During a gynecological examination, changes in the cervix can be detected. They do not always mean the presence of an oncological process.
If changes are detected on the organ, the doctor will prescribe an additional examination, the results of which will confirm or refute cancer.
Studies have shown that papillomavirus causes malignant processes in the cervix. It is transmitted from person to person through sexual contact. Oncogenic subtypes of the virus lead to severe dysplasia and cancer. A woman can become infected even in her youth, and after 10 years, papilloma will lead to cell mutation. The peak incidence of cancer falls on 40-55 years.
Photo and description of all types
Cancer of the cervix is of different types. This affects the appearance of the visible part of the organ. During a gynecological examination, the doctor can observe various patterns of pathological processes.
For a more detailed examination, a colposcopy is performed. The procedure is done like a normal examination with a mirror, but the doctor looks at the cervix and vagina with a colposcope (binocular with a light).
Squamous cell carcinoma
The external os is located in the area of the vagina. It is covered with non-keratinized stratified epithelium. Often, squamous cell carcinoma develops at the site of the transition of the epithelium from flat to cylindrical.
The appearance of squamous cell pathology depends on its subtype:
Infiltrative-ulcerative
The organ has a reddened, inflamed appearance. Numerous small ulcers bleed, their edges have clear limits, they are slightly elevated above the mucosa. There are areas with yellowish crusts. Pathology is located in the central part of the external pharynx, spreading in all directions.
The central entrance is poorly visible because of the tumor, it is filled with liquid. The part of the cervix not affected by oncology and the visible zone of the vaginal walls has a normal color and structure.
Tumor
On the neck, a volumetric formation is clearly visible, which is located on the edge. It grows on a wide base. Slightly protrudes above the surface of the mucosa. The formation itself has a bumpy and rough surface. In some places of the tumor, bleeding ulcers are visible.
The rest of the organ has a normal color and structure, the walls of the vagina are also not changed. The central hole is of a regular shape, slightly reddened in the middle.
Adenocarcinoma
The length of the neck is 3-4 centimeters. In addition to the external and internal pharynx, the organ has a cervical canal. It is filled with thick mucus, the purpose of which is to protect against germs.
The inner part of the cervical canal consists of a cylindrical epithelium, tubular glands. A neoplasm is formed from glandular particles. Therefore, the disease is often called glandular cancer.
Varieties of adenocarcinoma:
Endometrioid foma
The tumor grows into the tissues superficially. Pathology is located in the central part of the vaginal region of the cervix. The central opening is strongly clamped by a tumor. It has a red color, papillary growths, small bruises are visible. The pathogenic area is slightly recessed into the body of the neck.
On the surface of the external pharynx, small growths are visible and blood vessels are enlarged. The walls of the vagina are not changed.
Papillary form
The entire vaginal part of the cervix is covered with a white heterogeneous coating. This type of malignant tumor is caused by papillary growths from which it was formed. A large number of papillomas remotely resembles cauliflower.
The central part of the organ is dark red. The entrance to the cervical canal is clearly visible. The rest is covered with tumor. It shows bruising, yellowish areas. The edges of the neoplasm are not even, torn, slightly raised above the mucosa. The entire outer part of the cervix is affected. The visible part of the vagina is not changed by the oncological process.
mixed cancer
Mixed oncological neoplasms include the following types:
- glandular-squamous;
- adenoid-cystic;
- adenoid-basal.
The tumor has a heterogeneous texture, its growth over the mucosa is noticeable. The surface of the neoplasm is bumpy, juicy, with bruises. Pathology is colored red, blood vessels are visible through it. In some parts of the external pharynx, white-yellow formations and sores are visible.
The entrance to the cervical canal is almost invisible. It is closed by an overgrown tumor. In its center, a dark red spot is noticeable.
Malignant formation has spread throughout the mucosa. The surface has a non-uniform color. Multiple blood vessels show through the pink mucosa.
A whitish coating is smeared all over the mucosa, the contours of which slightly protrude beyond the neck.
The central entrance is clearly visible, but many blood vessels emanate from it. The neck itself is uneven in shape, its upper part is noticeably swollen.
The tumor is heterogeneous in shape and color. It has a rough structure, with multiple papillary processes.
The pathology is covered with a white coating that does not completely cover the neck. Reddened areas and a yellowish coating are visible.
The area of the external pharynx is strongly deformed, there is a recess filled with a gray-bloody mass.
The neck is markedly enlarged, has a rounded shape. The tumor is loose, with bruises in different areas, heterogeneous.
Color from pale pink to red, there are yellow patches. On the surface there may be sores and small growths resembling papillomas.
The central entrance is strongly open, has loose torn edges.
The visible part of the vagina is not affected, has a normal color and texture.
The mucous membrane is covered with blood, has an irregular shape. Its lower part is noticeably enlarged and has a loose surface. There is a vague blood clot in the area of deformation.
The color of the mucosa is pink. The entrance to the cervical canal is displaced due to deformation of the external os, it is filled with bloody secretions.
Photo and description of degrees
Oncology of the cervix is usually divided into 4 stages, each of which has its own characteristics. The staging is based on the spread of the disease. Depending on this, the appearance of the vaginal region of the organ changes.
Stages of pathology:
- 1 stage- the tumor has penetrated into the stroma of the external pharynx of the organ. It occupies the third or fourth part of the external pharynx.
- 2 stage- significant changes in the structure are visible, the tumor has affected most of the mucosa. Pathology has reached the vagina, uterus.
- 3 stage- the oncological process spreads to the pelvic region, kidneys.
- 4 stage- metastasis throughout the body.
What does a normal neck look like?
The surface of the external pharynx is smooth. Painted in a light pink color without any inclusions.
