Vagina. A word that conjures a myriad of images, thoughts, and feelings. Linguistically, the word is just a medical term for part of a woman’s reproductive system. The term originates from the same Latin word meaning sheath or scabbard. It was coined most likely in the late 1600’s by men of medicine, borrowing from existing language. While somewhat lacking in originality it is not difficult to understand their choice of available words. Interestingly, the word penis comes from the same Latin word meaning tail. This would seem an odd choice for men to have made given the idiom “tail between one’s legs” which refers to behavior in dogs expressing fear and submission. If women had been allowed to decide on terminology for their vagina, perhaps they would have considered something like via or iter, the Latin words for road and path. The number of things that go in and come out of a woman’s vagina during her lifetime is really quite staggering. Given it is not a primary orifice for elimination of waste products from the body it gets a lot of traffic. By the time a woman reaches midlife she has most likely spent significant time with her feet in the stirrups.
Here we are several centuries after that unfortunate naming and the male perspective of the vagina as primarily a source of sexual gratification is alive and well. While a woman’s vagina serves that purpose for a man, it is not the case for a majority of women. Rates vary depending on the study, but many women are unable to achieve orgasm through intercourse alone and require some level of clitoral stimulation to climax. While this information is certainly not new it has failed to have a major impact on the sexual practices of heterosexual couples to increase a woman’s enjoyment of love making. Too often women are socialized to refrain from talking about their bodies, about sex, or asking for what they want.
Why have these archaic views of women’s sexuality continued? If the female body, including sexuality and reproductive health remain mysterious it is only because the male dominated medical establishment and scientific research community have not deemed it important enough to explore. Despite the fact that women have been on the planet as long as men, the state of knowledge about women’s health and our sexual and reproductive health in particular lags vastly behind. Women continue to be under-represented in all areas of health research. As mentioned in my prior posts, the current administration has implemented policies that will negatively affect women’s reproductive health in this country and worldwide. These policies, in conjunction with recent cuts in programs, personnel, and research funding at the Centers for Disease Control and Prevention (CDC), will dramatically reduce research on women’s health, including reproductive and sexual health.
The study of women’s reproductive health is limited by a lack of knowledge about basic physiology of the uterus and menstruation. (Critchley et al., 2020) Views and messages about menstruation have not changed significantly over time with men and many women seeing it as a messy source of distress and discomfort. An interesting survey regarding women’s views on menstruation was conducted globally in 2016 by the women’s health app Clue in conjunction with the International Women’s Health Coalition. Responses were received from 90,000 women representing 190 countries. Who knew there were over 5,000 euphemisms for menstruation worldwide! In this country most people are familiar with terms like aunt flo, on the rag, that time of the month, and riding the crimson wave. The majority of survey respondents, regardless of their country of origin, reported discomfort discussing their menstrual cycle with others. (Itkowitz, 2016) In some cultures, women are forced to live separately during their menstrual cycle because they are considered unclean. In other cultures, menarche, the first menstrual cycle, is celebrated as a girl’s transition into womanhood. This monthly flow of blood is part of the cycle of fertility, the ability to create life. It should be revered and celebrated, not shunned and disparaged.
Throughout a woman’s life hormone levels change. From pre-puberty, through puberty, pregnancy, post-partum, perimenopause, menopause, to post-menopause the hormonal stew thickens and thins based on many internal and external catalysts. Too often, when a woman displays behavior that others disapprove of, this behavior becomes a manifestation of “being hormonal”. In August of 2015, after his first debate, Donald Trump said moderator Megyn Fox had “blood coming out of her eyes, blood coming out of her wherever”. (Yan, 2015) Donald Trump’s Blood Comment He made this statement in response to Fox asking him difficult questions during the debate especially related to his history of demeaning comments directed at women. His statement, and defense of it, was met with outrage from liberals and conservatives and deemed extremely inappropriate. This very public blaming of Fox’s difficult questions on her menstrual cycle is inexcusable but sadly it happens frequently in everyday life. Statements like “she must be on the rag” or “it must be that time of the month” are made about women in response to behavior that bothers others. These statements are not just made by men, but many women make the same statements about each other.
Why are women’s genuine emotions and reasonable actions so frequently blamed on hormones? Part of this is due to long established cultural beliefs and patterns of behavior and part is due to lack of knowledge. A woman’s uterus remains mysterious to many men and women who may not give much thought to what is happening “down there” other than acknowledging menstruation and pregnancy as normal events in the course of a woman’s life. Given what is known, let us briefly examine more closely the hormonal journey of a woman’s life.
