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Understanding Your Body

A practical guide to women’s health

Acknowledgment Understanding Your Body - a practical guide to women’s health is an outcome of a series of outreach programs on women’s health READ Bhutan conducted in 2013. The program focused on women’s reproductive and menstrual health and awareness on common cancer. The campaign was carried out with a mission to reach out to the community women in Changjiji. Subsequently, the classes were also conducted in other READ communities. READ Bhutan would like to thank Ms. Phyllis Bergman, a nurse practitioner from the US for kindly volunteering her time to conduct classes for the community women. READ Bhutan also would like to thank Ministry of Health, Royal Government of Bhutan for all the support rendered during the Outreach Program. And finally we would like to express our heart-felt gratitude to HomeNet South Asia (HNSA) for funding the making of this important publication. We hope that this publication benefits Bhutanese women throughout the country. Thank you! READ Bhutan

Table of Contents Acknowledgment 1. Occupational Health for Women weavers a. Repetitive Stress Injuries b. Symptoms c. Prevention 2. Your Amazing Body a. Menstrual Health b. Pregnancy c. Birth Control 3. Prevention and Detection of Common Diseases in Women a. Urinary Tract Infection (UTI) b. Cervical Cancer c. Breast Cancer 4. General Health Concerns a. Hand washing b. Ring worm c. Blood Pressure d. Fever and Colds e. Diabetes f. Choking g. Alcohol Abuse


Repetitive Stress Injuries (For weavers)


epetitive strain injuries (RSI) are a family of injuries affecting tendons, tendon sheaths, muscles, nerves and joints. They cause persistent or recurring pains most commonly in the neck, shoulders, forearms, hands, wrists, elbows and lower limbs. Symptoms




Dry, shiny palm


Tingling and burning sensations


Aches and pains which may be strongest at night


Eye strain

Preventative Methods & Exercises

Eye palming: A relaxation technique for the eyes is to place your fingers crossed over your forehead and cover the eyes with your palms. Do not apply pressure to the eyeball. Just concentrate on the blackness for a while.


Eye Palming

Hand Exercises


Stretch hands



2 Body Exercises


Wall stretch

Eye massage

Rub palms

Door stretch


Change your focus


Pull back on wrist


Sideway bend and twist

2 Your Amazing Body What is the strongest muscle in the human body?

Fallopian tube


Ovary Uterus

It’s your uterus! Just think about it---what other muscle can stretch so thin and then still push a baby out of an opening only 11 cm wide? Vagina

a. Menstrual health Menstrual Cycle Most periods are from 20 to 35 days and with an average of 28 days. The most important time is when the ovary releases the egg, which occurs about 12 to 14 days BEFORE your next period. If you want to get pregnant: have sex on your fertile days. If you DON’T want to get pregnant, avoid sex or use birth control on your fertile days. Every month your body gets ready to be pregnant!

Since the beginning of the last he las st menstrual lining the walll of th the he uterus thickens again. The ovary he ova ary ripens new egg cells and thus begins a new menstrual cycle

In absence of fertilization the egg fails. The lining of the uterus wall swells and peels off as menstruation.


Bleeding Cycle


1 2







23 22

5 6

Day Menstrual Cycle





Fertility Phase


9 10

18 17

1 11 16

The wall of the Th he lilining nin ng on tthe w n uterus and ut erus tthickens hi k d is ready to accept ac ccep pt tthe fertilized egg.




12 The ovary releases egg leasess the eg gg g between 12 - 14 days BEFORE E ORE EFO your next period.

Comfort measures If you experience pain during your period, following are some methods to reduce pain: • • • •

Drinking warm beverages like tea, hot water with lemon or honey Taking warm shower, Performing exercises like waist bending and walking, Using a hot water bag or hot moist towel

Abnormal bleeding More than 7 days • Soak a big pad in 1 hour • Bleeding is in large thumb size clots • You get very tired--anemic

Treatment for heavy bleeding • Birth control pills • Eat foods rich in iron like egg yolks, beans, red meat etc.