In some cases, the entrance to the cervical canal may have a reddish tint. The mucous secretion is transparent, it gleams in the photo.
The central hole can be of several types:
- round or oval shape- typical for nulliparous women;
- slit-like form- occurs in women who have given birth several times.
1 degree
At stage 1 cancer, the pathology is noticeable in the central part of the outer region of the cervix. Pathology covers a third of the mucosa. It looks like a reddened area. The contours of the tumor at stage 1 are blurred, not clear.
The tumor does not rise above the mucosal surface. There are several small sores in the affected area. They don't bleed. The central foramen is clearly visible but slightly deformed due to neoplasm exposure. Mucous secretion is transparent, sometimes yellowish areas are visible.
The neck and the visible part of the vagina are not changed. They have a smooth surface, light pink color.
2 degree
At stage 2 of the oncological process, most of the vaginal region of the cervix is affected. The malignant formation is painted white, has multiple bruises in different areas. Most of the bruising is concentrated in the central part.
The neoplasm has blurred contours, they differ markedly from the mucosa unaffected by cancer. The tumor is at the same level as the mucosal surface. The entrance to the cervical canal cannot be viewed, it is closed by a tumor. In the place where there should be a hole, a small depression is noticeable.
The visible part of the vagina has a normal color and texture.
3 degree
At stage 3, the outer part of the cervix is severely deformed. It has a loose structure, multiple tubercles are visible throughout its mucosa. Ulcers cover most of the cervix. The central part bleeds heavily, and it is impossible to see the opening into the cervical canal.
The mucosa is pale in color, covered with a white coating. The tumor affected the entire area of the organ. Cancer has affected the walls of the vagina.
4 degree
At stage 4, the oncological process has completely modified the outer part of the cervix. Cancer has gone beyond the mucosa, damaging the vagina. The tumor bleeds heavily over the entire surface of the external pharynx.
The surface is uneven, loose, bumpy, multiple ulcers are visible. In some areas, white-yellow discharge can be seen. Bloody depressions are also clearly visible. The entrance to the cervical canal cannot be determined.
The visible walls of the vagina are red with multiple ulcers that bleed. A large amount of blood collects in the vagina.
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The uterus is recognized as the main organ of the female reproductive system. The structure determines its functions, the main of which is the bearing and subsequent expulsion of the fetus. The uterus plays a direct role in the menstrual cycle, is able to change size, shape and position, depending on the processes occurring in the body.
Anatomy and size of the uterus: a photo with a description
The unpaired reproductive organ is characterized by a smooth muscle structure and a pear-shaped shape. What is the uterus, its structure and a description of the individual parts are shown in the picture.
In gynecology, the departments of the organ are distinguished:
- bottom- area above the fallopian tubes;
- body- middle cone-shaped area;
- neck- the narrowed part, the outer part of which is located in the vagina.
The uterus (in Latin matricis) is covered on the outside with perimetry - a modified peritoneum, from the inside - with the endometrium, which acts as its mucous layer. The muscular layer of the organ is the myometrium.
The uterus is supplemented by ovaries, which are connected to it through the fallopian tubes. The peculiarity of the physiology of the organ lies in mobility. The uterus is held in the body due to the muscular and ligamentous apparatus.
A detailed and detailed image of the female reproductive organ in the section is shown in the picture.
The size of the uterus changes throughout the cycle, depending on age and other features.
The parameter is determined by ultrasound examination of the pelvic organs. The norm is 4-5 cm in the period after the completion of menstruation. In a pregnant girl, the diameter of the uterus can reach 26 centimeters, the length is 38 centimeters.
After childbirth, the organ decreases, but remains 1-2 centimeters larger than before conception, the weight becomes 100 grams. The normal average size of the uterus is shown in the table.
In a newborn girl, the length of the organ is 4 cm, from the age of 7 it gradually increases. During menopause, the intact uterus decreases, the walls become thinner, the muscular and ligamentous apparatus weakens. 5 years after the end of menstruation, it becomes the same size as at birth.
The figure shows the development of an organ throughout life.
The thickness of the walls of the uterus varies from 2 to 4 cm, depending on the day of the cycle. The mass of an organ in a nulliparous woman is about 50 grams; during pregnancy, the weight increases to 1-2 kilograms.
Neck
The lower narrow segment of the uterus is called the cervix (in Latin cervix uteri) and is a continuation of the organ.
Connective tissue covers this part. The area of the uterus leading to the cervix is called the isthmus. The entrance to the cervical canal from the side of the cavity opens the internal pharynx. The department ends with the vaginal part, where the external pharynx is located.
The detailed structure of the neck is shown in the figure.
In the cervical canal (endocervix), in addition to folds, there are tubular glands. They and the mucous membrane produce mucus. Covers this section of the cylindrical epithelium.
In the vaginal part of the neck (exocervix) there is a stratified squamous epithelium, characteristic of this area. The area where one type of mucosal cells changes to another is called the transition zone (transformation).
Types of epithelium are depicted large in the picture.
The vaginal part of the organ is accessible to visual inspection.
Regular examination by a doctor allows you to identify and eliminate pathologies at an early stage: erosion, dysplasia, cancer, and others.
A special tool - a colposcope - conducts a detailed examination of the organ on the gynecological chair. The photo shows a close-up of a healthy cervix and with pathological changes.
An important indicator is the length of the cervix. The normal value is 3.5-4 centimeters.
The structure of the neck is given special attention during pregnancy. Narrow or small (short) breasts increase the risk of miscarriage. With isthmic-cervical insufficiency, it becomes difficult for the cervix to withstand the load created by the fetus.
