NEWS | homepage | LIST OF ALL TOPICS | MUM address & What does MUM mean? | e-mail the museum | privacy on this site | who runs this museum?? |
Amazing women! | the art of menstruation | artists (non-menstrual) | asbestos | belts | bidets | founder bio | Bly, Nellie | MUM board | books: menstruation and menopause (and reviews) | cats | company booklets directory | contraception and religion | costumes | menstrual cups | cup usage | dispensers | douches, pain, sprays | essay directory | extraction | famous women in menstrual hygiene ads | FAQ | founder/director biography | gynecological topics by Dr. Soucasaux | humor | huts | links | masturbation | media coverage of MUM | miscellaneous | museum future | Norwegian menstruation exhibit | odor (olor)| pad directory | patent medicine | poetry directory | products, current | religion | your remedies for menstrual discomfort | menstrual products safety | science | shame | slapping, menstrual | sponges | synchrony | tampon directory | early tampons | teen ads directory | tour of the former museum (video) | underpants directory | videos, films directory | Words and expressions about menstruation | Would you stop menstruating if you could? | What did women do about menstruation in the past? | washable pads
More articles by Dr. Soucasaux: Anatomical drawings - Anovulatory cycles - Archetypal aspects of the female genitals - The breasts: some morphological aspects - Colposcopy - Comments on the corpus luteum and related aspects - Comments on some anatomical and symbolic aspects of the female pelvis - The curious relations between androgens and estrogens in women - Drospirenone Oral Contraceptives - Due to prohibition, Brazilian women don't have access to modern medicinal abortion - Endocrinology of menstruation - The Fallopian tubes - Female sexual response - The Gräfenberg Spot (G-Spot) - The Gynecologic Palpation (descendant of "The Touch") - Gynecological assistance: the three basic areas - Gynecology and Gynecologic Surgery - Gynecologist versus obstetrician: what lies behind the combination? - "Gyneco-obstetric-surgical" stubborness and the perpetuation of one of the greatest mistakes of women's medicine - Hypermenorrhea and/or Menorrhagia (Prolonged and/or Excessive Menstrual Bleedings) - Hypertrichosis, Hirsutism and Androgenic Manifestations in Women - Mayer-Rokitansky-Kuster-Hauser (MRKHauser) Syndrome - Menstrual toxin: An old name for a real thing? - Nature and the ovaries - On the Intimate, or Small-Scale, Mechanisms of Menstruation - On the Strange Nature of the Ovaries - Oral hormonal contraceptives (the "Pill") - The Ovaries: Some Functional and Archetypal Considerations - Peculiarities of the Female Genitals' Sensory Innervation - Physiology of menstruation - Polycystic ovaries syndrome - The Possibility of Becoming Pregnant, Its Implications for Women, and Abortion - Premenstrual congestion of the breasts - Premenstrual syndrome (PMS) - The Psychology of Gynecology part 1 (part 2) - Psychosomatic and symbolic aspects of menstruation - Psychosomatic gynecology - Some Details on the Function of the Hypothalamus-Pituitary-Ovaries Axis - Stanislav Grof's Perinatal Matrixes of the Unconscious and Women's Medicine - Symmetric Patterns in the Female Genitals - Thoughts on Female Sexual Psychology - Uninterrupted use of hormonal contraceptives for menstrual suppression: why I do not recommend it - The uterine cervix - Uterine contractility - The Uterus and the Female "Passive-Active" - Women's corporeal consciousness and experience - Women's Experience of the Breasts - Women's Undesired Pregnancies and Women's Right to Abortion and see his Art of Menstruation


The Uterine Cervix

Dr. Nelson Soucasaux, Brazilian gynecologist

The uterine cervix is the inferior [lower] and intravaginal [inside the vagina] part of the uterus. The cervical canal is the uterine "way in" and "way out," since the uterine cavity communicates with the vagina by means of this narrow canal. In contrast to the uterine corpus, the amount of smooth muscle fibers contained in the cervix is very small, and most of its structure is constituted by dense collagenous tissue. It is also mostly through the cervix that the uterus is kept "anchored" and centralized inside the pelvis, and this is due to an intricate ligamentary structure named retinaculum uteri.

