Cylindrical neck shape. What does cervical cancer look like: pictures with explanations. External dimensions of a normal pelvis

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The cervix has its own clinical and morphofunctional characteristics at different age periods of a woman’s life, which determine the options for topographic-anatomical relationships in it.

The formation of the cervix occurs through the fusion of the Müllerian canals at 12–16 weeks of embryogenesis. As is known, in the cervix there is a vaginal part, protruding into the vaginal lumen, and a supravaginal part, located above the attachment of the vaginal walls to the uterus, consisting mainly of connective and muscle tissue in which blood vessels and nerves are located. The vaginal part of the cervix, covered with stratified squamous epithelium, is called exocervix. Muscle tissue is mainly contained in the upper third of the cervix and is represented by circularly located muscle fibers with layers of elastic and collagen fibers, the functional activity of which is regulated by dual sympathetic and parasympathetic innervation.

Muscle tissue provides the obturator function of the cervix during pregnancy; during childbirth, it forms the lower segment of the birth canal. The cervical canal has a spindle-shaped shape, its length from the external pharynx to the isthmus is no more than 4 cm, its width is no more than 4 mm, the external pharynx is round or in the form of a transverse slit. The cervical canal is covered with a single row of tall columnar epithelium and is called the endocervix.

The structure of the integumentary epithelium of the vaginal part of the cervix in women has been studied in detail at the light-optical and ultrastructural levels by domestic and foreign researchers (Bohman Y.V., 1989; Vasilevskaya L.N., Vinokur M.L., 1971; etc.).

The multilayered squamous epithelium of the vaginal part of the cervix is a highly differentiated tissue with a complex structure and certain functional features.

The epithelium covering the cervix consists of four layers:
1) basal- represents immature epithelial cells located on the basement membrane in one row. These cells have uneven contours and vary in size. The basement membrane separates the squamous stratified epithelium from the underlying connective tissue;
2) located above the basal cells parabasal cell layer located in several rows. Cells of the basal and parabasal layers have mitotic activity;
3) intermediate cell layer consists of 6-7 rows of moderately differentiated cells;
4) surface layer represented by 2-3 rows of superficial cells, which tend to become keratinized and are easily desquamated depending on the phase menstrual cycle.

The blood supply to the stratified squamous epithelium is carried out by blood vessels that are located under the basement membrane. The formation of terminal capillary loops is directly dependent on the level of sex hormones in the blood (estrogens and gestagens).

The main function of stratified squamous epithelium, like any epithelium located on the border with the external environment, is protective. Lumps of keratin provide strength to the mucous membrane and thereby create a mechanical barrier; the immunological barrier is created by lactic acid, which is formed due to the metabolism of glycogen with the participation of lactobacilli.

The mucous membrane of the cervical canal is covered with a single-row tall columnar epithelium with a basally located nucleus.

As is known, in the cervix the border of two genetically various types epithelium is the area of transition between the squamous stratified epithelium of the vaginal part and the high columnar epithelium of the mucous membrane of the cervical canal. The area of transition between flat multilayered and columnar epithelium has complex histoarchitecture.

The columnar epithelium of the mucous membrane of the cervical canal near the transition to stratified squamous epithelium is supplemented by a layer of reserve cells, where they are located in several layers and form, in some cases, immature metaplastic epithelium. At the junction itself, the metaplastic epithelium consists of a large number of cells and is characterized by a tendency to form layers. Reserve cells are located under the columnar epithelium on the basement membrane, as well as under the multirow epithelium of the transition zone. Most researchers recognize the bipotent properties of reserve cells, i.e. the possibility of their differentiation into multilayered squamous or columnar epithelium under the influence of various factors (Vasilevskaya L.N. et al., 1987; Kashimura M., 1980; etc.).

The transition area between tall cylindrical and flat stratified epithelium in women of reproductive age in most cases coincides with the area of the external pharynx. However, it can also be located on the vaginal part of the cervix, which is associated with age, as well as hormonal balance in the body (Vasilevskaya L.N. et al., 1987; Zharov E.V. et al., 2000; etc.).