Bottom
The structure of the uterus includes its body and neck. These 2 parts are connected by an isthmus. The highest region of the body of the reproductive organ is convex in shape, called the bottom. This area protrudes beyond the entry line of the fallopian tubes.
An important indicator is the height of the fundus of the uterus (VDM) - the distance from the pubic bone to the upper point of the organ. It is taken into account when assessing the development of the fetus during pregnancy. The size of the bottom of the uterus shows the growth of the organ, and normally the value ranges from 10 centimeters for a period of 10 weeks to 35 centimeters at the end of the gestation period. The indicator is determined by the doctor during palpation.
Body
This part is recognized as the main one in the structure of the uterus. The body consists of a triangular cavity and its walls.
The lower segment is connected to the neck at an obtuse angle with a normal structure, the upper one passes into the bottom, directed towards the abdominal cavity.
The fallopian tubes adjoin the lateral areas, wide uterine ligaments are attached to the right and left edges. The anatomical parts of the body also include the anterior or vesicular surface, which is adjacent to the bladder, the posterior one borders on the rectum.
Ligaments and muscles
The uterus is a relatively mobile organ, since it is held in the body by muscles and ligaments.
They perform the following functions:
- hanging- attachment to the pelvic bones;
- fixing- giving the uterus a stable position;
- supportive- creation of support for internal organs.
Suspension apparatus
The function of attaching an organ is performed by ligaments:
- round- 100-120 mm long, located from the corners of the uterus to the inguinal canal and tilt the bottom anteriorly;
- wide- resemble a "sail" stretched from the pelvic walls to the sides of the uterus;
- suspensory ligaments of the ovaries- proceed from the lateral part of the broad ligament between the ampulla of the tube and the pelvic wall in the area of the sacroiliac joint;
- ownovarian ligaments- attach the ovary to the side of the uterus.
fixing apparatus
Links include:
- cardinal(transverse)- consist of smooth muscle and connective tissues, are reinforced wide ligaments;
- uterovesical (cervical)- directed from the cervix and go around the bladder, prevent the uterus from tilting back;
- sacro-uterine ligaments- do not allow the organ to move towards the pubis, go from the posterior uterine wall, go around the rectum and attach to the sacrum.
Muscles and fascia
The supporting apparatus of the organ is represented by the perineum, which includes the urogenital and pelvic diaphragms, which consist of several muscle layers and fascia.
The anatomy of the pelvic floor includes muscles that perform a supporting function for the organs of the genitourinary system:
- sciatic-cavernous;
- bulbous-spongy;
- external;
- superficial transverse;
- deep transverse;
- pubic-coccygeal;
- iliococcygeal;
- ischiococcygeal.
Layers
The structure of the uterine wall includes 3 layers:
- serous membrane (perimetry) - represents the peritoneum;
- internal mucous tissue - endometrium;
- muscular layer - myometrium.
There is also a parametrium - a layer of pelvic tissue, which is located at the level of the cervix at the base of the broad ligaments of the uterus, between the layers of the peritoneum. The location between the organs provides the necessary mobility.
endometrium
The layer structure is shown in the figure.
The mucous epithelium is rich in glands, is characterized by good blood supply, and is sensitive to damage and inflammatory processes.
The endometrium has 2 layers: basal and functional. The thickness of the inner shell reaches 3 millimeters.
Myometrium
The muscular coat is represented by intertwined smooth muscle cells. Contractions of the myometrium on different days of the cycle are regulated by the autonomic nervous system.
Perimetry
The serous outer shell is located on the anterior wall of the body of the uterus, completely covering it.
At the border with the neck, the layer bends and is transferred to the bladder, forming the vesicouterine space. In addition to the surface of the body behind, the peritoneum covers a small area of the posterior fornix of the vagina, the rectum, forming a recto-uterine pocket.
These recesses, the location of the uterus in relation to the peritoneum are marked in the figure depicting the topography of the female genital organs.
Where is
The uterus is located in the lower abdomen, its longitudinal axis is parallel to the axis of the pelvic bones. At what distance it is from the entrance in the depths of the vagina depends on the structural features, usually it is 8-12 centimeters. The diagram shows the position of the uterus, ovary, tubes in the female body.
Since the organ is mobile, it is easily displaced in relation to others and when they are affected. The uterus is located between the bladder in front and the loop of the small intestine, the rectum in the posterior region, and its location can be determined using ultrasound.
The reproductive organ is to some extent deviated forward and has a curved shape. In this case, the angle between the neck and the body is 70-100 degrees. The adjacent bladder and intestines affect the position of the uterus. The body deviates to the side, depending on the filling of the organs.
If the bladder is empty, the anterior surface of the uterus is directed forward and slightly downward. In this case, an acute angle is formed between the body and the neck, open anteriorly. This position is called anteversio.
When the bladder is filled with urine, the uterus deviates backwards. In this case, the angle between the neck and the body becomes deployed. This state is determined by retroversion.
There are also types of bends of the body:
- anteflexio - an obtuse angle is formed between the neck and the body, the uterus deviates forward;
- retroflexio - the neck is directed forward, the body is posterior, an acute angle is formed between them, open back;
- lateroflexio - bend to the pelvic wall.
Appendages of the uterus
The complement of the female reproductive organ is its appendages. The detailed structure is shown in the figure.
ovaries
Paired glandular organs are located along the lateral ribs (sides) of the uterus and are connected to it through the fallopian tubes.
The appearance of the ovaries resembles a flattened egg, they are fixed with the help of a suspensory ligament and a mesentery. The organ consists of the outer cortical layer, where the follicles mature, and the inner granular (medulla) containing the egg, blood vessels and nerves.