These attach the uterine cervix to the pelvic bones and other pelvic organs. The most important of these ligaments that originate in the structure of the uterine cervix are the cardinal or cervico-lateral, the sacro-uterine and the pubo-vesico-uterine ones. The other ligamentary structures that also keep the uterus in its position do not originate in the cervix but in the uterine corpus [the "body" of the uterus] and they are mostly constituted by the broad and the round ligaments.

The cervical canal or endocervix is lined by a folded mucosa exhibiting innumerable branching tubular-shaped glands consisting of single-layered columnar epithelium. On the other hand, the epithelium that lines the ectocervix (the external part of the uterine cervix) is a squamous stratified one, identical to the vaginal. Due to the usual phenomenon of the ectopy, eversion or ectropium of the endocervical mucosa, very frequently part of the glandular tissue moves outward the external cervical orifice, "invading" the ectocervix.

Anatomically and physiologically, the cervical canal is the "transition point" between the higher and the lower parts of the female genital tract. The mucous secretion produced by the endocervical glands plays an important role in the cervical physiology. This secretion exerts a control upon the penetration of the spermatozoa inside the uterus and, in normal conditions, reduces the ascension of bacteria and other microorganisms towards the upper parts of the female genitals.

The mucous secretion produced by the endocervical glands is highly sensitive to the actions of the ovarian hormones. Thus, according to the hormonal influences, it may not only facilitate the penetration of the spermatozoa inside the uterus but also create some difficulty, though relative, to this penetration. Higher estrogen levels cause specific changes in the cervical secretion, by means of which it becomes more fluid and very receptive to the spermatozoa. Conversely, progesterone inhibits the estrogenic effect on this secretion, producing just the opposite changes: the mucous secretion becomes thicker, less receptive and even "hostile" to the male reproductive cells.

Under strong estrogen stimulation and in the absence of progesterone, the endocervical secretion becomes abundant, fluid and transparent, acquiring physico-chemical features that facilitate the quick ascension of the spermatozoa. In this condition, when it is collected on a microscope slide, slightly heated to dry and seen at the microscope, the endocervical secretion forms beautiful branching crystals resembling fern leaves. Its elasticity and capacity to form long filaments when distended [stretched] (phenomenon known as "spinnbarkeit") also becomes maximal. Progesterone reduces or inhibits all these changes, thickening the endocervical secretion and, therefore, creating variable degrees of difficulty for the penetration of the spermatozoa. Low estrogen levels also impede the adequate preparation of the endocervical secretion, keeping it less receptive to the male reproductive cells. Considering these facts it is obvious that, throughout the ovulatory cycles, the period of the cycle in which the cervical secretion is more receptive to the spermatozoa is just near ovulation [around the middle of the menstrual cycle].

When non-infected, the cervical canal also separates the septic part of the woman's genital tract (vulva and vagina) from the aseptic one (uterine cavity and Fallopian tubes). Due to its content of leukocytes, in ideal conditions the endocervical secretion seems to create some difficulty for the ascension of bacteria and other microorganisms to the interior of the uterus. Nevertheless, this difficulty is relative and of small magnitude, because the endocervical mucosa almost always exhibit variable degrees of infection and inflammation. More intense cervicitis can exert just the opposite effect, functioning as an infectious focus for the higher parts of the genital tract and also for the parametrium (the connective tissue that surrounds mostly the uterine cervix, including the cardinal or cervico-lateral ligaments).

Though its walls are mostly constituted by dense connective tissue containing only a few bundles of intermingled smooth muscle fibers, the uterine cervix exhibits an amazing capacity of dilation and distention at the moment of parturition [childbirth]. This is due to the great softening of its tissues that takes place along pregnancy and that is maximal near childbirth. As a result of this process, the uterine cervix becomes very malleable at the moment of parturition. In spite of this, cervical lacerations resulting from obstetric traumas were always very frequent.

The cervical canal possesses innumerable nervous endings highly sensitive to pressure whose stimulation, by means of a reflex neuroendocrine pathway, triggers the release of oxytocin by the hypothalamus. Thus, considering that oxytocin is the main hormonal factor responsible for the uterine contractility, the strong mechanical stimulation of the endocervix that takes place along parturition indirectly triggers more and more powerful uterine contractions. This is one of the main mechanisms of childbirth.

