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The cervix plays an important role in protecting the uterus itself, the fallopian tubes and ovaries from infection. Unfortunately, many of her diseases can develop asymptomatically.
Cervix – tasks
An extremely important task that the cervix fulfills is the production of mucus, which is a protective barrier for the bacterial flora. The second important function of the cervix is its importance in getting pregnant, carrying it on and giving birth to a baby. It is the cervical canal that allows sperm to enter the uterus from the vagina. During pregnancy, it acts as a sphincter to close the uterine cavity, and during labor, it allows the baby to escape.
Under the influence of hormones, the cervix undergoes many changes during the monthly cycle. In the infertile phase, it is hard, dry and closed. As ovulation approaches, the opening opens and the vaginal cervix becomes softer and rises. During this time, mucus is produced that is friendly to sperm. After ovulation, the cervix returns to its pre-ovulation state.
Cervix – erosion
As we mentioned before, a woman may not know that she has cervical problems because many conditions do not give clear symptoms. And those that appear are not clear-cut. This is also the case with a fairly popular ailment called cervical erosion.
But this term is often used to misspell any redness on the vaginal part of the cervix (technically known as erythroplakia). The concept of true cervical erosion is reserved only for defects in the cervical epithelium. On the other hand, the majority of erosions diagnosed “by eye” are ectopy, i.e. the displacement of the cylindrical epithelium from the cervical canal to the vaginal disc. True erosions most often occur in sexually active women between the ages of 25 and 35. They may be the result of cervicitis or vaginitis, mechanical trauma (e.g. during childbirth, miscarriage).
symptoms: Usually not present. Sometimes there are white, yellow or greenish, unpleasant-smelling discharge before menstruation. You may experience spotting between periods or after intercourse, and pain in the lower abdomen.
RESEARCH: The change can be detected during a gynecological examination. To make a correct diagnosis, it is necessary to undergo cytology or colposcopy.
Therapy: Pharmacological treatment is applied, and if it does not bring improvement, the lesion is lubricated with a special preparation, burned with electricity, frozen with liquid nitrogen or removed with light waves. In exceptional cases, more invasive procedures, such as excision of a fragment of the cervix (conization), are performed.
Worth knowing: True erosion may be a symptom of precancerous and cancerous conditions of the cervix.
Cervix – inflammation
Cervical inflammation develops due to infection with protozoa (e.g. vaginal trichomoniasis), bacteria (e.g. chlamydia, gonorrhea), viruses or fungi. The infection is favored by mechanical damage to the cervix, as well as the frequent change of sexual partners.
symptoms: Inflammation may be asymptomatic but vaginal discharge, sometimes spotting or bleeding between periods are more common.
RESEARCH: In order to detect cervical inflammation, a gynecological examination and collecting cervical secretions for culture are necessary. This allows you to identify the microbes that caused the inflammation.
Therapy: In the treatment of cervicitis, intravaginal anti-inflammatory drugs, antibiotics (topical or systemic), sometimes hormonal preparations are used.
Worth knowing: Untreated cervicitis can spread further to the genital tract.
The cervix and Naboth’s cysts (glands)
Cervical cysts are small single or multiple blisters filled with mucus or mucopurulent content. Purulent discharge appears when inflammation develops. Cysts are formed as a result of closing the mouth of the cervical mucus glands by the growing epithelium, most often during the healing of erosions. They are found in women of childbearing age, especially those who have already given birth.
Symptoms: There are no complaints.
RESEARCH: A gynecological examination and a cytology are performed.
Therapy: If the doctor decides to remove the cyst, the lesion is punctured, its contents removed, and the emptied gland is frozen with liquid nitrogen or burned with a laser or electric current.
Worth knowing: If left untreated, Naboth’s glands generally disappear over time, but tend to come back.
Cervix – tumor
Cervical cancer ranks first in terms of the incidence among cancers of the reproductive organ in women. Cervical cancer is most often detected in women aged 40–55, but there is also a large group of women who develop cancer after the age of 25. Certain types of the human papillomavirus (HPV), which are sexually transmitted, are responsible for the formation of cancer.
symptoms: Pre-cancerous lesions or early cancer do not cause any discomfort. As the disease progresses, unusual bleeding (between menstrual periods, after intercourse, postmenopause), profuse vaginal discharge, pain in the lower abdomen during intercourse or when urinating, and seemingly non-cancerous leg swelling may occur. Periods last longer and are more heavy.