How much it weighs and the size of the ovary depends on the day of the menstrual cycle. The average weight is 7-10 grams, length - 25-45 millimeters, width - 20-30 millimeters.
The hormonal function of the body is the production of estrogens, progestogens, testosterone.
During the cycle, the mature follicle in the ovary bursts and transforms into the corpus luteum. In this case, the egg passes through the fallopian tubes into the uterine cavity.
If pregnancy occurs, the corpus luteum performs intrasecretory functions, in the absence of fertilization, it gradually disappears. How the ovary is arranged, its structure is visible in the picture.
The fallopian tubes
A paired muscular organ connects the uterus to the ovaries. Its length is 100-120 millimeters, diameter is from 2 to 10 millimeters.
Sections of the fallopian tube:
- isthmus (isthmic part);
- ampoule;
- funnel - contains a fringe that guides the movement of the egg;
- uterine part - connection with the organ cavity.
The wall of the fallopian tube is predominantly composed of myocytes and is contractile. This is due to its function - transporting the egg to the uterine cavity.
Sometimes there is a life-threatening complication for a woman - an ectopic (ectopic) pregnancy. In this case, the fertilized egg remains inside the tube and causes a rupture of its wall and bleeding. In this case, it is urgent to operate the patient.
Features of the structure and function
The device and location of the uterus are subject to frequent changes. It is influenced by internal organs, the period of bearing a child, the processes that occur every menstrual cycle.
The condition of the cervix determines the onset of ovulation. During this period, its surface becomes loose, the mucus becomes viscous, it falls lower than on other days of the cycle.
In the absence of conception, menstruation occurs. At this time, the upper layer of the uterine cavity, the endometrium, is separated. In this case, the internal pharynx expands for the release of blood and part of the mucous membrane.
After the cessation of menstruation, the pharynx narrows, the layer is restored.
The functions for which the uterus is needed are defined:
- reproductive- ensuring the development, gestation and subsequent expulsion of the fetus, participation in the formation of the placenta;
- menstrual- cleansing function removes part of the unnecessary layer from the body;
- protective- the neck prevents the penetration of pathogenic flora;
- secretory- mucus production;
- support- the uterus acts as a support for other organs (intestines, bladder);
- endocrine- synthesis of prostaglandins, relaxin, sex hormones.
uterus during pregnancy
The most significant changes undergo the female organ during the period of bearing a child.
At the initial stage, the appearance of the uterus remains the same, but already in the second month it becomes spherical, the size and mass increase several times. By the end of pregnancy, the average weight is about 1 kilogram.
At this time, the volume of the endometrium and myometrium increases, the blood supply increases, the ligaments stretch during pregnancy and sometimes even hurt.
An indicator of the health and proper development of the fetus is the height of the fundus of the uterus, depending on the period. The norms are given in the table.
Another important indicator is the length of the cervix. It is evaluated to avoid the development of complications of gestation and premature birth. The norms of the length of the neck by weeks of pregnancy are indicated in the table.
By the end of the gestation period, the uterus stands high, reaches the level of the navel, has the shape of a spherical muscular formation with thin walls, slight asymmetry is possible - this is not a pathology. However, due to the advancement of the fetus to the birth canal, the organ gradually begins to descend.
Muscular contractions of the uterus are possible during pregnancy. The reasons are the tone of the organ (hypertonicity with the threat of miscarriage), training contractions.
Strong contractions occur during childbirth to expel the fetus from the uterine cavity. The gradual opening of the cervix releases the baby out. The placenta comes out next. The neck of a woman giving birth after stretching does not return to its original shape.
Circulation
The genital organs have an extensive circulatory network. The structure of the blood circulation of the uterus and appendages with a description is shown in the figure.
The main arteries are:
- mother- is a branch of the internal iliac artery.
- Ovarian- departs from the aorta on the left side. The right ovarian artery is more often considered a branch of the renal artery.
Venous outflow from the upper sections of the uterus, tubes, ovaries on the right occurs into the inferior vena cava, on the left - into the left renal vein. Blood from the lower uterus, cervix, vagina enters the internal iliac vein.
The main lymph nodes of the genital organs are the lumbar. Iliac and sacral provide lymph outflow from the neck and lower body. A slight outflow occurs in the inguinal lymph nodes.
innervation
The genital organs are characterized by sensitive autonomic innervation, which is provided by the pudendal nerve, which is a branch of the sacral plexus. This means that uterine activity is not controlled by volitional efforts.
The body of the organ has predominantly sympathetic innervation, the neck - parasympathetic. The contractions are due to the influence of the nerves of the superior hypogastric plexus.
Movements occur under the influence of neurovegetative processes. The uterus is characterized by innervation from the uterovaginal plexus, the ovary - from the ovarian plexus, the tube - from both types of plexus.
The action of the nervous system is due to severe pain during childbirth. The innervation of the genital organs of a pregnant woman is shown in the figure.
Pathological and abnormal changes
Diseases change the structure of the body and the structure of its individual components. One of the pathologies why a woman's uterus can be enlarged is fibroids - a benign tumor that can grow to an impressive size (over 20 centimeters).
With a small volume, such formations are subject to observation, large ones are removed with the help of an operation. The symptom of a "dense uterus", in which its walls thicken, is characteristic of adenomyosis - internal endometriosis, when the endometrium grows into the muscle layer.
Also, the structure of the organ is changed by polyps, cysts, fibromas, pathologies of the cervix. The latter include erosion, dysplasia, cancer. Regular inspection significantly reduces the risk of their development. With dysplasia of 2-3 degrees, conization of the neck is indicated, in which its cone-shaped fragment is removed.
