects of the Masters and Johnson study who reported that orgasm from masturbation is frequently stronger than from coitus. Of course, as feminists, we were not very concerned with whether or not the orgasm was obtained during coitus, or by manual or oral stimulation, or with a vibrator. Our aim was not to train ourselves to have orgasms in dull sexual sessions where the only clitoral stimulation is from the penis. We found that women usually strive to achieve orgasm during coitus to reassure the partner. In self-help clinics, one of my favorite questions to ask is 'Would everyone here who has never faked an orgasm, please raise your hand?" I have yet to see one hand raised.

Other feminists, many of whom participate in self-help, conduct therapy groups for women called preorgasmic groups. Rather than viewing women's sexuality solely in the context of heterosexual intercourse, they help women to learn to achieve orgasm through masturbation. These groups use a variety of approaches, but all include group discussion, instruction on the basic facts of the sexual response cycle, and practical tips on how to masturbate to orgasm. Women who participate in these groups have excellent results.

Women in self-help groups not only reexamined the emphasis on a woman's having an orgasm during coitus but reexamined the advice given to couples to aid the woman in achieving orgasm at that time in light of our improved understanding of the structure and function of the clitoris. A typical piece of therapists' advice is to have the woman sit astride the male, in order to bring her glans and shaft into closer proximity to his penis and public bone. While this advice is successful in many cases, especially if a couple work together conscientiously with the one goal being the woman's orgasm, it seems probable to us that the success comes more often from the woman's ability to maneuver freely and to control the amount of stimulation she receives and the man's sincere interest in helping her to achieve orgasm, rather than from direct stimulation of the glans and the shaft.

Of course, we talked to women who wanted-indeed, needed-very strong direct stimulation of the glans and shaft, but most seemed to prefer stimulation of the other parts of the clitoris instead. The penis is in good contact with the clitoris at all times in all positions. For example, when the male inserts the penis from behind, the penis is thrusting toward the urethral sponge, which is along the roof of the vagina. Also, many women have said that direct stimulation of the floor of the clitoris, the perineal sponge, gives maximum pleasure.

Misunderstanding the clitoris as merely the glans and the shaft, along with the patriarchal insistence that women rely only on penile stimulation for "normal" orgasms, has led to shocking consequences. Some therapists refer women for female circumcision (clitoridotomy) to have their clitoral hoods removed so that they can be more sensitive to the thrusts of the penis. One gynecologist, James Burt of Dayton, Ohio, has even developed a two-hour operation for surgically redesigning the vagina, referred to as the "reborn Burt vagina." In addition to moving the glans and the shaft closer to the clitoral opening, he narrows and tightens the vagina, cuts the pubococcygeal muscle (which forms the floor of the pelvis and through which the vagina runs), and removes the hood. Some of the women who have this surgery are very satisfied, but others have had problems, such as vaginismus, afterward.

These operations are reminiscent of surgeries and mutilations performed on women's clitorises in the 19th century-and even today in a few countries. As far as we could determine, most of these surgeries were limited to excising the glans and some or all of the shaft (although an operation called infibulation can include the inner lips also). Surely these mutilations had a devastating impact on women's ability to have sexual pleasure and to achieve orgasm, but, physiologically it would seem that since most of the clitoris was left intact, including extensive networks of nerves, blood vessels, erectile bodies, and muscles, orgasm would still have been possible. Masters and Johnson even cite a case where a woman had orgasm despite amputation of the shaft. As for men, those who have had the outer shaft amputated are still capable of having orgasm.

As part of our sex research, we reviewed current sex theraphy practices and discussed them in self-help groups. One criticism women have consistently made of therapeutic measures is that often the assumption is made that it is possible for a woman to have a carefree, uninhibited sex life despite the difficulties she faces in a sexist society: "Oh, sure, just casually lie down in the field of wildflowers and have sex! What about birth control? Or is everybody supposed to use the Pill or IUD?" Or, "Well, I'm forty, and frankly, most men my age or even older just want casual sex with me and they seek out younger women to have even semipermanent relationships with." We came up with a list of institutions, laws, and practices that reinforce women's oppression or sexual repression; our evaluation of this list amounted to a broad-scale condemnation of patriarchal society. Any therapist who tells a women "it is up to her" and implies that she is responsible for her "hang-ups" is merely rubbing salt in the wounds inflicted by her church, which preaches the evil of sexuality, especially women's; by schools, which withhold sex education from her, except for perhaps a lecture on menstruation in junior high and another lecture on birth control in high school; and the ubiquitous pornography that degrades her.