The displacement of the transition zone to the exocervix in the prenatal period is considered a normal stage of development of the cervix and is explained by the hormonal effects, in particular, of estrogens produced by the maternal body. In this case, the so-called “congenital erosions” or ectopia that arose during intrauterine development can persist until prepubertal age.

At the same time, in most girls, as the body grows and develops, ectopia decreases and by the period of puberty, the border between flat multilayered and high cylindrical epithelium is established at the level of the external pharynx. In some cases, this process is delayed and then the area of ectopia on the cervix remains. The maximum frequency of such ectopia is observed in young nulliparous women under 25 years of age.

As the woman’s body grows and develops, the transition zone shifts to the area of the external pharynx, and the ectopia disappears. During reproductive age, cyclic changes occur in the cervix during the normal menstrual cycle associated with the influence of ovarian hormones. From the 8-9th day of the cycle, the opening of the cervical canal begins to expand, and transparent glassy mucus appears in it.

By the 10-14th day of the cycle, the opening of the cervical canal expands from 0.25 to 0.3 cm in diameter, becomes rounded, becomes shiny, and when the exposed cervix is illuminated with the help of vaginal speculum, it resembles a pupil. In the following days of the cycle, the amount of mucus decreases again, it disappears, and the cervix becomes dry. The functional significance of cervical mucus is that it actually acts as a barrier between the vagina and the uterine cavity and plays a protective role against the penetration of bacteria into the uterine cavity.

During the menopause, against the background of age-related changes in the whole organism, involutive processes primarily affect the reproductive system. They are characterized first by the cessation of reproductive and then menstrual function. This is based on a sharp decrease in the synthesis of ovarian sex hormones, which have a multifaceted effect on metabolic processes and, accordingly, on the function of various organs and systems.

During the postmenopausal period, due to involutional processes in the reproductive system, a shift of the transition zone to the lower third of the endocervix is noted. Against the background of age-related estrogen deficiency, morphological changes occur, manifested in the form of atrophic colpitis and nonspecific cervicitis. At the same time, dystrophic changes develop in the underlying stroma, associated with deterioration of trophism, a decrease in microcirculation of the blood flow and processes of extravasation of the stroma and all layers of the vaginal wall. The onset of postmenopause is not always accompanied by atrophic changes in the epithelium of the cervix and vagina, since for a long time it is possible to be exposed not only to ovarian hormones, but also to hormones produced compensatory by the adrenal glands.

Listed age characteristics The cervix predisposes to a certain topographic-anatomical localization of pathological processes: thus, vulvovaginitis is more common in girls, endocervicitis is more common in women of reproductive age, inflammatory-proliferative processes in the mucous membrane of the exocervix, localization of cancer on the exocervix is typical. For postmenopausal women, degenerative-dystrophic processes of the exocervix are specific; cancer is localized in the endocervix, i.e. in the cervical canal.

The condition of the cervix is determined not only by the age characteristics of the woman, but also by the nature of the biocenosis of the genital tract and the level of local immunity.

It is believed that a woman’s reproductive tract contains three “ecological niches” (Rusakevich P.S., 2000): 1) squamous epithelium of the vagina; 2) prismatic epithelium of the cervix (crypt); 3) the unique environment of the cervical glands (if any). Each “niche” has its own microbial ecosystem. The nature of the microcenosis is influenced by a number of factors (acidic pH in the vagina and alkaline in the endocervix). In the vagina there is only a slightly greater diversity of species. It was found that 1 ml of vaginal secretion from healthy non-pregnant women contains 108-1010 microbial cells (µ/ml). Aerobes account for 105-108 μ/ml, anaerobes - 108-109 μ/ml. The microbial landscape of the vagina and cervix is dominated by lactobacilli (Doderlein bacillus). In 71 - 100% of women they are found to be 106-109 μ/ml.

Other microflora is represented by staphylococci (aureus in 4 - 33% of women, epidermal - in 10-74% - up to 107 μ/ml), bifidobacteria (in 10% of women up to 107 μ/ml), lactic acid bacteria and streptococci (14%), bacteroides (6%), peptostreptococci (14% of cases). Enterobacteriaceae, non-hemolytic and hemolytic streptococci, fusobacteria and other types of microbes can also be found in the cervix.

