The cervix, or the lower segment of the uterus, is sort of like a gateway into the uterus. The pear-shaped body of the uterus tapers into the cervix, which protrudes into the upper part of the vagina. During a pelvic exam, health care professionals can use a speculum to open up the vagina and look at the cervix. We swab it and scrape it to test for cancerous cells (a.k.a. a Pap smear) or bugs like Chlamydia. The cervix has some cool party tricks. Normally the cervical os, which is the opening at the center of the cervix, is closed to prevent infections and other junk from climbing up into the uterus. But the os opens a little to allow menstrual fluid out every month. The cervix also opens in a major way during childbirth, to allow the baby to exit the womb. The cervix can also produce fluid. During the time of the month when a woman has ovulated and is most fertile, her cervical fluid has a special thin texture that actually helps guide sperm up into the cervix to increase chances of fertilization. But during “infertile” times of the month, such as before ovulation, the cervix produces a thick acidic fluid that can kill off sperm or other potential uterine invaders. The cervix can also change its position and texture to either help or hinder sperm, depending on where a woman is in her menstrual cycle.Finding a cervix during a pelvic exam can be really tricky. Sometimes you insert the speculum and open it up and the cervix pops into view, perfectly centered. But oftentimes the cervix isn’t so cooperative. Some women have a cervix that points to the ceiling, or toward the floor, or way off to the left or the right. These are all normal positions. If you’ve ever been told you have a tilted uterus or a cervix that’s difficult to find, it doesn’t mean you’re abnormal or less fertile than other women. In the vast majority cases, it’s perfectly normal and healthy to have a wonky womb.The cervix, for all of its neat features, has some vulnerabilities too. It’s especially prone to infection by sexually transmitted infections. Some of these infections, like gonorrhea, can clear up after a course of antibiotics. Others, like human papillomavirus, like to hang around and cause problems like cervical cancer. You can keep your little cervix happy and healthy by using condoms during intercourse and receiving your regularly scheduled Pap tests. The new Pap guidelines say you don’t have to have your first Pap test until age 21, and you don’t necessarily need one every year (more like every other year or once every three years, depending on your age group) unless there’s a problem. You can access the American College of Obstetrics and Gynecology’s new Pap guidelines here. Women between ages 9 and 26 are also candidates for the HPV vaccine. This vaccine prevents women from catching the strains of HPV most likely to cause cancer. There are two vaccines on the market now: Gardasil and Cervarix. I think these vaccines will greatly reduce the financial and emotional burden of abnormal Pap tests and cervical cancer over the next few decades.
Vitals And Bits #6: The Cervix
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