Current sex therapy that relies primarily on sex histories and taeching techniques to overcome problems such as vaginismus, inability to achieve orgasm, or inability to maintain an erection seems to be of most help to men and women. Although Masters and Johnson pioneered this type of therapy, their excellent works is tainted with sexism in their use of prostitutes for research and the use of women as surrogate partners.

Like the use of surrogate partners, other tools of the sex therapist are less acceptable to feminists-tools like permission giving, advising, role playing or setting examples by role modeling and desensitization. Permission giving is the reverse side of the authoritarian coin that has denied people the right to decide their own sexuality. Advising is only as good as the adviser, and our experience is that therapists are as much a part of our culture as anyone else and pass on their own biases and hang-ups; the same criticisms applies to role playing and role modeling. Desensitization involves bombarding the clients with films of tapes of explicit scenes or shocking words to numb them to any feelings of shock or embarrassment. Feminists see a problem with these methods if a woman, in the process of losing her upsetness, also loses her very necessary armor against hurtful influences. Sexist jokes and pornography are more than distasteful; they shame and humiliate women and support sexist practices that cause harm to women.

If sex therapists, male or female, are sincere in wanting to help their female clients, they would be wise to consult feminists, especially those in the women's health movement, to reduce to the minimum their inevitable sexism. Unless sex researchers, counselors, and therapists raise their consciousness about women's oppression, they will perpetuate the models of heterosexuality that suppress women's sexuality. For example, Multi Media Resource Center puts out a series of films showing people having sex. One film starts out with a couple riding their motorcycle on a country road (of course, the man is in the lead, but perhaps that is nit-picking). As they turn down the lane toward their house, they dismount and lie down together among the leaves. The man, Rich, playfully pulls at Judy's clothes. She resists, he persists, and he finally succeeds in disrobing her. Then, in a scene on the sundeck next to their pool, he first applies suntan lotion to her and incorporates it as foreplay, but then he starts teasing her, then chases her and wrestles her down to the mat. He mounts her and embarks on a vigorous (actually borderline violent) coital session. Then, after his orgasm, he picks her up and throws her into the pool! When I asked a representative of the organization who made the film, he sidestepped any responsibility for the mock rape format by saying that this was the way this couple had sex and that their aim was not to judge but to record.

As part of their well-woman health-care program, the Women's Choice Clinic of the Feminist Women's Health center in Los Angeles has initiated a special self-help program where women can learn in groups about the female organs and sexual response. During the group session, which lasts two to three hours, women do self-examination and identify the parts of the vulva, clitoris, vagina, uterus, egg tubes, and ovaries. The phases of the sexual response cycle are presented. Each woman prepares an extensive sexual "herstory" as the group share their experiences and problems. Specific techniques for enhancing sexual enjoyment are demonstrated. The difference between these groups offered at the clinic and at the self-help clinics is that although all self-help clinics talk about sexuality to a greater or lesser extent, and some self-help clinics have chosen to concentrate on sexuality, the clinic sessions offer women the opportunity to come together for the express purpose of learning more about sex.

So a century after Freud asked plaintively, "What do women really want?", women are coming together and overcoming patriarchally instilled and socially enforced taboos to find out what type of sexuality they really want, and of course, from there, it is a short step to demanding that institutions change so that both men and women will be free to express their sexuality to other human beings constructively, joyously, and for mutual satisfaction.

1 The vagina, uterus, uterine ligaments, egg tubes, and ovaries-as well as the breasts, indeed, the whole body-are involved in female sexual response. We are merely focusing on the clitoris. For a detailed description of the clitoris, compatible with the observations in our study, see Masters and Johnson (1966, pp. 56, 60-61).

REFERENCES
-Hite, The Hite report. New York: Dell Publishing, 1976, pp. 419-420.
-Kinsey, A.C., Pomeroy, W. B., Martine, C.E., and Gebhard, P.H. Sexual behavior in the human female. New York: Pocket Books, 1965, p. 577
-Masters, W., and Johnson, V. Human sexual response. Boston: Little, Brown, 1966, pp. 56, 60-61.
-Murry, L. Building a better vagina. Playgirl, 1977, 5, 40+.
-Netter, F. H. The CIBA collection of medical illustrations, Vol 2. Summit, N.J.: CIBA Pharmaceutical Company, 1970.
-Sherfey, M. J. The nature and evolution of female sexuality. New York: Random House, 1972.
-Testut, J. L. Traite d'anatomie humaine (ed. 8, revised and enlarged by A. Latarjet), Vol. 5: Appareil urogenital peritoine. Paris: Doin, 1931.
-Toldt, C. Anatomisher Atlas. Berlin and Wien: Urban and Schwarzenberg, 1928.