With a normal biocenosis of the female genital tract, the total number of microorganisms is less than 107 μ/ml of secretion; they are dominated by Doderlein bacilli (lactobacillus), gardnerella make up 5-37%, mycoplasma 15-30% (Rusakevich P.S., 2000).

Normal vaginal biocenosis with local immunity factors are the first line of anti-infective defense.

Factors of local immunity include cellular and humoral factors. Cellular factors resemble the lymphoid elements of the bronchi and Peyer's patches in the intestine. In the submucosal layer there are accumulations of lymphocytes, plasma cells, tissue macrophages, and neutrophils. The latter are functionally complete, have high phagocytic activity, a powerful lysosomal apparatus (enzymes), and an oxygen-dependent cytotoxicity apparatus.

The humoral system of the genital organs is quite independent. In this case, the cervix is the place of greatest immunological activity. There are several types of humoral protective factors. Immunoglobulins (Ig) are represented mainly by Ig A and Ig G, and to a lesser extent by Ig M. They are contained in the mucous membrane of the cervix and are secreted by plasma cells. The amount of immunoglobulins G and A in cervical mucus changes cyclically according to the phases of the menstrual cycle (increases at the beginning and end of the cycle). Progesterone (endo- and exogenous) is also able to enhance the secretion of immunoglobulins. An increase in the amount of immunoglobulins indicates an increase in the activity of local anti-infective immunity.

Complement plays an important role in protecting the mucous membranes of the genital tract. It is produced by the mucous membrane of the cervix and vagina. The complement of mucous membranes, mainly cervical mucus, is able to attach to secretory Ig A. As a result, the phenomenon of opsonization of microorganisms and their subsequent phagocytosis by mucus neutrophils occurs. Cervical and vaginal fluids contain lysozyme. It causes a direct bactericidal effect and enhances the phagocytic activity of neutrophils. Means of local anti-infective protection are represented by lactoferrin, B-lysines, interferons.

V.N. Prilepskaya, E.B. Rudakova, A.V. Kononov

Ultrasound of the cervix, polyps, cysts and other pathologies

Cervical diseases a fairly common gynecological pathology, on average up to 55% of women, when visiting a gynecologist, encountered various manifestations. Basically, these are background diseases that are asymptomatic, completely reversible under the influence of appropriate therapy, or often, specific treatment do not require and heal on their own. IN last years There has been an increase in the number of cases of cervical disease in young women. The age range from 15 to 24 years is critical in relation to exposure to harmful factors.

Modern diagnosis of cervical pathology is based on a wide range of special studies:

Examination of the cervix in a speculum with various tests performed when a pathological area is detected.
Survey, extended and microcolposcopy - examination of the cervix with a magnification of tens and hundreds of times using a colposcope or an optical system for “intravital histological examination”.
Cytological studies and biopsy.
Quite rarely, if a malignant process is suspected, cervicoscopy, cervicohysterography, MRI, CT, angio- and lymphography are used.

The possibilities of ultrasound diagnostics are not used enough by gynecologists, despite the high information content and availability of the method in the whole group diseases of the cervix. This is due to the relatively recent introduction of the transvaginal pelvic ultrasound method, where the probe is placed directly to the cervix.
Ultrasound can be used as an important additional method in examining patients with cervical pathology, which allows one to assess the thickness and structure of the mucous membrane of the cervical canal, and identify formations and inclusions of the muscular layer of the cervix. In addition, echography provides additional information about the size, structure of the cervix, characteristics of the blood supply (with digital Doppler mapping and pulse Doppler), the condition of the parametrium, and sometimes the pelvic lymph nodes.

One of the most common reasons for sending patients for ultrasound of the pelvic organs is in cervical examination, are:

Cervical cysts and cervical polyps
Hypertrophy or severe deformation of the cervix
Uterine fibroids and endometriosis
Female sexual dysfunctions, accompanied by pain and contact bleeding during or after sexual intercourse.
Dysmenorrhea (painful menstruation) and pelvic pain of unknown etiology
Stress urinary incontinence due to prolapse of the pelvic organs.
Suspicion of cervix
Preparing for pregnancy and childbirth
Infertility examination
Preparation for IVF (in vitro fertilization)
.
Cervix represents the lower segment of the uterus. The wall of the cervix is a direct continuation of the wall of the uterine body. The place where the body of the uterus passes into the cervix is called isthmus. While the uterine wall is primarily composed of smooth muscle, the cervical wall is primarily composed of connective tissue.
The lower part of the cervix protrudes into the vaginal cavity and is therefore called vaginal part of the cervix, and the upper part lying above the vagina is called supravaginal part of the cervix. Cervical canal located in the cervix, connects the uterine cavity and vagina. Visible on the vaginal part of the cervix external os- a branch leading from the vagina into the cervical canal and continuing into the uterine cavity, where it opens internal throat.

