Cervical Health

1- Picture of the Cervix
2- Cervicitis
3- What Are Cervical Polyps?

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1- Picture of the Cervix

Picture of the Cervix

The cervix is a cylinder-shaped neck of tissue that connects the vagina and uterus. Located at the lowermost portion of the uterus, the cervix is composed primarily of fibromuscular tissue. There are two main portions of the cervix:

• The part of the cervix that can be seen from inside the vagina during a gynecologic examination is known as the ectocervix. An opening in the center of the ectocervix, known as the external os, opens to allow passage between the uterus and vagina.
• The endocervix, or endocervical canal, is a tunnel through the cervix, from the external os into the uterus. 

The overlapping border between the endocervix and ectocervix is called the transformation zone.

The cervix produces cervical mucus that changes in consistency during the menstrual cycle to prevent or promote pregnancy.

During childbirth, the cervix dilates widely to allow the baby to pass through. During menstruation, the cervix opens a small amount to permit passage of menstrual flow.

Cervix Conditions

• Cervical cancer: Most cervical cancer is caused by infection by the human papillomavirus (HPV). Regular Pap tests can prevent cervical cancer in most women.
• Cervical incompetence: Early opening, or dilation, of the cervix during pregnancy that can lead to premature delivery. Previous procedures on the cervix are often responsible.
• Cervicitis: Inflammation of the cervix, usually caused by infection. Chlamydia, gonorrhea, and herpes are some of the sexually transmitted infections that can cause cervicitis.
• Cervical dysplasia: Abnormal cells in the cervix that can become cervical cancer. Cervical dysplasia is frequently discovered on Pap test.
• Cervical intraepithelial neoplasia (CIN): Another name for cervical dysplasia.
• Cervix polyps: Small growths on the part of the cervix where it connects to the vagina. Polyps are painless and usually harmless, but they can cause vaginal bleeding.
• Pelvic inflammatory disease (PID): Infection of the cervix, known as cervicitis, may spread into the uterus and fallopian tubes. Pelvic inflammatory disease can damage a woman's reproductive organs and make it more difficult for her to become pregnant.
• Human papillomavirus (HPV) infection: Human papillomaviruses are a group of viruses, including certain types that cause cervical cancer. Less dangerous types of the virus cause genital and cervical warts.

Cervix Tests

• Pap test: A sample of cells is taken from a woman's cervix and examined for signs of changes. Pap tests may detect cervical dysplasia or cervical cancer.
• Cervical biopsy: A health care provider takes a sample of tissue, or biopsy, from the cervix to check for cervical cancer or other conditions. Cervical biopsy is often done during colposcopy.
• Colposcopy: A follow-up test for an abnormal Pap test. A gynecologist views the cervix with a magnifying glass, known as a colposcope, and may take a biopsy of any areas that do not look healthy.
• Cone biopsy: A cervical biopsy in which a cone-shaped wedge of tissue is removed from the cervix and examined under a microscope. Cone biopsy is performed after an abnormal Pap test, both to identify and to remove dangerous cells in the cervix.
• Computed tomography (CT scan): A CT scanner takes multiple X-rays, and a computer creates detailed images of the cervix and other structures in the abdomen and pelvis. CT scanning is often used to determine whether cervical cancer has spread, and if so, how far.
• Magnetic resonance imaging (MRI scan): An MRI scanner uses a high-powered magnet and a computer to create high-resolution images of the cervix and other structures in the abdomen and pelvis. Like CT scans, MRI scans can be used to look for the spread of cervical cancer.
• Positron emission tomography (PET scan): A test to look for spread or recurrence of cervical cancer. A solution, known as a tracer solution, containing a mildly radioactive chemical is injected into the veins. The PET scan takes pictures as this solution moves through the body. Any areas of cancer take up the tracer and "light up" on scanner images.
• HPV DNA test: Cervical cells can be tested for the presence of DNA from human papillomavirus (HPV). This test can identify whether the types of HPV that can cause cervical cancer are present.

