Cervix Defined
08/06/2022 By AskAwayHealth

Understanding The Cervix – Ten Common Health Problems

Cervix Defined

The cervix is one of the very important parts of your anatomy as a woman, so in this post, let’s take a closer look at the cervix and tell you what it does and the common problems that can affect it.

What’s the difference between the cervix and uterus?

The cervix is a part of the womb. It is also known as the neck of the womb.

Your womb is a muscular organ that can stretch and accommodate a growing baby. 

Every month, the womb prepares for the implantation of the egg. However, if there is no pregnancy, some of the womb lining is shed along with the egg during your menstrual period.

The womb is located in your pelvis just above the junction of your legs.

It is lying behind the bladder and in front of the rectum. The pubic bone in front protects these organs. 

Before puberty, your womb is about the size of a small orange (3.5cm).

After puberty – and before you get pregnant (known as a nulliparous womb), your womb starts to grow under the influence of hormones.

 It is about the size of a pear/melon/orange/large grape at this stage.

But, of course, by the last stages of pregnancy, the womb size will enlarge so many times from carrying the developing baby.

What does your cervix look like?

The cervix is an essential part of the womb. It is the neck or entrance to the womb and sits at the end of the vagina. Thus it is also made of muscle. 

In this image, you can see the cervix sitting at the bottom of the womb. 

This picture is taken looking straight ahead, but the other view is what your doctor views when you have a speculum examination – it’s a circular view of the tip of the cervix. 

Here it looks like a doughnut. A small opening known as the os is in the middle of the cervix. It changes shape from a tiny pinhole before you get pregnant to a circle as wide as 10 cm when you are about to deliver your baby. As you can see in this image, if you’ve had a baby, the os resembles a slit rather than a hole. 

The cervix position can also change during your menstrual cycle.

How to locate your cervix:

By inserting two (clean) fingers into the vagina, you can feel your cervix toward the back of the vaginal space. Some women use the position of the cervix to help them identify their fertile periods. It feels soft and higher up during ovulation, while it feels firm and lower within the vaginal canal during the less fertile period. 

What does your cervix do?

The job of the cervix is to act as a gate. It will either allow or deny entry (and exit) to and from the womb through the os.

Let’s see how this happens:

  • The cervix allows sperm to enter the womb and the rest of the reproductive tract. The os opens to allow sperm entry during ovulation, but it narrows afterwards. In addition, it will allow menstrual blood to come out of the womb. 
  • Sometimes it can prevent infections like STIs from getting into the womb from the vagina. 
  • Another job of the cervix is cervical monitoring for fertility awareness. This is where you use the cervical mucus to determine when you are most fertile to avoid falling pregnant or having a baby. 
    • The cervix makes a fluid-like gel or discharge known as cervical mucus or cervical fluids. 
    • Cervical mucus is different for women in terms of quality, consistency and colour. Still, some common patterns or changes in the nature of cervical mucus tell us what else is happening in the body. 

How your cervical mucus changes during the cycle

  1. You may not notice the mucus during your menstrual period because the blood covers it.
  2. Immediately after the period, you may be dry and not notice any discharge.
  3. In the days leading up to ovulation, your cervix produces mucus that may be yellow/white or cloudy when the egg is released. It may feel like glue or stretchy.
  4. Just before ovulation, it may look clear and more slippery or watery.
  5. During ovulation, the mucus is stretchy and clear – it feels like the white of an egg – this type of mucus protects sperm and facilitates pregnancy.
  6. After ovulation, the mucus may become cloudy again or gluey/sticky again. You may even have dry days.
  7. The cervical mucus may also change when you fall pregnant – early on, it may be thick and clear and change again, becoming yellow or whitish as pregnancy progresses.

What the cervix does during labour

So we see the cervix is a channel connecting the main section of the womb to the vagina. But in vaginal birth and labour, the cervix has an important role.

