The menstrual cycle is central to female reproductive function. In an idealized cycle, cyclical variations in the production and concentrations of hypothalamic, pituitary, and ovarian hormones over a 28-day period lead to the release of a mature ovum at approximately midcycle and to the concurrent development of the endometrium in anticipation of fertilization. When fertilization does not occur, the endometrium is shed, menstruation ensues, and the cycle begins anew.
Menses is composed of blood that is depleted of clotting factors as well as desquamated endometrial tissue, sloughed vaginal cells, and cervico-vaginal secretions. The composition and physical properties of menses vary both temporally and among individuals because the concentration of menses constituents changes as flow progresses. Menses and blood might be expected to differ in their potential effects on vulvar skin because menses is more complex and contains endometrial metalloproteinases not present in blood. However, vulvar patch testing of blood and menses revealed minimal vulvar irritation in response to these substances when compared to patch testing on the upper arm. These findings suggest that vulvar skin may be uniquely adapted to be less sensitive to the cyclical exposure to menses that occurs during women's reproductive years.
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