B. Pregnancy

5. The fertilized egg starts growing and dividing into many cells.

1. The egg is released from the ovary.

2. The egg travels into the fallopian tube and stays there until single sperm fertilizes it.

3. Each ejaculation produces millions of sperm (40 to 150 million). They live for 42 to 78 hours.

4. It takes millions of sperm pushing on the egg in order to let just one in.

6. The fertilize egg attaches to the lining of the uterus, after which some cells become the placenta while others become embryo.

c. Birth control

Emergency Contraception

• Fertility awareness—no sex • Increase in clear vaginal discharge Use Condom

Take within 72 hours of unprotected sex. It is meant to be used only as an emergency method and not as a regular birth control method. Pulling Out

Birth Control Pills

This method is the least safe because men do not always know when to pull out.

IUD disrupts sperm mobility and hence prevents fertilization


Prevention and Early Detection of Common Diseases in Women

A. Urinary TracT Infection (UTI)

Female urinary system

What is Urinary Tract Infection (UTI)? A urinary tract infection (UTI) occurs when one or more parts of the urinary system (kidneys, ureters, bladder, or urethra) become infected with a pathogen (most frequently, bacteria). UTIs most commonly occur in females; about 50% of all females get a UTI during their lifetime. Many UTIs are not serious but if infection reaches the kidneys, serious illness, and even death, can occur. Infections are very common in women and girls. Men have less problem with UTI because their urethra is longer.

Symptoms • • • • •

Pain while urinating Pain in the lower back, Fever, Chills, Nausea

Common cause of UTI • • • • • •

Through sex Not enough water in the body Holding urine Diabetes Older women During pregnancy

Treatment 1. Drink LOTS of water. 2. Hygiene • Change diapers and menstrual pads often • Tell girls to pee often • Wipe front to back - after defecation, wipe from front to back • Avoid taking hot bath

b. Cervical Cancer What is Cervical Cancer? Cervical cancer is caused by the human papillomaviruses (HPVs). HPVs are a large group of viruses, about 40 of which can infect the human genital tract. Some HPVs are known to cause cervical cancers, while others cause genital warts. Most genital HPV infections go away on their own, but when they become chronic, they can cause precancerous and cancerous changes in the cells that line the uterine cervix. Cervical cancer is the highest cause of cancer death of women in Bhutan.

Symptoms At the very early stages of cervical cancer, there are usually no symptoms. As the cancer grows, symptoms can include abnormal vaginal bleeding. Abnormal vaginal bleeding is bleeding that occurs between periods, during sex, or after menopause. Pain during sex and vaginal discharge are other possible symptoms.

If you do not detect it early, it will spread. Once you are at stage 4, the cancer has spread to other parts of the body. Over 90% of cervical cancers are caused by HPV infection.

Who is at risk? • Any one who has ever had sex • Smokers Condoms may lower the risk of acquiring the infection, but they are not 100% effective.

Detection and prevention Pap smear test The Pap smear test has been a success in preventing many cases of cervical cancer because it is able to detect abnormal cells before they turn into cancer cells. During the pap test, a swab is taken of the cervix that is then examined for abnormal cells. Women should have a Pap test every 3 years starting at age 21. HPV vaccine

HPV vaccine is provided to prevent HPV virus, which causes cervical cancer. The most effective time for girls to get vaccinated is between the ages of 12 to 26. If a female is pregnant she cannot be vaccinated. HPV vaccine is given in three doses. The second dose is given 2 months after the first dose. The final dose is provided 4 months after the second. Even if you have received the HPV vaccine, you still need Pap smear tests, because the vaccine does not protect against all the types of HPV that can cause cancer.


1. Surgery is often the main treatment for women with early stage cancer of the cervix. 2. Chemotherapy is used to treat cancer that has spread to the distant part of the body.

c. Breast Cancer

Lump Skin Changes

Pulled in Nipple Redness / Rash


Breast cancer may or may not show symptoms. Some women may discover the problem themselves, while others may have the abnormality first detected on a screening exam.


Biopsy can be done at the hospital in Thimphu.

How to examine your breast?

• Look at your breast in your mirror with shoulders straight and arms on your hips. • Raise your arms and look for the changes. • Look for any signs of fluids coming out of nipples. • Feel your breast while lying down or sitting or standing.

When to do a breast exam?

You should do it after a period is over. Do not do it before periods as the breast are often lumpy.

Who gets breast cancer?

• 100 times more in women than men

• Women over 55 years of age and with a close relative that also has breast cancer • 80% have no relative with breast cancer


• Lumpectomy - surgery to remove tumor and small portion of normal tissues around it. • Partial mastectomy - surgery to remove the parts of the breast that has cancer and some tissues around it. • Total mastectomy - surgery to remove the whole breast that has cancer.