RESEARCH: The basic tests are cytology and colposcopy. During the examination, material is collected for histopathological examination.
Therapy: Treatment of cervical cancer depends on the stage of the disease. Pre-cancerous lesions are treated pharmacologically. If it is a pre-invasive cancer, laser surgery, cryosurgery, or surgical conization (removal of part of the cervix) are used. In the invasive stage, the uterus must be removed (hysterectomy), and radiotherapy is the complementary treatment. When metastases to other organs, chemotherapy is used.
Worth knowing: Every year over 3,5 thousand A Polish woman learns that she has cervical cancer, and as many as 5 women die from it every day. But cancer can be effectively prevented by proper prophylaxis and early diagnosis. Cytology is a valuable examination (it should be performed for the first time after the start of sexual intercourse, then regularly every year). Vaccines are also a weapon against HPV (they can be administered from the age of 12).
Dangerous Liaisons
Women don’t usually know that they are at risk of various infections since they have sexual intercourse, including HPV, which can cause cervical cancer. The tumor develops as a result of long-term infection with the human papillomavirus, especially with the highly carcinogenic types HPV 16 and 18, which cause over 70% of the disease. cases of disease. About 30 types of HPV affect the genital mucosa and 15 causes cervical cancer. If the virus is oncogenic, the risk of contracting the disease increases: 2 times – when sexual intercourse is started at an early age, and also when we smoke, 2 to 4 times after three or more children are born, and when she becomes infected with sexually transmitted diseases, 4- times if we use oral contraceptives for years.
HPV can also cause the development of other neoplasms, such as squamous cell carcinoma of the anus, vulva, penis and even the esophagus. Recent studies show that condoms do not protect against HPV unless they contain virucides. Relative security is provided by the so-called barrier contraception, i.e. vaginal inserts and rings. An important element of prevention is staying in monogamous relationships and being faithful by both partners.
The cervix and cytology. Why is this study so important?
In countries where Pap smear testing was introduced 20 years ago, mortality has decreased. In Iceland by 80%, Finland by 60%, the USA and Sweden by 50%. You can order LBC liquid cytology with gynecological consultation at medonetmarket.pl. Compared to traditional cytology, it shows a 2 times higher detectability of intraepithelial lesions.
The epithelial cells from the cervix are classified into normal, atypical, precancerous and cancerous. The presence of atypical cells requires repetition of cytology after anti-inflammatory treatment. If precancerous changes are suspected, colposcopy is ordered. Colposcopy and HPV DNA testing, which is a test for oncology of the virus, is also performed to verify unclear results.
Colposcopy is a specialized examination of the cervix performed with an optical apparatus illuminating its interior. Sometimes the walls of the cervix are covered with a special solution that makes the affected areas visible and allows for precise sampling. If nevertheless the changes cannot be accurately assessed, colonization is carried out. This is a type of biopsy performed under general anesthesia. Examination of the collected cervical fragment allows to determine whether the changes are a precancerous condition or a cancer.
If the diagnosis is “cancer”, it is necessary to determine the severity of the disease. And so: I degree means that the cancer is limited to the cervix, II – extends beyond the cervix and may occupy 2/3 of the vagina in its upper part, III – invades the uterine wall and the entire vagina, IV – cancer invades the urinary bladder, rectum and others organs.
It happens that the cytology does not show any lesions early enough. This is when they are positioned where the Pap smear brush cannot reach. It is possible because the cervix is about 4 cm, and the bristles of the brush – 1 cm.
Cytology after removal of the uterus
Many women after a hysterectomy wonder if they should have regular smear tests. If the rest of the cervix or its part – cytology is obligatory. If the surgeon has left the so-called vaginal stump – also. The exception is when the uterus and appendages have been removed due to fibroids.
Test: Anna Jarosz