SELF-HELP CLINIC Part II

Copyrighted 1971

Much has happened since we first wrote our Self-Help Clinic article last summer E.W. July, 1971. At that time, under Carol Downer's direction, we had been meeting for about four months evolving a concept that would have far reaching effects. Since early spring, first working within women's liberation cell groups, then expanding to community women's church groups, Y.W.C.A. groups, and then taking the concept across the country, we are pleased to announce that over 2,000 women (including a group in London, England begun by a Connecticut Self-Help sister), have been introduced to self-examination and the Self-Help Clinic concept. Little did we realize that first night when we all agreed to confront our physical hang-ups in a physical way, that we were all to share real sisterhood in a very meaningful way. Our grandmothers and great-grandmothers knew well the meaning of sisterhood. Mothers, daughters and aunts would meet together to share their womanly experience and be ready to help one another through their physical crises. Since grandmother's time, we have lost the closeness of sisters' experiences and helpful hands. This, along with being denied access to modern knowledge, has left us without knowledgeable good preventative health care. The Self-Help concept of self-examination is based on this reintroduction of sisterly sharing of experiences and knowledge in a commonsense, honest manner. Collective knowledge used within close sisterly groups that we call The Self-Help Clinic, have already had positive results as valuable preventative health care measures.

The Self-Help Clinic consists of 3 meetings; usually an evening a week for three weeks. These meetings deal primarily with learning self-examination with the help of all the sisters in the group. This is a very meaningful sharing experience for all, since we learn what is normal by having the opportunity to examine many women, under well-conditions. Occasionally we will have a sister who has a more serious problem and having caught it within self-examination, is encouraged to seek professional help. The Self-Help Clinic provides the opportunities for women to confront the many myths, misconceptions, and misinformation that we have been fed our entire lives. Being able to examine ourselves in a group situation gives us the first real concrete opportunity to compare the "text book" with reality. This is also the time when we learn to recognize cervical cap changes (in color, tone and other signs) in one another. Each woman during the first session has learned to insert her own speculum for the self-examination procedure and keep this speculum for continuous use. We also learn to give bi-manual (two hands) pelvic examinations by the 3rd evening. Looking at diagrams of our pelvic organs and being able to touch them and know their structure manually, gives us a far greater understanding of our bodies. We also spend the sessions reading and discussing a variety of written material, much of it brought in by the members of the group. We use the Birth Control Handbook as a major source for discussion and reference.

One major learning skill we have readily available is being able to recognize what is "normal". Since the meeting are primarily for women who want to learn about their own bodies, we have the perfect opportunity to see many, many normally healthy women. Contrary to clinics' and physicians' experiences (they have been trained and continue to work with patients suffering with some kinds of symptoms of illness), we are in the most fortunate position to learn to recognize what is a well-woman. By being able to recognize what is well and normal, we are better skilled to recognize that which is abnormal. It is interesting to note that Dr. Donald Ostergard of Harbor General Hospital in Torrance, Calif. * has been medical director for a similar program providing "book" and clinical training for women with similar non-medical backgrounds. His findings show that non-medical personnel with a high percentage of accuracy, can recognize deviations from normal. For example; Vulvar lesions, 89%, breast lesions, 85%, vaginal well muscle breakdown, 90% plus, uterine and surrounding structural abnormalities, 90%, antiflexed (elbowed backward) uterus, 90% plus. These are very high percentages of accuracy. Dr. Ostergard explains that his family planning patients are generally well patients who have come into the clinic for birth control information. His training program for the women paramedics stress normal breast and pelvic examinations. When a deviation from normal is found, the patient is referred to the physician. It is not important that the trainee recognize the exact nature of the abnormality. Dr. Ostergard's findings agree with our Self-Help Clinics' similar opportunities for well-women examinations: Women with varying non-medical backgrounds with sufficient training opportunities for examining well-women, can effectively recognize abnormal conditions.

