Our Bodies, Ourselves (5 page)
Read Our Bodies, Ourselves Online
Authors: Boston Women's Health Book Collective
Look at your breasts in the mirror or feel them. Like fingerprints, no two breasts are alike, and there is no “perfect” pair. Breasts come in all sizes and shapes: large, small, firm, saggy, lumpy. Your breasts may be slightly different from each other in size or shape. Nipples may lie flat, stick out, or retract (be inverted). The areola (the area surrounding the nipple) may be large or small, darker or lighter, and it usually has little bumps just under the skin. These bumps are the sebaceous glands, which secrete a lubricant that protects the nipple during breastfeeding. Sometimes there are hairs near the edge of the areola. Some women have one breast noticeably bigger than the other. Breast size is not related to the sexual responsiveness of the breast or to the amount of milk you produce after giving birth; small-breasted women are able to breastfeed just fine. Weight gain and loss also affect breast size.
Breasts usually become droopier over the years as skin becomes less elastic and milk glands get smaller. This happens even faster after childbirth (when breastfeeding is completed) and again after menopause, when the milk glands are no longer stimulated to grow.
DISORDERS OF SEXUAL DEVELOPMENT
Disorders of sexual development (or DSDs) are conditions in which a person is born with sex chromosomes, external genitals, or an internal reproductive system that is not clearly male or female. The clitoris may be larger than usual, or the vagina may be small, lack an external opening, or be absent altogether. DSDs are not always visible by looking at the outside genitals; for example, a person may be born with external female genitals but with male chromosomes and internal testes (male reproductive glands) rather than ovaries.
For many years, the term “intersex” has been used by and about people born with genital or reproductive anatomy that is not clearly or exclusively male or female. Recently, concerns about the stigma sometimes associated with the term “intersex,” along with advances in treatment and diagnosis, have led to the use of the term “disorders of sexual development” in its place.
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When DSDs are detected in infants, most are surgically assigned a female or male sex at birth, and many discover that their internal organs are different only when they reach puberty. They may not mature physically in the way a typical girl or boy would at that age; for example, those assigned female may not menstruate.
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There is also some controversy over the choice of “disorder” rather than “difference” or “divergence.” See, for example, Elizabeth Reis, “Divergence or Disorder? The Politics of Naming Intersex,”
Perspectives in Biology and Medicine
50 (2007): 535â43.
The traditional medical model of treatment for babies born with DSDs, developed in the 1950s, involves using surgery to alter a baby's genitals to look clearly male or female. This practice is based on the assumption that altering the genitals to look as typical as possible and keeping the condition hidden are the only way these babies (and their parents) can avoid emotional trauma and live a “normal” life.
There is growing controversy over the practice of surgically altering babies born with DSD. Often the surgeries themselves create health problems, impair sexual functioning later in life, and contribute to emotional trauma. Angela Moreno, author of the essay “In Amerika They Call Us Hermaphrodites,” describes her experience.
When I was twelve, I started to notice that my clitoris (that wonderful location of pleasure for which I had no name but to which I had grown quite attached) had grown more prominent. Exactly one month later, I was admitted to Children's Memorial Hospital in Chicago for surgery. They told me a little bit about the part where they were going to “remove my ovaries” because they suspected cancer or something like that. They didn't mention the part where they were going to slice off my clitoris. All of it. I guess the doctors assumed I was as horrified by my outsized clit as they were, and there was no need to discuss it with me. After a week's recovery in the hospital, we all went home and barely ever spoke of it again. I'm now twenty-four. I've spent the last ten years in a haze of disordered
eating and occasional depression. Four months ago, I finally got some of my medical records from Children's Memorial Hospital in Chicago. They are shocking. The surgeon who removed my clitoris summarized the outcome as “tolerated well.”
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Many people with DSDs and their advocates now believe that cosmetic genital surgery should be performed only when a child or young adult is old enough to make his or her own decisions. Organizations such as the Accord Alliance (accordalliance.org) and the Androgen Insensitivity Syndrome Support Group (aissg.org) are fighting to end the secrecy and shame around DSDs, to develop better approaches to health care, and to create support for healing emotionally from well-meaning but misguided or involuntary medical interventions.
One woman in her twenties talks about the healing this movement brought her.
At the age of eighteen, a workshop on intersex changed my life. I was finally able to get angry at the way I had been treated by doctors, about the assumptions that had been made about me and my body, and about the pressure put on me by doctors that I need to be “fixed.” I made the decision that I would keep my body as it is and have finally learned to love and enjoy my sexuality again.
I really believe that the stigma or shame that is used to justify operating on intersex people is a result of this being kept such a secret. The idea that those of us outside the “norm” must conform to the status quo is absurd! If we were all raised with the understanding that not all people are male or female, it would not be so traumatic for those of us outside of the sex binary.