For several reasons, the uterine cervix functions as a kind of "shock organ" in the female genital tract. In the uterine cervix there is a strange focus of epithelial "unquietness," which is related to a physiological process by which the usual eversions of the endocervical mucosa are resurfaced by the squamous stratified epithelium typical of the ectocervix, giving rise to the so-called "transformation zones." A sum of irritative, inflammatory and infectious factors collaborate for making the area of these eversions the site of sometimes problematic histological changes. The main infectious factor responsible for the development of cervical epithelial atypias is the HPV (Human Papillomavirus).

Fortunately, in most cases this epithelial "unquietness" is benign, and the new squamous stratified epithelium that develops for resurfacing the ectopic area of glandular epithelium is entirely normal. In such cases, the result is the formation of what we call a "typical transformation zone." However, with some frequency this cellular proliferation gives rise to several degrees of epithelial atypias and abnormalities, resulting in the development of "atypical transformation zones." Among the abnormalities that may develop there we can mention, in increasing order of severity, the slight, moderate and accentuated "cervical dysplasias" and the carcinoma in situ of the cervix (see note below). The carcinoma in situ of the cervix is the initial stage of cervical cancer, while it is still restricted to the epithelium. At this stage it is non-invasive and can be easily and successfully treated through very small surgical procedures.

As it is widely known, the "cervical dysplasias" (also known as "cervical intraepithelial neoplasias" or "squamous intraepithelial lesions") are epithelial abnormalities that may give origin to cervical cancer, mostly as they aggravate and progress in severity. An accentuated "dysplasia" or 3rd degree "cervical intraepithelial neoplasia," for instance, is clinically almost equivalent to the carcinoma in situ of the cervix. On the other hand, while part of the slight "dysplasias" or 1st degree "cervical intraepithelial neoplasias" may disappear after clinical treatment or even spontaneously, they also may progress in severity and give rise to more serious lesions and, finally, to cervical cancer. In this way, all epithelial abnormalities and atypias of the uterine cervix (detected at cytological examinations, colposcopy or biopsy), even the low-degree ones, require great and constant medical attention.

Finally, I would like to emphasize that, concerning the prevention and early detection of cervical pre-malignant and malignant pathologies, all women ought to undergo a cytologic examination of the uterine cervix every six months or, at least, once a year. Periodic cervical colposcopic examinations should also be performed.

Note: Presently the traditionally named "cervical dysplasias" are being mostly known as "cervical intraepithelial neoplasias" (CIN) or, according to the new Bethesda System, "squamous intraepithelial lesions" (SIL). A slight "dysplasia" corresponds to a 1st degree "cervical intraepithelial neoplasia" (CIN 1). A moderate "dysplasia" corresponds to a 2nd degree "cervical intraepithelial neoplasia" (CIN 2), and an accentuated "dysplasia" to a 3rd degree "cervical intraepithelial neoplasia" (CIN 3). Nevertheless, the new Bethesda System is reducing the aforementioned three stages of "cervical dysplasias" or "cervical intraepithelial neoplasias" that can be found at cytological examinations to two types: the low-degree "squamous intraepithelial lesions" (low-degree SIL) and high-degree "squamous intraepithelial lesions" (high-degree SIL). They also have introduced two new concepts in cervical cytology: ASCUS ("atypical squamous cells of undetermined significance") and AGUS ("atypical glandular cells of undetermined significance").

The text above is an updated excerpt from my book "Os Órgãos Sexuais Femininos: Forma, Função, Símbolo e Arquétipo" ("The Female Sexual Organs: Shape, Function, Symbol and Archetype"), published by Imago Editora, Rio de Janeiro, 1993. For more information on the book, see page http://www.nelsonginecologia.med.br/orgaos.htm from my website www.nelsonginecologia.med.br .