While every woman’s path through puberty is unique, hormonal changes begin approximately a year before a girl’s first menstrual cycle. The brain, adrenal glands (situated atop the kidneys), and ovaries stimulate changes in the level of close to a dozen different hormones, leading to breast development, growth of pubic hair, a growth spurt, and menarche. While it varies considerably, the average age of menarche is 12. (Guarneri & Kamboj, 2019) These physical changes can be distressing with the growth of breasts and spread of hips causing embarrassment, sometimes leading to a very familiar pulled in posture, a subconscious attempt to cover up. Early and late pubertal development can also be sources of stress because at that age we all want to fit in and being different can be socially disastrous.
Once a girl reaches menarche the uterus begins its monthly cycling. The endometrium is the lining of the uterus. I realize most women never think about their endometrium but this tissue has some remarkable properties. Here is a very simplified version of what happens during menstruation. Estradiol (one form of estrogen) causes an increase in vascular and endometrial tissue priming it for implantation of a fertilized ovum. At the same time, a different hormonal cascade including follicular stimulating hormone (FSH) prepares the ovary to mature and release an ovum into the fallopian tube so it can travel to the primed uterus. Progesterone enters the mix as a necessary hormone to establish and maintain a pregnancy. If there is no implantation of a zygote (fertilized ovum) the progesterone triggers the uterus to shed the endometrium resulting in menstruation. This process is miraculous enough on its own but then the endometrium quickly regenerates itself in preparation for the next cycle. (Critchley et el., 2020) It is one of the many wonders of a woman’s body.
There are a number of things that can interrupt this monthly process. Contraceptives including pills, injections, implants, and Intrauterine Devices (IUDs) can stop menstruation. Poor nutritional status and low body weight can disrupt menstruation as can changes in circadian rhythm such as working night shifts or chronic sleep disruption. Emotional stress and trauma can alter the menstrual cycle. Diseases of the endocrine and reproductive system can also interfere with menstruation leading to difficulty getting pregnant. Did you know that is some situations, women living in close proximity over time can experience synchronization of their menstrual cycles? While the exact mechanism responsible for this is undetermined, I find this connection fascinating. Regardless of their beliefs or state of emotional connection, this biological solidarity occurs. It would be so amazing if we could learn from our bodies and allow this synchronization to spread to an emotional connection, embracing our shared roles and experiences as women.
During pregnancy a woman’s body undergoes tremendous change, affecting multiple systems. Hormone levels increase with estrogen peaking at a level 100 times greater than pre-pregnancy. (Jee & Sawal, 2024). After birth there is a dramatic shift in hormones as a woman’s body creates a new post-partum baseline. As a woman ages, her ovaries become less functional, leading to fluctuations in hormones that cause symptoms like hot flashes and changes in menstrual patterns, sleep, vaginal tissue, sexual function, mood, and cognition. The timing of this is quite variable in terms of both onset and duration. Menopause is reached approximately one year after cessation of menses. (Delamater & Santoro, 2018) Diagnosis and treatment of perimenopausal and menopausal symptoms is in definite need of ongoing research. There are current therapies that can be helpful in targeting these symptoms and improving quality of life but once again, because this is specific to women’s reproductive and sexual health funding and interest have limited high quality research.
While men do not experience monthly fluctuations in hormones the way women do, their hormone levels do change. It is important to remember that the hormonal differences between men and women are not just about estrogen and testosterone. There are over 50 hormones produced in the human body and there are no hormones that are exclusive to either men or women. That’s right, women produce testosterone and men produce estrogen, although the levels and function are very different.
Do hormones affect mood? Yes but, and this is a huge but, there are a multitude of other factors that also influence mood in men and women. Lack of sleep, poor nutrition including low blood sugar from not eating often enough, physical illness, mental illness, and substance use can cause changes in mood. Any one of these by themselves is enough to disturb mood briefly but in combination they can lead to chronic mood changes. It is also important to remember that events happening in our day-to-day environment can also affect how we feel and this is not necessarily a “bad” thing. When a woman expresses strong emotions, anger in particular, it is often blamed on “being hormonal”. Emotions themselves are not good or bad, they just are. Anger is one of many emotions everyone experiences. It gets a bad rap. What is problematic is not what a person is actually feeling, but how that person responds to the emotion.