4 General Health Concerns A. Hand washing What is the single most important thing you do to prevent getting a communicable disease?

It is important to wash your hands!

B. Ringworm Ringworm is caused by a fungus not a worm. It is called tinea. The most common places are on body, scalp, feet, groin.

Ringworm of the face (tinea faciei)

Ringworm of the hand (tinea manus) Ringworm of the nail (tinea unguium)

Ringworm of the scalp (tinea capitis) Ringworm of the beard (tinea barbae)

Ringworm of the body (tinea corporis)

Ringworm of the groin (tinea cruris)

Ringworm of the foot (tinea pedis)

The round spots of ringworm spread and get bigger over time. Children are more susceptible than adults.

The most common place - also called athletes foot. It is scaly, itchy and sometimes can cause blisters.

Also in the folds of skin in the groin where it is damp and warm.

On the hands—usually only one hand. It causes thickening and scaling.

On the face, it is not ring shaped but rather scaly and red with indistinct edges.

Ringworm commonly infection the toenails. The nails are thick yellow and brittle. Artificial nails promote this infection as the fungus grows beneath the nails.

How do you get ringworm?

Ringworm is highly contagious and can be spread multiple ways:a. From an infected person b. From Animals

Treatment Use anti-fungal cream. You can get this in many pharmacies and BHUs.

Don’t share clothing, sports gear, towels, or sheets. Shower and shampoo well after any sport that includes skin-to-skin contact.

Wear slippers or sandals in public pool and bathing areas.

Wash your undergarments and don’t lend them to anyone.

Wear loose-fitting cotton clothing. Change your socks and underwear at least once a day.

c. Blood Pressure High Blood Pressure

Hypertension may not produce any symptoms, even if you have had it for years. That’s why it is sometimes referred to as a “silent killer.” If not properly treated, high blood pressure can damage the heart and circulation, lungs, brain, and kidneys.

Normal 110 75

Lifestyle changes can help many people with prehypertension to lower their blood pressure.

The heart has to work harder to pump up the blood through the vessel below.

The only way you know you have high blood pressure is to have it checked.

Warning 130 85

High blood pressure makes you at higher risk for stroke and heart attacks.

Danger 140 90

Blood pressure is given as a reading of two numbers, such as 110/70. The higher number (systolic) is the pressure when the heart beats. The diastolic, or lower number shows the pressure between the heartbeats, while the heart is refilling with blood.

Who gets high blood pressure? • • • •

Family has it Overweight History of diabetes Older people

High blood pressure during pregnancy can cause death of mother or baby. Lose weight before pregnancy.

Sodium, a chemical found in salt, raises blood pressure by promoting the retention of fluid by the body.

Stress and worry cause only temporary rise in blood pressure but stressed people tend to eat poorer and high salted diets and they often increase smoking and alcohol.

Some medicines---cold and flu, some pain pills will increase your blood pressure.

Being overweight will in crease your blood pressure.


• Good and healthy diet • Exercise • Medication Alcohol increases blood pressure.

Fruits vegetables and low fat dairy

Lose weight—even as little as 5 kg. Avoid second helpings!

D. Fever and Colds

Colds are caused by viral infections. Viruses that cause colds are spread from person to person through tiny droplets of mucus that enter the air from the nasal passages of infected persons and are inhaled by others.


One teaspoon of salt a day! Use other spices instead.

While it is impossible to completely prevent the spread of colds, there are steps you can take to reduce your and your family’s chances of becoming infected with a virus that causes colds.

Doing housework is not enough exercise. Yoga is good , too. Stretch, but not to the point of pain.

Most importantly, avoid touching the nose, mouth, and eye areas if you are around someone with a cold or have been touching surfaces in a public area.

Wash toys

Inhaling the steam relieves congestion.

Throw away used tissues.

Salt water gargle will bring more blood to your throat and help you reduce the pain.

Home treatments

Vitamin C will help to reduce how long the cold lasts. Drink hot tea.

Get plenty of rest!

E. Diabetes There are two types of diabetes.

• Bacterial infections • Fungal infections Girls with type 1 diabetes are more likely to get genital yeast infections. Babies can develop candidiasis, a severe form of diaper rash caused by yeast that can easily spread from the diaper area to the thighs and stomach.