"Rabies" of the uterus (hypersexuality) can also be a symptom of problems in the reproductive system. Pathologies, anomalies, features of the body can cause infertility. For example, with a "hostile uterus" (immunoactive), immunity prevents the fertilization of the egg, destroying the spermatozoa.
In addition to pathological phenomena that change the structure of the organ, there are anomalies in the structure of the uterus:
- small (children's) - its length is less than 8 centimeters;
- infantile - the neck is elongated, the size of the organ is 3-5 centimeters;
- one-horned and two-horned;
- double;
- saddle and so on.
Doubling
In addition to the presence of 2 uterus, there is a doubling of the vagina. In this case, the development of the fetus is possible in two organs.
bicorn
Outwardly, it resembles a heart; in the bottom area, the horned uterus is divided in two and connected in the neck area. One of the horns is underdeveloped.
Saddle (arc-shaped)
A variant of a bicornuate uterus, the bifurcation of the bottom is minimally expressed in the form of a depression. Often asymptomatic.
Intrauterine septum
The uterus is completely divided in two. With a complete septum, the cavities are isolated from each other, with an incomplete one they are connected in the neck area.
Omission
Displacement of the uterus below the anatomical boundary due to weakness of the muscles and ligaments. It is observed after childbirth, during menopause, in old age.
elevation
The organ is located above the upper pelvic plane. The reasons are adhesions, tumors of the rectum, ovary (as in the photo).
Turn
In this case, the rotation of the uterus is distinguished, when the entire organ with the neck is rotated or torsion (twisting), in which the vagina remains in place.
eversion
An everted uterus is rare in real gynecological practice and is usually a complication of childbirth.
A completely inverted organ is characterized by the output of the neck, the body of the vagina. Partially inside-out is manifested by incomplete descent of the uterine fundus beyond the boundaries of the internal opening.
Bias
The anomaly is characterized by the displacement of the organ forward, backward, to the right or to the left. The figure schematically shows a curved uterus, deviated in opposite directions.
Dropping out
Pathology occurs when the muscles and ligaments are weak and is characterized by a displacement of the uterus down to the vagina or out through the labia.
In reproductive age, the position of the organ is restored by surgical intervention. If it fell out completely, deletion is shown.
Uterus removal
Extirpation of an organ (hysterectomy) is performed according to serious indications: with large fibroids, uterine oncology, widespread adenomyosis, heavy bleeding, and so on.
During the operation, it is possible to preserve the ovaries and uterine cervix. In this case, hormone replacement therapy is not prescribed, eggs from the ovaries are suitable for use in surrogate motherhood.
Options for removing the uterus are briefly shown in the photo, after the operation, the bladder moves back, the intestines down.
The rehabilitation period is characterized by pain in the area of the excised organ, bleeding, which gradually subside. Not only physical, but also moral discomfort is possible. Negative consequences are associated with the displacement of organs due to the removed uterus
SURGICAL GYNECOLOGY
Anatomical structure of the cervix
Cervix (cervix uteri) - the lower part of the uterus, which connects to the upper end of the vagina. The cervix has a cylindrical or conical shape. Half of it is visible during vaginal examination, the other half is behind the vagina. The part of the cervix that is in the vagina is the vaginal part of the cervix. It is about 3 cm long and 2.5 cm wide. It is divided into anterior and posterior lips.
The cervix opens into the vagina with an external opening (pharynx). The size of the pharynx, its shape and the neck itself can vary. It depends on age, hormonal status and previous births. The opening of the pharynx of the cervix in nulliparous women is round and small, and in those who have given birth it is wide, in the form of a gap.
Vagina and uterine cavity connected to each other by the cervix, inside which the cervical canal passes (cervical canal). Its size and shape may vary. The width of this channel is 8 mm. The cervical canal ends with an internal opening (pharynx).
There are crypts in the mucous membrane of the cervical canal. Their function is the production of cervical mucus. The mucous membrane of the cervical canal forms folds.
in the cervical canal there are numerous branching glands. The mucosal epithelium of the canal, and the epithelium of these glands, consists of tall cylindrical cells that secrete mucus. This epithelium is called columnar.
In the epithelial cells of the cervical canal cyclical changes occur under the influence of hormonal changes that occur in a woman's body during the menstrual cycle. During the period of ovulation, the secretion of mucus by the glands of the cervical canal increases, and its qualitative characteristics change. The glands of the cervix can sometimes become blocked, and cysts are formed (nabate follicles or cysts of the naboth glands).
The vaginal part of the cervix and the vaginal wall covered with stratified squamous epithelium. There is a transition zone between the stratified squamous epithelium and the columnar epithelium. The zone of transition between the two types of epithelium can sometimes shift, while the columnar epithelium of the cervical canal covers a small area of the vaginal part of the cervix. In such cases they say about pseudo-erosion. The stratified squamous epithelium, which normally covers the vaginal part of the cervix, is pinkish-gray in color, and the columnar epithelium of the cervical canal is red, hence the term erosion or pseudo-erosion.
cervical mucus. At the end of menstruation, the cervical canal is filled with thick mucus. This happens to prevent infection from entering the uterine cavity. A few days before ovulation, it becomes less dense, and its reaction is close to neutral. This allows spermatozoa to pass through this canal into the uterus and from there into the fallopian tubes. After ovulation, cervical mucus thickens again and becomes acidic (low pH).
Methods for determining the likelihood of becoming pregnant are based on determining the properties of cervical mucus. Many methods of hormonal contraception are based on preventing ovulation (the release of an egg from the ovarian follicle). However, their effectiveness is increased, as they prevent the liquefaction of cervical mucus. Thick mucus prevents sperm from entering the uterus. During pregnancy, the cervix is completely blocked by mucus, which protects the uterine cavity from infection.