How much better off we are, being able to recognize the unusual and to confidently make arrangements to get professional help; compared to remaining in ignorance until our problems have progressed to the point of seriousness and possible permanent damage. The Self-Help Clinic concept also helps us learn to take better overall care of our bodies. We stress breast examination and strongly encourage yearly Pap smears for cancer detection. We have found that, just like a sore throat, when we recognize an early infection or inflammation, some kind of personal care which includes lots of rest for our body, often connects the problem.

The Advanced Self-Help Clinics

One of the most exciting outgrowths of the Self-Help Clinics is in the development of advanced groups who have dedicated themselves to implementation and research. These groups feel that it is time that we women do the deciding on what we want in research areas on better health care for women. A large number of these women are guiding new Self-Help Clinics, sharing their experience with newer sisters to the concept, as well as perfecting their paramedic training skills. Quality libraries with up-to-date material and references on research into women's health needs, is another area of implementation. Another advanced Self-Help Clinic has published our "Ho To Start Your Own Self-Help Clinic" booklet which is available to anyone or groups interested in starting a Self-Help Clinic. There is presently a sizeable number of advanced, very dedicated and brave women who are determined to research out the possibilities of menstrual extraction. Let us here, clear up any misconceptions involving the experimentations being done within these advanced groups. And that is, menstrual extraction is not a euphemism for abortion. When the Self-Help Clinic means abortion we refer to it as abortion. This is a most important point. Our advanced groups must not be misrepresented if they are going to continue to work effectively for all women. These dedicated women, working and learning together are providing valuable information in the skills of menstrual extraction. Most of them seem to quite comfortable extract on the first day of their flow. We are told that a policy of these groups is that at no time is a sister allowed to experience discomfort. We are also told that it is almost unnecessary to mention the need for caution and gentleness, although both are major considerations in every case. Caution and gentleness seem to be almost instinctive.

While working within one of the advanced Self-Help Clinics, Lorraine Rothman found that the device that the group was attempting to use at that time needed vast improvement. It consisted of a simple syringe specially constructed to hold vacuum by the pull-back plunger; some plastic tubing; and a specially constructed small bored flexible cannula. (Neither the tubing used in manufacturing the cannula nor the finished cannula are available through laboratory or surgical suppliers. It is specially made by a large bio-instrument manufacturer and sold for a very high price.) Lorraine decided that since the syringe fell apart so easily causing air and fluid to back up into the uterus, she would devise another that would, 1) Provide a portable and continuous vacuum without back up worry, 2) Provide a syringe that need not be specially constructed, and 3) Provide a by-pass collection bottle which is a must since menstrual flows vary from woman to woman. She also realized the need to have ready access to the specially manufactured high quality, semi-flexible cannulas. They cannot be purchased at local lab houses, standard lab catalogs, nor can they be improvised out of the hardware store or drug store supplies. Lorraine's invention, tagged "Del'-Em", presently has a patent pending in hopes of keeping it within the women's movement as well as to encourage other women to put their heads and hearts to work for the movement. The semi-rigid cannula, which is a critical component of Del'-Em, when chemically sterilized, can be inserted through the undilated cervix. The cannula will bend to conform to the uterine walls without breaking or losing its flexibility and yet is not hard enough to damage the uterine lining. In addition, the cannula bore is large enough to facilitate removal of the menses. The research in these advanced groups is conducted under the guidance of medically trained personnel within clinical settings. They learn hospital and clinically acceptable sterile techniques under careful guidance. They also have access to the specially built cannulas and use only them. The women examine each other carefully to determine whether the procedure of menstrual extraction is safe for each. In this way they learn that a select group of women are eligible for the procedure. The following conditions, which are screened very carefully, are ineligible: Retroflexed (elbowed backwards) or antiflexed (elbowed foreward) uteruses, serious infections, polyps, extensive scarring, endometriosis and double uteruses. The Advanced Self-Help Clinics have also found that there is no way for a woman, by herself, to know her exact uterine conditions. Sisterhood is Safety: Safety is Sisterhood. In addition, continued research with Del'-Em indicates that group experience, knowledge, cooperation and sisterly concern improves the kit's efficiency. It would be irresponsible, here, to give step by step written directions in menstrual extraction. Just as in learning to sail a boat, it can't be done just by reading a book. It takes a seasoned sailor along to instruct with a properly outfitted vessel. The Advanced Self-Help Clinic groups, some of whom have been experimenting with Del'-Em for almost a year, know by personal experience that if this movement is to succeed, it will-only through SISTERHOOD. Groups of sisters learning from sisters and helping other sisters to fully realize their control over their own bodies is a very meaningful and workable concept. The idea of a "kit in each woman's private bathroom" is anti-sisterhood and anti-women's liberation. By being a select item for one woman only, within the confines of her own four walls, and without the collective help and support of her sisters, everyone and especially the movement looses. The concept of Self-Help stresses Sisterhood that makes possible the benefits from collective knowledge, collective experiences, collective training and especially the sisterly concern for one another. When it is necessary to travel for more extensive experiences or information, we do. Lastly, the Self-Help concept emphasizes competent medical backup and the use of safe equipment at all times.