Copyright Nelson Soucasaux 1993, 2002

______________________________________

Nelson Soucasaux is a gynecologist dedicated to clinical, preventive and psychosomatic gynecology. Graduated in 1974 by Faculdade de Medicina da Universidade Federal do Rio de Janeiro, Brazil, he is the author of several articles published in medical journals and of the books "Novas Perspectivas em Ginecologia" ("New Perspectives in Gynecology") and "Os Órgãos Sexuais Femininos: Forma, Função, Símbolo e Arquétipo" ("The Female Sexual Organs: Shape, Function, Symbol and Archetype"), published by Imago Editora, Rio de Janeiro, 1990, 1993.

Web site: www.nelsonginecologia.med.br

Email: nelsons@nelsonginecologia.med.br

NEWS | homepage | LIST OF ALL TOPICS | MUM address & What does MUM mean? | e-mail the museum | privacy on this site | who runs this museum?? |
Amazing women! | the art of menstruation | artists (non-menstrual) | asbestos | belts | bidets | founder bio | Bly, Nellie | MUM board | books: menstruation and menopause (and reviews) | cats | company booklets directory | contraception and religion | costumes | menstrual cups | cup usage | dispensers | douches, pain, sprays | essay directory | extraction | famous women in menstrual hygiene ads | FAQ | founder/director biography | gynecological topics by Dr. Soucasaux | humor | huts | links | masturbation | media coverage of MUM | miscellaneous | museum future | Norwegian menstruation exhibit | odor (olor)| pad directory | patent medicine | poetry directory | products, current | religion | your remedies for menstrual discomfort | menstrual products safety | science | shame | slapping, menstrual | sponges | synchrony | tampon directory | early tampons | teen ads directory | tour of the former museum (video) | underpants directory | videos, films directory | Words and expressions about menstruation | Would you stop menstruating if you could? | What did women do about menstruation in the past? | washable pads
More articles by Dr. Soucasaux: Anatomical drawings - Anovulatory cycles - Archetypal aspects of the female genitals - The breasts: some morphological aspects - Colposcopy - Comments on the corpus luteum and related aspects - Comments on some anatomical and symbolic aspects of the female pelvis - The curious relations between androgens and estrogens in women - Drospirenone Oral Contraceptives - Due to prohibition, Brazilian women don't have access to modern medicinal abortion - Endocrinology of menstruation - The Fallopian tubes - Female sexual response - The Gräfenberg Spot (G-Spot) - The Gynecologic Palpation (descendant of "The Touch") - Gynecological assistance: the three basic areas - Gynecology and Gynecologic Surgery - Gynecologist versus obstetrician: what lies behind the combination? - "Gyneco-obstetric-surgical" stubborness and the perpetuation of one of the greatest mistakes of women's medicine - Hypermenorrhea and/or Menorrhagia (Prolonged and/or Excessive Menstrual Bleedings) - Hypertrichosis, Hirsutism and Androgenic Manifestations in Women - Mayer-Rokitansky-Kuster-Hauser (MRKHauser) Syndrome - Menstrual toxin: An old name for a real thing? - Nature and the ovaries - On the Intimate, or Small-Scale, Mechanisms of Menstruation - On the Strange Nature of the Ovaries - Oral hormonal contraceptives (the "Pill") - The Ovaries: Some Functional and Archetypal Considerations - Peculiarities of the Female Genitals' Sensory Innervation - Physiology of menstruation - Polycystic ovaries syndrome - The Possibility of Becoming Pregnant, Its Implications for Women, and Abortion - Premenstrual congestion of the breasts - Premenstrual syndrome (PMS) - The Psychology of Gynecology part 1 (part 2) - Psychosomatic and symbolic aspects of menstruation - Psychosomatic gynecology - Some Details on the Function of the Hypothalamus-Pituitary-Ovaries Axis - Stanislav Grof's Perinatal Matrixes of the Unconscious and Women's Medicine - Symmetric Patterns in the Female Genitals - Thoughts on Female Sexual Psychology - Uninterrupted use of hormonal contraceptives for menstrual suppression: why I do not recommend it - The uterine cervix - Uterine contractility - The Uterus and the Female "Passive-Active" - Women's corporeal consciousness and experience - Women's Experience of the Breasts - Women's Undesired Pregnancies and Women's Right to Abortion and see his Art of Menstruation

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