Type 1 In people with type 1 diabetes, the pancreas cannot make insulin. Insulin helps the body’s cells convert sugar into energy. Without it, sugar builds up in the blood and can reach dangerous levels.

The symptom of type 1 diabetes may include: • • • • •

Feeling more thirsty than usual Dry mouth Fruity breath Frequent urination Weight Loss

As blood sugar levels remain high, type 1 diabetes often leads to: • Unintentional weight loss • Increase in appetite • Lack of energy

More Dangerous Signs When blood sugars are not controlled, type 1 diabetes can cause more serious symptoms, such as: • • • •

Numbness or tingling in the feet Blurred vision Low blood sugar Loss of consciousness

What causes diabetes?

Skin Problems Many people with type 1 diabetes experience uncomfortable skin conditions, including:

• • • •

In your family Virus Diet Pregnancy

Type 1 is treated with insulin

Thirst Headaches

Long-Term Complications Prolonged high blood sugar can damage many of the body’s systems over time. People with type 1 diabetes have a higher risk of: • Heart disease and stroke • Kidney failure • Vision problems and blindness

Increased time for cuts to heal. More skin and urinary track infections. Sexual dysfunction in men and vaginal dryness in women.

Long-Term Damage to Arteries • Gum disease and tooth loss • Nerve damage in the hands, feet, and organs

People with diabetes are also at an increased risk of stroke.

Type 2 Diabetes In type 2 diabetes, the body’s cells cannot take up glucose properly, leading to high levels of glucose in the blood. Symptoms similar to Type 1 diabetes.

Prevention • Change your diet • Exercise • Consume less sugar, fat, and more green vegetables • Avoid alcohol


Child over one year

This is the universal sign of choking. IF person can speak or cough, do not do anything! Often the cough will dislodge the food.

Or bend down on your knees to be at child’s level.

Use a J type thrust. Continue thrusts until the object is dislodged or the person loses consciousness.

Not so hard as to life the child off his feet. Repeat until it is dislodged.

Infant choking • Do NOT finger sweep mouth • Turn baby over and thump on back Sweeping into the mouth may push the food further into the throat. Try to keep small objects away from a baby.

G. Alcohol Abuse

Alcohol affects your red blood cells. This condition, known as anemia, can trigger a host of symptoms, including fatigue, shortness of breath, and lightheadedness.

WHY Alcohol abuse?

l Genes l Drug use l Social environment l Childhood Trauma l Mental Illness Find other ways to deal with stress.

Addiction Cancer

l MORE l MORE § MORE 1. Tolerance---you need more and more 2. You need more to get to the previous levels of intoxication

Scientists believe the increased risk comes when the body converts alcohol into acetaldehyde, a potent carcinogen. Cancer sites linked to alcohol use include the mouth, pharynx (throat), larynx (voice box), esophagus, liver, breast, and colorectal region.

3. Effects decrease if using the same amount.

Withdrawal symptoms § Don’t want to give up! § You feel anxious, upset if you think you will have to give up. § You may headaches.



MED Dr. Dendup S. Med. Specilist Bhutan 0021458752


Bye bye control § You end up drinking more than you intended—”just one more” § You drink for longer than intended---”just one more—I’ll leave after that.”

Heart disease Heavy drinking causes blood clots, which can lead to heart attack or stroke.

Liver Your liver gets scarred and cannot function. Women develop this quicker than men.

Brain sickness

Your brain shrinks. You cannot make judgments, solve problems or plan anything.


Your brain goes crazy. If you already have epilepsy, alcohol will make it worse.


Gout is caused by the formation of uric-acid crystals in the joints. Although some cases are hereditary, alcohol and other diets aggravate the condition.


Drinking causes depression.

High Blood Pressure

Alcohol increases your blood pressure.

Warning 140 90


Heavy drinking increases your risk in getting a Sexually Transmitted Disease.

Stomach distress

Alcohol causes distress on the stomach, abdominal pain and diarrhea.

People who drink may make bad decisions on who they have sex with.

Nerve Damage

Alcohol is bad for nerve cells.

Human dignity dissolves in a alcohol!

How can you stop drinking? § Be committed § Decide on a start date § Get rid of temptations § Tell your friends and family § Avoid bad influences § Eat more or drink water between drinks

Understanding Your Body  

...a practical guide to women's guide by READ Bhutan

Understanding Your Body  

...a practical guide to women's guide by READ Bhutan