We are seeing, today, unbelievable gains springing from this movement of sisterhood. We also forsee that it will take continued dedication by all sisters, vast investments of time, motivation, enthusiasm, and $$ for this movement to succeed. Throwing off the oppression of centuries takes total commitment and sisterhood.

The West Coast Sisters


* "Family Planning and Cancer Screening Services as Provided by Paramedical Personnel, A Training Program", by Donald R. Ostergard, M.D., AM. Assoc. Plan. Parent. Phys., Kansas City, Mo., April 5-6, 1971.

Mirror Flashlight and Speculum

In 1971 a woman named Carol Downer took a speculum from an illegal abortion clinic in Los Angeles, went to her home and using a mirror and a flashlight, looked at her own cervix.

She was the mother of six children, had had an illegal abortion and had never seen her own cervix. She saw where her babies had passed through, where her menstrual flow had come from, and what the doctors had commented on over the years. It was a very enlightening moment for her.

What she did with that knowledge was revolutionary.

-Women's Health Specialists

Self-Help Clinic

Copyright 1971

Visit Our History, Self Help Clinic, Staying Well, Our Anatomy, Our Periods, Reclaiming Abortion, Our Birth Control, and Library web pages for further detailed information.

A group of women not long ago banded together to seriously consider some mutual questions concerning the care of their reproductive and sexual organs. It all came about because each of us seemed to be getting the same kind of no help from our physicians. So we decided to just rap, share experiences, and maybe as a group seek out some answers on our own. Our results were so mind blowing that we want to share them with our sisters in hopes of encouraging others to do the same. Some of the problems we first attacked were: how can I recognize vaginal infections early, before they become so advanced that I have to visit a physician and probably wind up on antibiotics$$$. Can I see early infections, especially yeast (Monilia) effectively and inexpensively? How do I recognize yeast? What does syphillis look like, and can I recognize gonorrhea -- in spite of what the physicians say? Are there marked changes on the cervix of my uterus during my 28-30 day menstrual cycle? If so, does the cervix also show change due to pregnancy, and if so how soon can I see the change? We realized early in our rap sessions that being able to recognize very early pregnancy would be a great asset if we were to decide to terminate the pregnancy. Each of us at one time or another had been told by a physician that chemical test for pregnancy wasn't foolproof. We would really have to wait for at least the 4th and 5th week after the missed period to know for sure. Too long, we all decided!

Another point in which we were all up-tight about was the present methods of health care for women. For instance: I've got an itch. So I've gotta call the doctor. When I call, the receptionist asks, "What's wrong?" and proceeds to make an appointment from one to two weeks hence. So I wait. Take sitz baths, douches, and so sex. Sometimes the waiting alone helps, usually not. Often the bladder becomes infected while waiting for the appointment interval to pass. Finally I get to see the physician and his comment on examining me, draped in a sheet so that I couldn't even if I wanted to, -- "Usual female infection, take the antibiotic prescription and come back in two weeks."$$$ When I ask him if I can see what the infection looks like, the physician is appalled at the idea. "You shouldn't worry your little head about this kind of thing. After all, isn't that what I'm here for?" So I return in 2 weeks$$$, and maybe it's cleared and maybe it isn't. Another kind of antibiotic is prescribed and another appointment is made$$$. I again ask for specific information about the infection and by now the answer usually comes in Greek (which I am obviously not very fluent in.)

With pregnancy it's pretty much the same thing. See him, wait, and come back. $$$ I know that the longer I wait the more difficult it will be on my body to terminate the pregnancy. In addition, different states' laws offer time limiting restrictions.

