In most women, pubic hair spreads downward in a triangular pattern, pointing toward the vagina. In 10% of women, it may form an inverted triangle, pointing toward the umbilicus. This growth is usually not completed until the middle 20s or later.
Just before menarche there is a physiologic increase in vaginal secretions— a normal change that sometimes worries a girl or her mother. As menses become established, increased secretions (leukorrhea) coincide with ovulation. They also accompany sexual arousal. These normal kinds of discharges must be differentiated from those of infectious processes.
Ovarian function usually starts to diminish during a woman's 40s, and menstrual periods cease on the average between the ages of 45 and 52, sometimes earlier and sometimes later. Pubic hair becomes sparse as well as gray. As estrogen stimulation falls, the labia and the clitoris become smaller. The vagina narrows and shortens and its mucosa becomes thin, pale, and dry. The uterus and ovaries diminish in size. Once menopause has occurred, the ovaries may no longer be palpable. The suspensory ligaments of the adnexa, uterus, and bladder may also relax.
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