So here are some of the things that happen with the cervix around pregnancy/delivery:

  • When you go into labour, the mucus plug that covers the opening of the cervix falls off – this is an essential part of vaginal delivery. That plug is critical for keeping the womb a safe, sterile space so that infection does not enter and place the baby at risk.
  • During pregnancy, the cervix is firm, stiff and closed, which is meant to help keep the baby safe and in place until it is time for labour.
  • Usually, the cervix softens and relaxes as you approach the last few days or weeks of pregnancy. This is what doctors typically mean when they say the cervix is ripe. The cervix is getting ready to open and allow the baby to exit from the womb. In some cases, this does not happen, and the cervix is not prepared or unripe. It will need some help before labour starts, and your doctors can use some medicines applied through the vagina or taken by mouth to relax or soften the cervix. 
  • As labour progresses, the cervix stretches apart to open the womb’s entrance and allow the baby to pass through. This is the purpose of your contractions to help stretch the cervix open and push the baby out of the womb when the cervix is fully open.

Checking on the cervix during labour

  • How to know if your cervix is dilating – your doctor or midwife will examine you to decide if your cervix is dilating – this means the os is stretching open and upwards to allow the baby’s delivery.
  • How to know if your cervix is softening – this is something else your medical team can determine when you are very close to term and about to begin labour. By examining your cervix through the vagina, they can decide if it is softening, also known as ripening. This is a sign that your body is preparing to deliver your baby.
  •  When the cervix is fully open – we call this 10 cm, you have reached another important stage of labour when the baby can emerge safely from the womb.

Health problems of the cervix

Now, let’s look at conditions that can affect your cervix:

Colpscopy procedure can detect Cervical cancer or Cervical Ectropion

Cervical Cancer

This is cancer that affects the cervix. The most common cause is infection with the Human Papilloma Virus HPV, so the most important things you can do to reduce your risk are getting the Cervical cancer vaccine and attending your cervical screen when it is due. Important factors that can also contribute to the risk of cervical cancer are: having multiple sexual partners, sex at an early age, STIs such as chlamydia, gonorrhoea, syphilis and HIV/AIDS and most importantly – Smoking.

Cervical Warts

Cervical warts are a type of genital warts. Genital warts are small painless growths or lumps around the genital area or on the anus. In the genitals, they can cause itching and make you feel uncomfortable, but if you don’t treat them, they can grow.

Some of the symptoms include bleeding with or after sex. But they can grow in the cervix and grow to such an extent that they block the cervical canal. In this case, you may need to have a C section. Warts are also caused by Human Papillomavirus, known as low-risk HPV, which is not the same type of strain of the virus that causes Cervical cancer (i.e. High-Risk HPV).

Just because you have genital warts does not mean you will get cervical cancer. Warts can also be treated with creams or procedures like burning off or cutting off warts. Wart treatments may include Cauterisation · Laser surgery · Cryosurgery · Electrocautery · Surgical excision.

Cervical Polyps

– Another condition that affects the cervix is a cervical polyp. A polyp is a benign growth that can happen anywhere, but this one is located in the cervix. 

As you see in this image, this growth often appears to be sticking out of the cervix. 

It often has no symptoms, but it can be one of the causes of vaginal bleeding, especially after sex or heavy menstrual bleeding. It can be treated by simply cutting off the polyp or using cauterisation or laser. 

Cervical Ectropion

 You may hear this condition described as cervical erosion. It happens when cells from inside the cervix grow onto the outside of the cervix.

You often don’t know that you have cervical ectropion, but it can cause vaginal bleeding after or while having sex. It is a common but harmless cause that the doctor observes when looking at your cervix with a speculum, as you can see in this picture.

We think cervical erosion happens from hormonal changes, so we often see it in younger people, those going through puberty, if you are pregnant or while taking the combined contraceptive pill.

Cervical Dysplasia

Dysplasia means an abnormal change to cells of an organ which may predate the development of cancer. That means they can be early cancer signs.

One of the abnormal changes we see from a cervical smear is dysplasia. Remember, in a smear, we collect cells from the cervix.

The specialist examines the cells under the microscope and can identify dysplasia from the abnormal appearance of the cells. It does not have any symptoms, but it must be treated when detected on the smear. Check out my video here on reasons for errors on your cervical smear to learn more about this.

Cervix Defined

Cervicitis from STIs

Cervicitis means irritation or inflammation of the cervix caused by germs. These germs lead to sexually transmitted infections, such as Chlamydia, Herpes, Gonorrhoea, or Trichomoniasis, which travel through the vagina after sex.