So the women got together. We rapped about our common medical encounters. Then we made a discovery on that very first meeting. In order to better understand what we were talking about we had to look. So we encountered our first, last and only hangup in the entire rap/self-help clinic. And we did it with the help of 5% courage and 95% curiosity. Up on the table each of us went. Some of us were a little shy going up, all of us thoroughly with it by the time we got down. All of us were learning about our sexual organs and realizing that we were not only sharing our answers but were learning things about the cervix that was a gold mine of information. No wonder physicians have been reluctant to share the information$$$. We realized that there was a great deal that we could do for ourselves in personal health care, long before it becomes to see a physician, and all because we learned a very simple self-examination procedure. We were able to purchase plastic speculums (one for each woman). The speculum opens the vaginal cavity to allow examination of the vaginal walls and the cervix.

With the use of a lamp and mirror, it became quite simple to examine ourselves for irritations, infections, discharges, changes on the cervix. Since the cervix has essentially no pain nerve endings, we realized that it was quite easy to have an infection developing without giving any signs. Not until a heavy discharge has reached the vulva (outer lips) or burning and itching is taking place, do we realize what's going on. But by then it is too late to do anything but go through the ritual of visiting a physician at this convenience$$$. We also recognized that there are differences in the cervix, depending on the size of the woman, numbers of children, etc. We were able to easily recognize problems early so as to seek medical help quickly, before the problem becomes a major disease. Results of our self-help clinic were so obvious that some of us are now taking methods and going into neighboring communities to form new self-help clinics. Everywhere we go we are finding the same responses: "Wow! No wonder the physicians haven't wanted us to know our bodies." $$$ "Now I understand how the diaphragm works!" "It's like looking into your own mouth!"

We feel another important aspect of this clinic is to talk about the political implications of women being able to control their own bodies; Giving abortion referrals, becoming fully aware of the great need for abolishing all laws that restrict and control women. We believe that getting to know yourself can save your life. Women are killing themselves with panic abortive methods, because our laws refuse them proper care. In spite of our restrictive laws, getting to know our own bodies and what we can do for them has opened up far better choices of personal care. We are continuing to live under outrageous laws and barbaric medical practices. We believe that in learning to accept the care and knowledge of our own physical selves, we will be well on the road to self determination.

Some of the finding that came of our original self-help clinic and on which we were then able to take positive action were: 1) A woman who is exposed to the risk of pregnancy, by examining herself once a week, and becoming thoroughly familiar with her own cervix, can within one week after missing her period, recognize that she is pregnant. She need not depend on chemical tests. 2) Gonorrhea is still difficult but when uterine discharges occur, we catch them early and can take positive early action. 3) Yeast infections can be recognized easily, and treated inexpensively and in many cases with positive results within 24 hours without prescription. You need not be a highly skilled clinician to learn to recognize by name the most common vaginal infections. By being able to recognize early infections we have taken control of our right to choices of treatment. Including the choice of ultimate self determination which is also called "doing the job myself."

In starting a self-help clinic we can make some suggestions. We have no leader, no formal structure. We use some of the consciousness-raising techniques during our discussions. Although physical experience is essential, rapping about sex, reproduction and physiology especially when you don't know what you are talking about can lead to some fancy bullshitting. That has to be dealt with right on with good factual material. In addition to standard texts, we strongly recommend the Birth Control Handbook put out by Montreal Women's Liberation. (P.O. Box 1000, Station G, Montreal 130, P.Q., Canada.) There are films available through most public and school libraries. They are informative and can be valuable for comparative purposes. After viewing a film on the present, medically approved hospital abortion method (commonly called D and C), we checked into and found a better, more humane, and safer method being developed and used. This method is not to be confused with the aspiration method used today in many hospitals and used in conjuction with D and C's. We have found a more highly refined aspiration technique that is both simple and safe.

Our rap sessions have no rules governing participation. We believe that the modesty hangups for each of us fall in their own time. And they do fall as our consciousness is being raised. Age makes little difference once we get our goals in mind. Our group has an R.N. -- which was totally unplanned. She has been able to steer us into competent references. We also have a sympathetic physician with whom we confer. But no one lectures.

About 10 people seem to be the ideal number to participate. When our group has grown to as many as 15 we spinoff into the neighboring communities.

We feel that by far the most important aspect of our self-help clinic is in its political implications that women already have the right to control their own bodies. There is nothing to fear but ignorance. Get rid of that ignorance and you are doing it!

-The West Coast Sisters