Cervix Treatments

• Cervical cerclage: In women with cervical incompetence, the cervix can be sewn closed. This can prevent early opening of the cervix during pregnancy, which can cause premature delivery.
• Antibiotics: Medications that can kill the bacteria that causes infections of the cervix and reproductive organs. Antibiotics may be taken orally or given through a vein, or intravenously, for serious infections.
• Cryotherapy: An extremely cold probe is placed against abnormal areas on the cervix. Freezing kills the abnormal cells, preventing them from becoming cervical cancer.
• Laser therapy: A high-energy laser is used to burn areas of abnormal cells in the cervix. The abnormal cells are destroyed, preventing them from becoming cervical cancer.
• Cervical cancer vaccine: To prevent cervical cancer, a vaccine against certain strains of the human papillomavirus (HPV) is recommended for most adolescent girls and young women.
• Chemotherapy: Cancer medications that are usually injected into a vein. Chemotherapy is usually given for cervical cancer that is believed to have spread.
• Total Hysterectomy: Surgical removal of the uterus and cervix. If cervical cancer has not spread, hysterectomy can offer a complete cure.
• Cone biopsy: A cervical biopsy that removes a cone-shaped wedge of tissue from the cervix. Because a large portion of the cervix is removed, cone biopsy can help prevent or treat cervical cancer.
• Loop electrosurgical excision procedure (LEEP): An electrified wire loop is touched against abnormal cells in the cervix. The electrical current destroys the cells, preventing or treating cervical cancer.
• Radiation therapy: Using radioactive energy to kill cervical cancer cells. Radiation therapy is given as a beam from outside the body or in small pellets implanted in the cervix, known as brachytherapy.

2- Cervicitis

Cervicitis

Cervicitis is inflammation of the cervix -- the lower end of the uterus that opens into the vagina.

Cervicitis is common. It may be caused by a number of factors, including infections, chemical or physical irritations, and allergies.

Determining the cause of cervicitis is important. If an infection is the problem, it can spread beyond the cervix to the uterus and fallopian tubes and into the pelvic and abdominal cavity and cause life-threatening infection. This may cause problems with fertility --the ability to become pregnant. Or it may cause problems with your unborn baby if you are already pregnant.

Here's what you need to know about symptoms, causes, risk factors, tests, diagnosis, and treatment of cervicitis.

What Is Cervicitis?

Cervicitis is inflammation of the cervix, which can be due to:

• Irritation
• Infection
• Injury of cells that line the cervix

These irritated or infected tissues may become red, swollen, and ooze mucus and pus. They may also bleed easily when touched.

What Causes Cervicitis?

Severe cases of inflammation are usually caused by infections that are passed during sexual activity.

Sexually transmitted diseases (STDs) that may cause cervicitis include:

• Gonorrhea
• Chlamydia
• Genital herpes
• Trichomoniasis
• Mycoplasma and ureaplasma

But many women with cervicitis don't test positive for any type of infection. Other causes of the inflammation may include:

• Allergies to chemicals in spermicides, douches, or to the latex rubber in condoms
• Irritation or injury from tampons, pessaries, or from birth controldevices like diaphragms
• Bacterial imbalance; normal, healthy bacteria in the vagina are overwhelmed by unhealthy or harmful bacteria. This is also called bacterial vaginosis.
• Hormonal imbalance; having relatively low estrogen or high progesterone may interfere with the body's ability to maintain healthy cervical tissue.
• Cancer or cancer treatment; rarely, radiation therapy or cancer may cause changes to the cervix consistent with cervicitis.

Symptoms of Cervicitis

Many women with cervicitis don't have any symptoms. The condition may be discovered only after a routine exam or test.

Signs and symptoms, if present, may include:

• Grayish or pale yellow vaginal discharge
• Abnormal vaginal bleeding, such as bleeding after sex or between periods
• Pain during sex
• Difficult, painful, or frequent urination
• Pelvic or abdominal pain or fever, in rare cases

Risk Factors for Cervicitis

You may be at higher risk for cervicitis if you:

• Had recent sexual intercourse without a condom
• Recently had multiple sexual partners
• Have had cervicitis before

Studies show that cervicitis will recur in 8% to 25% of women who get it.