Location of the cervix
After menstruation and under the influence of the female hormone estrogen, the cervix undergoes a number of changes in its location and structure:
- During the menstrual cycle, the cervix is hard, like the tip of the nose, it is lowered and closed.
- As ovulation approaches, the cervix softens, lifting and opening in response to high estrogen levels. These changes facilitate the penetration of spermatozoa into the uterus.
During menstruation the cervical canal opens slightly so that the desquamated endometrium comes out through it. This opening of the channel in many women is considered one of the causes of pain during menstruation. During childbirth, the cervical canal opens up to 10 cm in diameter, this allows the baby to be born.
The appearance of the cervix in normal and pathological conditions
according to the materials of the international organization for the control of diseases of the cervix (INCGC)
Examination of the cervix is a mandatory step in the gynecological examination.Cervix(cervix uteri- 20) represents the lower segment of the uterus. The wall of the cervix (20) is a continuation of the wall of the body of the uterus. The place where the body of the uterus passes into the cervix is called isthmus. While the wall of the uterus is mostly smooth muscle, the wall of the cervix is mostly connective tissue with a high content of collagen fibers and less elastic fibers and smooth muscle cells.
The lower part of the cervix protrudes into the vaginal cavity and is therefore called vaginal part cervix, and the upper part, lying above the vagina, is called supravaginal part cervix. During a gynecological examination, it is available for examination vaginal part of the cervix. On the vaginal part of the cervix is visible external pharynx- 15, 18) - an opening leading from the vagina to the cervical canal ( cervical canal - 19, canalis cervicis uteri) and continuing into the uterine cavity (13). The cervical canal opens into the uterine cavity internal os.
Fig.1: 1 - the mouth of the fallopian tube; 2, 5, 6 - fallopian tube; 8, 9, 10 - ovary; 13 - uterine cavity; 12, 14 - blood vessels; 11 - round ligament of the uterus; 16, 17 - vaginal wall; 18 - external pharynx of the cervix; 15 - the vaginal part of the cervix; 19 - cervical canal; 20 - cervix.
Fig. 2: 1 - uterus (bottom of the uterus); 2, 6 - uterine cavity; 3, 4 - anterior surface of the uterus; 7 - isthmus of the uterus; 9 - cervical canal; 11 - anterior fornix of the vagina; 12 - anterior lip of the cervix; 13 - vagina; 14 - posterior fornix of the vagina; 15 - posterior lip of the cervix; 16 - external pharynx.
The mucous membrane of the cervical canal consists of an epithelium and a connective tissue plate located under the epithelium ( lamina propria), which is fibrous connective tissue. The mucous membrane of the cervical canal forms folds (18, Fig. 1). In addition to the folds in the cervical canal, there are numerous branching tubular glands. Both the epithelium of the mucous membrane of the canal and the epithelium of the glands consist of high cylindrical cells that secrete mucus. Such epithelium called cylindrical. Under the influence of hormonal changes that occur in a woman's body during the menstrual cycle, cyclic changes also occur in the epithelial cells of the cervical canal. During the period of ovulation, the secretion of mucus by the glands of the cervical canal increases, and its qualitative characteristics change. Sometimes the glands of the cervix can become blocked and cysts form ( Naboth's follicles or glandular cysts).
The vaginal part of the cervix is covered stratified squamous epithelium. The same type of epithelium lines the walls of the vagina. The place of transition of the cylindrical epithelium of the cervical canal into the stratified squamous epithelium of the surface of the cervix is called transition zone. Sometimes the zone of transition between the two types of epithelium can shift, and at the same time the columnar epithelium of the cervical canal covers a small area of the vaginal part of the cervix. In such cases, they talk about the so-called pseudo-erosions (stratified squamous epithelium, which normally covers the vaginal part of the cervix, has a pinkish-gray color, and the cylindrical epithelium of the cervical canal is red; hence the term erosion or pseudo-erosion).
Medical examination
The purpose of a visual examination of the cervix is to identify patients with changes in the appearance of the cervix, erosion and select women who need a more in-depth examination and appropriate treatment. An important point is the timely detection of women with pre-oncological changes in the cervix in the early stages. When conducting a screening examination, in addition to the examination by a doctor, a colposcopy and a Pap smear may be recommended.
Inspection of the cervix is carried out on a gynecological chair in the position of the patient for a gynecological examination. After examining the external genitalia, a speculum is inserted into the vagina and the cervix is exposed. Excess mucus and whites are removed from the cervix with a cotton swab. Inspection of the cervix is usually not carried out during menstruation and during treatment with topical vaginal forms of drugs.
Inspection results:
The appearance of the cervix is normal
The surface of the cervix is smooth, pink; mucous secretion is transparent. The central opening - the external pharynx of the cervix - is round or oval in nulliparous women and slit-like in multiparous women. There is no need for medical procedures. A preventive Pap smear is recommended once a year.
The appearance of the cervix in the postmenopausal period:
The cervix of the uterus in postmenopausal women is atrophic. There is no need for medical procedures. A preventive Pap smear is recommended once a year.
Ectopia (erythroplasia)
Normal physiological changes in the cervix during pregnancy and the postpartum period. There is no need for medical procedures.
View of the cervix with changes
cervicitis
Chronic cervicitis
Chronic inflammatory process in the cervix with the formation of cysts of the natural glands. Naboth glands (naboth follicles) are formed when the excretory ducts of the glands of the cervix are blocked and secretion accumulates in them. This can cause the formation of cysts and local protrusion of the surface of the cervix. Testing for urogenital infections, anti-inflammatory therapy, Pap smear, colposcopy are recommended.