The symptoms of cervicitis can include pus-filled vaginal discharge that may be yellow, creamy, brown, grey, bloody and smelly. You may also have pelvic pain, bleeding between periods or after sex, and problems passing urine. The germs which cause cervicitis can travel into the womb and fallopian tubes if you do not treat this condition quickly.

It can thus lead to PID – Pelvic Inflammatory Disease. This serious condition can lead to infertility or a severe infection within the abdomen and pelvis called peritonitis which can kill. Check out this video on Acute Causes of Pelvic Pain to learn more about PID. 

Cervical Prolapse

 A prolapse is when an organ sags or slips from its natural position. Many organs can prolapse – commonly, the womb, bladder or rectum.

One of the key contributors to prolapse is the weakness of the pelvic floor, the muscle which holds up the organs in their natural place. The floor can be weakened by pregnancy and delivery, overweight, menopause and other problems.

I have videos on the pelvic floor and how you can strengthen your floor on my channel – please check them out.

Now when the womb prolapse, often it is the first part of the womb that sags and in the most severe cases, the organ pushes down and can be seen outside the vagina. This part you can see is the cervix, i.e. the first part of the womb that pushes its way out.

Cervical Fibroid

Next up is fibroids. These are benign growths of the womb and can locate themselves all over the womb, including the cervix.

Fibroids can have different effects depending on their size and location in the womb. For instance, a large fibroid in the cervix may be able to block the birth canal, so the C section is the only avenue for their delivery.

Please check out the videos on our fibroids playlist to know more about how fibroids develop and treatment options. 

Closed Cervix

Next, let’s talk about a Closed cervix and how to tell if your cervix is closed.

Remember we saw that the cervix is the doorway between the vagina and the rest of the womb.

So it allows or prevents entry or exit into and out of the womb through the opening called the os. In some cases, the os is closed permanently. We also call this cervical stenosis.

First, you should know it is possible to be born with a closed cervix. However, it can also develop as a complication of womb surgery; or scars that form after infections like PID. Other ways you may end up with a closed cervix are endometriosis and cancer of the cervix.

Symptoms include irregular and painful or absent periods. A closed cervix can also result in infertility because the sperm cannot travel to meet the egg through the os. You can tell if your cervix is closed by an examination by your GP or gynaecologist to see the os. We can usually tell if the os is open or not by looking at it or when we try to take a swab sample or perform a cervical smear. If it seems unusually narrow or abnormal in some other way, we may attempt to pass a probe – any of these can help us tell what is going on.

Incompetent Cervix

And finally, let’s look at an Incompetent Cervix. 

It’s a rather old term that we use to describe a cervix that cannot stay closed during pregnancy.

We also refer to it as cervical insufficiency, and it can lead to premature birth or miscarriage because the cervix opens too early in pregnancy.

Sadly, we cannot know who has this condition before premature birth or loss.

In some cases, having some treatments for abnormal cervical smears or following a D &C may put you at risk of having an incompetent cervix.

Some studies suggest that black women have a higher risk of developing cervical insufficiency. It isn’t clear why. There are no signs in the early stage of pregnancy.

Symptoms may be mild pelvic pain or spotting from 14 to 20 weeks of pregnancy. If your doctor determines you had an incompetent cervix in a previous pregnancy, they will provide preventive treatments in the next one to avoid the risk of it happening again.

These include having frequent pelvic scans and using a cervical stitch to keep the cervix closed.

So these are some of the conditions that affect your cervix.

But I also get this question – Why does my cervix hurt? 

There can be various reasons, including any of these medical conditions we have looked at already. But one of the simple reasons is during sex.

Don’t forget that the position of your cervix changes during different times in your menstrual cycle and pregnancy. If you are at that time of the month when your cervix is lying low, pain may happen if the penis strikes it during sex. 

Don’t ignore any symptoms – check with your doctor or give us a call to advise on the next steps.

More Reading

Useful Sources

Editing by AskAwayHealth Team

Disclaimer

All AskAwayHealth articles are written by practising  Medical Practitioners on a wide range of health care conditions to provide evidence-based guidance and to help promote quality health care. The advice in our material is not meant to replace the management of your specific condition by a qualified health care practitioner.
To discuss your condition, please contact a health practitioner or reach us directly through info@askawayhealth.org

Image Credits – Canva

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