Let us consider an example of managing anger in a specific situation to illustrate this. Imagine you are driving on the freeway with the flow of traffic at the posted speed limit of 60 miles per hour. Seemingly out of nowhere, another vehicle cuts in front of you too closely causing you to brake quickly. Fortunately, the vehicle behind you is leaving enough space that they do not rear-end you at high speed. This event triggers your fight or flight response filling your body with adrenaline and briefly causing fear about what might have just happened. This fear quickly turns to anger over the reckless behavior of the other driver who is endangering lives. What has just happened in your body and your mind are perfectly reasonable responses to this event and not within your control. What happens next is definitely within your control as you make conscious choices about how to respond to this incident. You have many options available including, but not limited to: verbalizing your thoughts about the action which may include the use of expletives; taking a few deep breaths; cranking up your tunes; practicing calming self-talk; moving into a different lane; expressing your dissatisfaction with hand gestures; honking your horn to show your outrage; tail-gating the vehicle if it is still in front of you; chasing the vehicle if it has moved on; using your car as a weapon; or retrieving the gun you keep in the glove box and using it to exact revenge. As you can see, the emotion itself is not the problem, it is the conscious behavior choices that follow that can lead to negative consequences. We have done a poor job as a society in teaching people how to manage their emotions in ways that are not harmful to themselves or others.
Now that we have examined the role of hormones in a woman’s body, the multitude of factors that affect mood, and the concept of conscious choices in managing emotions, let us revisit women being “hormonal”. While there is some debate about the origins of hysteria, the word has been in the world for a very long time, perhaps as many as several thousand years. In much of the literature Hippocrates is credited with coining the term used at that time to describe any behavior in women that did not occur in and was confusing to men. Seizure-like behavior and any extremes of emotion fell into this category. While swooning was also closely associated with hysteria, I personally think this was more related to the tightness of corsets restricting respiration and leading to lower oxygen levels. These behaviors were thought to be a result of a suffocation of the uterus, a drying up of the organ due to lack of intercourse, allowing it to become lighter and move throughout the body contacting other organs and systems that caused these unusual symptoms. The cure for this of course, was to have sex with a man which would bring the uterus back where it belonged. In some way, this belief still exists. Have you ever heard someone say “she just needs to get laid” in response to a woman’s behavior that someone does not like? (Paulon, 2022; Madva et al., 2019)
In the Middle Ages hysteria was more likely to be attributed to witchcraft rather than a wandering uterus and of course the cure for that was being burned at the stake. In the 19th Century the disease would be reframed as a personality disorder and in the 20th Century Freud developed psychoanalysis as a treatment method focusing on reintegration through revelation and expression of inner thoughts and repressed impulses which in hysteria were thought to be erotic in nature. Today the symptoms typically associated with hysteria fit most closely with a psychiatric diagnosis called Functional Neurological Disorder, formerly Conversion Disorder for which the treatment of choice is cognitive behavioral therapy. While no longer a diagnostic medical term, sadly the word hysteria is alive and well in the English language. (Paulon, 2022; Madva et al., 2019)
This brings us back to where we started, with language. Despite the evolution of human beings and some progress in women’s rights, why are there still so many derogatory slang words for women, seemingly many more than for men? These words range from labels of behavior like slut, whore, and hag, comparison to animals like cow, dog, pig, and bitch, to body parts like cunt. While there are certainly derogatory slang words directed at men, many of them are terms used to demean women, thereby insulting a man by comparing him to a woman or degrading his mother. These include terms like cunt, pussy, son of a bitch, and motherfucker. Men and women are labeled very differently when engaging in the exact same behaviors. When a man is confident, decisive, and unapologetic he is described as ambitious and a strong leader but when a woman displays the same behavior, she is just a bitch. When a man dresses in a way that calls attention to his physique he is described as a stud or a hunk and when a woman dresses the same way she is just a slut or a whore. Blaming women’s behavior and emotions exclusively on hormones and degrading women because of these hormonal differences is damaging in many ways. In addition to being inaccurate it is demeaning, devaluing, and shaming. It prevents women from being taken seriously, being heard, being respected, and getting their personal, social, professional, and medical needs met. As we have seen, this is a very entrenched pattern in the history of human beings. It needs to stop.