Polyp of the cervical canal
This is a good education. The causes of occurrence are chronic inflammatory processes, cervical trauma, hormonal imbalance. Pap smear and colposcopy are indicated. The polyp is removed in combination with the treatment of concomitant diseases.
In addition to the listed violations, a benign tumor of the cervix (papilloma) can be detected during a doctor's examination; cervical hypertrophy; deformation of the cervix; redness (hyperemia of the cervix); simple erosion (does not bleed when touched); prolapse of the uterus; abnormal cervical secretion (foul-smelling; dirty/greenish in color; or white, caseous, blood-stained discharge).
Cervical changes suspected of being malignant(eg, erosion of the cervix, bleeding or crumbling when touched, with an irregular or loose surface). Cervical erosion (mucosal defect) is one of the most common gynecological diseases in women. Erosion is a defect in the mucous membrane covering the vaginal part of the cervix, which occurs as a result of inflammatory processes, traumatic and other injuries. Cervical cancer. For further examination and decision on therapy, the patient is referred to an oncogynecologist.
In addition to a simple examination of the cervix, for additional information, in some cases, an examination is carried out after the treatment of the cervix with a 3-5% solution of acetic acid.
It is believed that a gynecologist should be visited for a preventive examination at least once a year. This is explained by the existence of diseases that appear for no apparent reason, develop without manifesting themselves, and then give severe complications. Cervical dysplasia is a pathology of the epithelial layer of the cervix, which is characterized by pathological changes in the structure of its cells. There are pathological growths of cells with an atypical structure that do not perform their functions. The natural processes of maturation and rejection are also perverted.
A special danger of dysplasia is given by the fact that atypical cells are characteristic of oncological pathologies. Therefore, this pathology is referred to as precancer. Given the seriousness of these cell transformations, women with diagnosed dysplasia are strongly advised to be examined for the presence of cancer cells, treated and observed by a doctor.
Dysplasia affects the cervix in women of completely different ages. Most often it is detected in young women 20-25 years old.
Reliable causes of dysplasia have not been determined to date. Only factors that provoke the formation, development of dysplasia and its transition to oncological pathology are known.
- The presence in the body of the concomitant human papillomavirus. If a woman is healthy, has good immunity, then the papilloma virus leaves the body on its own. It takes no more than a year. If it lingers for more than a year, then the likelihood of malignant dysplasia increases significantly. This virus is found in 90% of women with diagnosed dysplasia.
- The herpes virus (type 7) increases the likelihood of malignancy.
- Early onset of sexual activity and childbirth too young.
- Lack of immunity.
- Chronic female diseases and hormonal disorders.
- Venereal diseases.
- Injuries of the cervix during childbirth, manipulations, etc.
- Frequent change of partners.
- Joining the inflammatory processes in the female genital organs of the infection can lead to the appearance of dysplasia.
- Long-term use of combined oral contraceptives. After 5 years of its use, the probability of dysplasia increases by 4-5 times.
Also, studies have shown that oral contraceptives using only proteins did not have a pathological effect. Hormone replacement therapy also did not increase the risk.
Dysplasia is promoted by any pathologies that lead to a possible change in the structure of basally located cells. These are such pathomorphological pathologies: ectopia, leukoplakia, ectropion, erosion, etc.
With the diagnosis of cervical erosion, dysplasia is not excluded. However, these two ailments are completely different. And even a certain similarity in their diagnosis and treatment does not identify them. Erosion does not entail changes in the cellular structure. Cell atypicality does not occur. And with dysplasia, this is a prerequisite.
Read all about a healthy uterus .
Symptoms of cervical dysplasia
Unfortunately, cervical dysplasia is characterized by the absence of symptoms at the initial stage. She can remain mute for a long time. Characteristic changes in the epithelium are determined in women who have turned to a gynecologist for other reasons. A dysplasia of the epithelium of the cervix is an accidental finding.
This fact is sad because it is in the initial stage that dysplasia responds well enough to treatment. Unfortunately, discovered at later stages, dysplasia is treated only through surgery.
As a rule, the patient turns to the gynecologist with complaints of concomitant dysplasia conditions. Sometimes patients come to the doctor with chlamydia and genital warts ...
The appearance of pain, complaints of a general nature are not typical.
Sometimes patients complain of the appearance of discharge of an unpleasant odor and an unusual color. Occasionally, there may be a slight discharge of blood in the secretions. Especially after intercourse or the use of vaginal tampons. The appearance of blood indicates a mucosal lesion, usually a dysplastic process, which leads to the fact that the slightest touch causes "contact bleeding".
Degrees of dysplasia
In the diagnosis of dysplasia, the degrees are graded depending on the severity of changes in the epithelial layer..
- Light. Structures of cells are changed slightly. They are determined only in one third of the epithelium.
- Moderate. It is characterized by a progressive change in the intracellular structure. Changes are already determined by 2/3 of the epithelium layer.
- Severe (non-invasive cancer). Changes take place in all layers. But there is no germination in nearby tissues and vessels.
Change in the structure of the cervix
The cervix is a small isthmus at the transition of the vagina into the uterus. It has an exit to the vagina in the form of the so-called external pharynx. The internal os opens into the uterus. As a rule, it is the supravaginal part of the cervix that is affected. It is possible to examine it in mirrors during a gynecological examination.
The entire neck is 4 cm long. The cervical canal is located in it along its entire length. It is made mainly by cells of muscle and connective tissue. During labor, they help to ensure that the cervix can expand to the required size, and then recover to its original state.
To perform this function, the connective tissue here has a large number of collagen and elastic fibers. Thus, they form an elastic frame. The cervix contains many blood and lymphatic vessels and is abundantly innervated.