Because breasts react to sex hormones produced by the ovaries, you may notice pronounced changes during the menstrual cycleâyour breasts may be bigger and fuller right before you menstruate. This fullness can produce tenderness in some women and can be felt up into the armpit in the part of the breast called the tail. During pregnancy and breastfeeding, breasts often enlarge considerably. They may also swell during sexual arousal. Your breasts may have areas of hardness or softness, different textures, and varying areas of sensitivity.
In girls, around the time the ovaries begin producing estrogen (a year or two before menstrual periods start), the breasts respond by growing. At first, a firm mass develops directly behind the nipple. This is called the bud. As puberty progresses, the ductal tissue in the bud grows out into the fatty tissue, forming branches and lobules to make up the glandular portion of the breast. The fatty and fibrous tissues that support it (stroma) also increase during puberty. Most of this growth happens early, but slower growth continues during the teen years. One breast may develop more quickly than the other, and it's not uncommon for breasts to be different sizes.
With the great increase of sex hormones during adolescence, the milk-producing glands in each breast start to develop and increase in size. During the reproductive years, breast tissue consists of the glandular breast lobules, which are
supported by connective tissue ligaments that anchor breast tissue to the skin and to the connective tissue covering the underlying muscles. Variable amounts of fat fill the spaces between the breast lobules and the supporting ligaments. After menopause, the glandular breast tissue is gradually replaced by fat. The amount of fat in the breast is determined partly by heredity. This fat causes breast size to vary.
© Casserine Toussaint
Parts of the breast
For years, experts advised women to perform monthly breast self examinations (BSEs), believing that doing so would allow women to find potentially cancerous lumps and get diagnosed and treated for breast cancer more quickly. Unfortunately, scientific studies designed to measure the efficacy of BSEs have
not
found that women who perform BSEs are any less likely to die of breast cancer than women who don't perform them. For this reason, many medical guidelines and health organizations no longer recommend monthly BSEs. However, exploring your breasts is a good way to get to know your body and become familiar with what is normal for you.
© Peggy Clark
Breast changes over a lifetime
Puberty is the transition from childhood to physical maturity. In women, puberty is characterized by growth of the breasts and pubic and armpit (axillary) hair, and a growth spurt that results in increased height and weight, followed by the end of bone growth. Menstruation starts near the end of puberty, about two years after breast development, on average at about age twelve, though any age from nine to sixteen is normal.
Menstruation continues until age fifty-one on average, but stopping anytime between forty and fifty-five is normal. Menopause technically means the time of the last period, but because periods can be irregular in the last few years, menopause can be identified only retrospectively, after a year of no bleeding. The body changes that occur between the reproductive and postreproductive phases of our livesâa period of time called perimenopauseâoften take place over as many as fifteen years.
This entire reproductive process is regulated by hormones, chemicals in the bloodstream and in the brain that relay messages from one part of the body to another. The levels of sex hormones are low during childhood, increase tremendously during the reproductive years, and then become lower and differently balanced after menopause.
During the reproductive years, monthly hormonal rhythms determine the timing of ovulation and menstruation. This cycle, the menstrual cycle, regulates our fertility, allowing for the possibility of pregnancy a few days every month. Many women experience signs of this rhythmâchanging emotions, changes in breasts, changes in sexual arousal, and even variation in foods we enjoy eating at different times over a month.
My cycle. My red friend. The curse. Aunt Flo. On the rag. Many different termsâmost commonly, my periodâare used to describe menstruation. You may have created your own slang, known only to family or friends. This section covers the wide range of experiences with, and feelings about, menstruation.
The first period may come as a surprise, and negative attitudes from friends or family can color the experience, but most of us find a way to cope and may even look back in humor.
In class, I got up to go to the bathroom. Inside, I noticed that my panties had a funny discharge on them. Then suddenly it hit me: I'd gotten my period! I was so excited and could hardly wait to tell my friends.
The beginning of menstruation is a major marker in the transition from girl to woman. The age of menarche (MEN-are-kee)âwhen a girl first begins to menstruateâvaries, depending on many factors. Some factors are biological; for instance, body fat must be about one quarter of a girl's total weight in order for her to menstruate. Diet, weight, race, environment, and family history also affect when menstruation begins.
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Women in different countries may have different average ages for entering puberty.
In the United States, the average age of girls' first period has fallen over the last century from around age sixteen to around age twelve, with some girls beginning to develop breasts as early as seven years old. The reasons girls are maturing earlier are not completely clear. Some pediatricians and other medical experts are convinced that childhood exposure to plastics, pesticides, and other environmental endocrine disruptors plays a role. (Endocrine disruptors are chemicals that often act like estrogen and interfere with genetic or hormonal signals, causing changes to the body's finely tuned hormonal system.)
Other possible causes include better nutrition than in the past, obesity, inactivity, premature birth, and formula feeding.
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A major concern about early puberty in girls is that it increases the odds of developing breast cancer later in life, since longer exposure to sex hormones is a risk factor for breast cancer. Once a girl starts to menstruate, her estrogen levels rise and don't drop off until menopause. All other factors being equal, the more years a woman menstruates, the more years she is exposed to higher levels of estrogen, and the higher her risk of breast cancer.