Photo by Kathy Kroening. Moclips, WA. June 2021
How do we turn the tide of degradation and shaming of women, women’s bodies, women’s emotions, and women’s experiences? We can start by providing girls and women with accurate information about their bodies. We can be gentle with ourselves and others. Individually we can work towards appreciation of our own bodies, celebrating both the inside and the outside. We can extend this appreciation and celebration to other women without judging, comparing, or competing. We can be thoughtful about our own use of language and refrain from terminology that is offensive and degrading. We can model the type of respect we would like all women to receive. The most stunning sunsets are created by turbulent weather, wind blowing particulates into clouds reflecting light onto moving waves and sand. Let us celebrate the beautiful complexity of being hormonal.
Until next time sisters stay safe, be well, be kind to yourself, support each other, and spread the love.
Photo by Kathy Kroening. Seattle, WA. May 2025
References:
Critchley, H., Babayev, E., Bulun, S., Clark, S., Garcia-Grau, I., Gregersen, P., Kilcoyne, A., Kim, J., Lavender, M., Marsh, E., Matteson, K., Maybin, J., Metz, C., Moreno, I., Silk, K., Sommer, M., Simon, C., Taryial, R., Taylor, H., Wagner, G., & Griffith, L. (2020). Menstruation: Science and Society. American Journal of Obstetrics and Gynecology, 223(5), 624-664. https://pmc.ncbi.nlm.nih.gov/articles/PMC7661839/
Critchley, H., Maybin, J., Armstrong, G., & Williams, A. (2020). Physiology of the Endometrium and Regulation of Menstruation. Physiological Reviews, 100(3), 945-1414. https://journals.physiology.org/doi/full/10.1152/physrev.00031.2019
Delamater, L. & Santoro, N. (2018). Management of the Perimenopause. Clinical Obstetrics and Gynecology 61(3), 419-432. https://pmc.ncbi.nlm.nih.gov/articles/PMC6082400/#:~:text=In%20the%20SWAN%20cohort%2C%20prevalence,very%20upsetting%20life%20events44.
Guarneri, A. & Kamboj, M. (2019) Physiology of Pubertal Development in Females. Pediatric Medicine, 2(42). https://pm.amegroups.org/article/view/4978/html
Itkowitz, K. (2016) Many Women Still Can’t Talk Openly About Their Periods – This App is Trying to Change That. The Washington Post. https://www.washingtonpost.com/news/inspired-life/wp/2016/02/28/is-aunt-flo-visiting-so-many-women-still-cant-talk-about-their-periods-openly/
Jee, S. & Sawal, A. (2024). Physiologic Change in Pregnant Women Due to Hormonal Changes. Cureus, 16(3). https://pmc.ncbi.nlm.nih.gov/articles/PMC10993087/#:~:text=The%20levels%20of%20progesterone%20and,is%20described%20in%20Table%202.
Madva, E., Ross, D., & Cooper, J. (2019). What’s All the Hysteria About? A Modern Perspective on Functional Neurological Disorders. Biological Psychiatry, 85(2). https://pmc.ncbi.nlm.nih.gov/articles/PMC6444349/
Paulon, M. (2022). Hysteria: Rise and Fall of a Baffling Disease. A Review on History of Ideas in Medicine. Journal of Psychopathology, 28:152-161. https://old.jpsychopathol.it/wp-content/uploads/2022/11/06_Paulon-2.pdf
Siddiqui, N., Chinchole, S., Khan, S., Bose, S., & Mishra, P. (2023). Study of Menstrual Cycle Synchrony in Female Medical Students Sharing Common Accommodation. Journal of Family Medicine and Primary Care, 12(11), 2922-2926. https://pmc.ncbi.nlm.nih.gov/articles/PMC10771221/
Wang, Z., Asokan, G., Onnela, J-P., Baird, D., Jukic, A.M., Wilcox, A., Curry, C., Fischer-Colbrie, T., Williams, M., Hauser, R., Coull, B., & Mahalingaiah, S. (2024). Menarche and Time to Cycle Regularity Among Individuals Born Between 1950 and2005 in the US. Journal of the American Medical Association Network Open, 7(5). https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2819141
Yan, H. (2015). Donald Trump’s Blood Comment About Megyn Kelly Draws Outrage. CNN Politics. https://www.cnn.com/2015/08/08/politics/donald-trump-cnn-megyn-kelly-comment
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