From the inside, the neck is lined with layers of squamous epithelium and cylindrical. The squamous epithelium has the ability to renew itself. It has local immune properties and protects the uterus from infectious agents.
Cylindrical cells are arranged in one layer. They synthesize a secret that prevents the contents from the vaginal cavity from penetrating into the uterus.
In the region of the external pharynx is the so-called "transformation area". Here the cervical epithelium passes directly into the uterine.
The epithelium of the cervix in its composition contains layers: basal, functioning and intermediate.
Banal cells divide and multiply, thus ensuring the renewal of the mucosa. This layer lies on the layer of muscle cells with vessels and nerve fibers.
In the intermediate layer, epithelial cells complete their formation. The surface layer is the place where they directly perform their function.
If the division and development of cells in the basal part is disturbed, then the entire structure of the mucosa and, accordingly, its function are distorted. That is, dysplasia occurs.
Restructuring in the development of cells leads to a change in their appearance, size, functions and capabilities. They become atypical. These cells are terrible because they can also acquire the possibility of atypical aggressive growth. And then we will talk about the tumor consisting of these cells. It can, progressing, germinate into the vessels, infiltrate the surrounding tissues.
Of course, it is wrong to say unequivocally that cervical dysplasia is cancer.. Dysplasia can even heal itself, but malignancy in a short time is not excluded. Therefore, a high probability of malignancy makes it necessary to attribute dysplasia of the epithelium of the cervix to the state of precancer.
Diagnostics
The only way to prevent dysplasia is regular gynecological examinations, which should be carried out regularly. They are necessary for the timely diagnosis and prevention of dysplastic changes in the cellular composition of the cervix.
For diagnosis, various examination options are used. Moreover, the need for each subsequent depends on the result of the previous one.
First of all, a detailed examination is carried out in the mirrors on the gynecological chair. In this case, an assessment is made of the color of the mucosa, the presence of foci of a changed color, and the macrostructure.
Be sure to take a smear from all patients for cytological examination for atypical cells. The material is carefully obtained from several places most typical for dysplasia: from the transitional zone of the cylindrical epithelium of the cervix to the stratified squamous, from the epithelium of the cervical canal. The material obtained after preliminary preparation is examined by a laboratory assistant under high magnification.
If there are mucosal disorders and/or the response to cytology does not correspond to the physiological norm, then colposcopy is recommended.
Treatment
When choosing therapy for patients diagnosed with dysplasia, the cause of the disease plays an important role. Any treatment begins with the treatment of the root cause and the elimination of provoking pathologies. With a timely and competent approach, this can lead to a full recovery.
Treatment methods are chosen by a specialist, taking into account the severity of the condition, the results of the examination, the degree of dysplasia, comorbidities, age, and the need to maintain the ability to bear children.
Usually these are immunostimulating therapy, surgical treatment and local chemical therapy.
If there are superficial erosions, then the treatment is conservative. Here you will have to be patient. If necessary, antibacterial drugs, anti-inflammatory, antifungal drugs are recommended.
Specific treatment of comorbidities is applied. Local treatment is also prescribed with the use of gynecological applications and baths with medicines.
Modern hardware technologies
Surgical treatment is to eliminate the site of dysplasia.
- Moxibustion. This technique is recommended in the absence of the effect of conservative therapy. It is used at 2 and 3 degrees. In this case, electrocoagulation and cryodestruction are used. The latter is more gentle, but there is a risk that some atypical cells will not be sufficiently frozen and some atypical cells will remain alive.
- Laser coagulation. This method of cauterization is quite effective, painless. Complications after it are practically excluded
- radio wave destruction. With this method, the affected areas are cauterized using radio waves of a special frequency. This technique is one of the most promising. Its advantages are that the surrounding tissues are little involved. Healing occurs within a month.
A big plus is that the muscle cells of the cervix do not suffer. There is no scar left after the procedure. And this is a guarantee of the absence of complications in childbirth.
- Electroconization. This method is used in severe cases. With its help, pathologically altered cells are eliminated throughout the entire thickness of the epithelium.
- Conization is the elimination of a cone-shaped section of the cervix. It is used when the previous methods are ineffective.
Therapy using chemical methods is carried out with special preparations that have a cauterizing effect. After such exposure, a crust forms, which, after a few days, leaves on its own. It is used only for small areas of damage. It may be necessary to carry out the procedure several times.
New therapeutic methods
Relatively new methods of treatment are organotherapy, mistletoe therapy, photodynamic therapy.
In organotherapy, organ preparations are used, based on intracellular biologically active substances from the glands and organs of animal and plant origin.
Mistletoe therapy consists in the use of medicines from white mistletoe, which activates the protective immune system of the body. This inhibits tumor growth and the possibility of metastasis.
Photodynamic therapy involves the use of photoactive substances that are injected into the body and then exposed to a laser. It is effective in the treatment of not only inflammatory pathologies, but also malignant tumors.
Folk remedies
If there is cervical dysplasia, treatment with folk remedies is not excluded by doctors. Traditional medicine is recommended for use, however, only in parallel with traditional treatment.
Tampons soaked in a mixture of propolis and butter are also effective. The mixture is boiled for 15 minutes. Cooling down. The procedure is carried out once a day before bedtime for a month.
Tampons with pharmaceutical ready-made sea buckthorn oil have a healing effect. They are used twice a day for a month.
Eucalyptus leaves (2 tablespoons) are poured with a glass of boiling water and infused for a couple of hours. Then the broth is filtered, diluted in half with boiled water and douching is carried out twice a day for a month.
To date, the choice of treatment methods is quite wide. Cervical dysplasia, despite the high risk of dangerous complications, responds well to treatment.
Timely diagnosed cervical dysplasia has a favorable prognosis.
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