Diagnosing Cervicitis

If your doctor suspects you have cervicitis, he or she may do a pelvic exam. This lets the doctor get a closer look at the cervix.

The doctor will probably also swab the cervix to collect vaginal fluids or to see how easily it bleeds.

Your doctor will also probably ask questions about your sexual history. The doctor will want to know:

• The number of partners you've had in the last 60 days
• Whether or not you've had sex without a condom
• The kind of contraception you used

Even if you don't have symptoms, your doctor will perform a routine exam to look for cervicitis if:

• You are pregnant
• The doctor thinks you are at high risk for an STD

Tests for Cervicitis

Your doctor may swab the cervix to check for discharge, swelling, tenderness, and bleeding. Your doctor will test your vaginal fluid for the presence of harmful bacteria or viruses.

Cervicitis Treatment

You may not need treatment for cervicitis if a sexually transmitted infection is not the cause.

If an infection is suspected, the main goal of treatment is to eliminate the infection and prevent it from spreading to the uterus and fallopian tubes, or if you are pregnant, to your baby.

Depending on what organism is causing the infection, your doctor may prescribe:

• Antibiotics
• Antifungal medications
• Antiviral medications

Your doctor may also recommend that your partner be treated to make sure you don't get infected again. You should not have sex until you and your partner have finished treatment.

Treatment is especially important if you are HIV positive. That's because cervicitis increases the amount of virus that is shed from the cervix. This may increase your chances of infecting a partner. Also, having cervicitis can make it easier for you to get HIV from an HIV-positive partner.

If your symptoms persist despite treatment, you should be reevaluated by your doctor.

Nondrug treatments like douches or yogurt-based therapy do not work for cervicitis and may actually worsen symptoms. They are not recommended.

Preventing Cervicitis

You can decrease your risk of getting cervicitis by taking the following steps:

• Have your partner always use condoms during sex.
• Limit the number of people you have sex with.
• Don't have sex with a partner who has genital sores or penile discharge.
• If you get treatment for a sexually transmitted disease, ask your doctor if your partner should also be treated.
• Don't use feminine hygiene products. These may cause irritation of your vagina and cervix.
• If you have diabetes, try to maintain good control of your blood sugar.

3- What Are Cervical Polyps?

What Are Cervical Polyps?

Cervical polyps are growths on the cervical canal, the passage that connects the uterus to the vagina. They’re often reddish, purplish, or grayish in color. They may be shaped like a finger, bulb, or thin stem. They can range in size from a few millimeters to several centimeters long.

These bumps inside your cervixare pretty common. They’re most common in women over age 20 who’ve given birth to more than one child. They’re rare in girls who haven’t started their period.

Most cervical polyps are benign (not cancer).

What Are the Symptoms?

About two out of three women who have cervical polyps don’t have symptoms. Doctors normally find these growths during a Pap test or other procedure. If you do have symptoms, they may include:

• Periods that are heavier than usual
• Bleeding after sex
• Bleeding after menopause
• Bleeding between periods
• Vaginal discharge, which may stink due to infection

What Causes Them?

Doctors aren’t sure, but think they may be linked to:

• Cervical infections
• Chronic inflammation
• An abnormal response to the hormone estrogen
• Clogged blood vessels near the cervix

How Are They Diagnosed and Treated?

If your doctor finds cervical polyps during a routine pelvic exam and Pap smear, she’ll probably take a sample of the tissue (biopsy) and send it to the lab to make sure it’s not cancer.

She’ll probably remove them at that time. She’ll use a tool called a polyp forceps to gently twist the growth off your cervix.

You might bleed and cramp just a little during or after the procedure. An over-the-counter pain medication like acetaminophen (Tylenol) or ibuprofen (Motrin or Advil) can relieve the pain.

If your polyp is large, your doctor may recommend removing it in the operating room using a local or general anesthetic.

Most cervical polyps are benign, cause no problems, and don’t come back once they’re removed.

Can I Prevent Cervical Polyps?

No, but routine pelvic exams and Pap tests can help detect and treat cervical polyps before they cause symptoms.