Ultrasound picture

1. The position of the cervix in relation to the body is determined
The cervix is located at a wide angle to the body of the uterus; the narrowing of this space and sharpening of the angle refers to the so-called inflections of the uterus
2. Shape
The cervix has a cylindrical shape, cross section in the form of an oval
3. Outlines
The contours of the cervix should be smooth and clear. The thickness of the front and rear walls is also assessed here; normally it is the same
4. Dimensions
The size of the cervix varies widely. Not only individual anatomical and physiological characteristics are important, but also resulting in childbirth through the natural birth canal. The maximum size of the cervix/hypertrophy of the cervix/ is 37*30*34 mm and the minimum size/shortening of the cervix/ is 29*26*29 mm, the most important indicator for a successful pregnancy. The physiological ratio of the length of the uterine body to the length of the cervix is assessed (3:1 in reproductive age)
5. Echogenicity
The myometrium of the cervix has a slightly greater echogenicity in relation to the body, due to a more pronounced fibrous component in the muscle tissue
6. Structure
The myometrium of the cervix should have a homogeneous structure. Single round anechoic inclusions up to 5 mm and hyperechoic inclusions in women who have given birth are interpreted as a variant of the norm. Hypoechoic round formations visualized in the wall of the cervix are most often represented by endocervical cysts.
7. The cervical canal of the cervix is assessed separately according to several parameters
The cervical canal is represented by a hyperechoic (bright) linear structure. Its contours are clear and even. The width of the cervical canal, the thickness of the mucosa (endocervix), the assessment of folding, the presence of polypoid formations, the deposition of calcifications, and the identification of other pathological areas are carried out. Much attention, especially in pregnant women, is paid to examining the internal os of the canal.
The external os and superficial structures of the vaginal part of the cervix are in most cases poorly visualized, so their assessment must be treated with extreme caution.

The echographic picture of the cervix does not undergo significant changes during the menstrual cycle. Significant differences during the secretory period (menstruation) are the high echogenicity (brightness) of the endocervix in combination with the heterogeneous internal echostructure of the canal contents, due to the presence of a rejected component (bleeding).

Classification of cervical diseases
. /important for ultrasound diagnostics/

Cervicitis

Cervicitis is a total inflammation of the cervix, including the mucous membrane of the vaginal part of the cervix (exocervicitis) and the mucous membrane of the cervical canal (endocervicitis). In the postmenopausal period, atrophic cervicitis develops due to thinning of the cervical mucosa. Superficial cervicitis and erosions are not examined by ultrasound; the echo signs of endocervicitis are quite conditional and are associated mainly with changes in the ultrasound picture of the cervical canal, which cannot be explained by other reasons. For example, disruption of the contours and expansion of the cervical canal, thickening of the endocevix, multiple cysts or microcalcifications in a nulliparous woman will be classified as this pathology.

Cervical cyst

Cervical cysts are a common pathology, mainly due to inflammatory changes or hormonal imbalance. There are single and multiple cervical cysts. Gynecologists call such cysts “Nabothian cysts” or “Ovulae Nabothii”. Nabotovs arise as the end result of “self-healing” of cervical ectopia/i.e. This is a type of cervical erosion/. There is a blockage of the excretory ducts of the glands of the cervix and a thick grayish secretion in the form of mucus accumulates under the thin transparent capsule. Round anechoic inclusions detected on ultrasound in the cervix are considered to be nabothian gland cysts; the detection of fine suspension in similar inclusions with thickening of the wall in which they are located usually indicates endometriosis of the cervix.

Polyp of the cervical canal and endometrium on a stalk

Polyps of the mucous membrane of the cervical canal are connective tissue growths covered with epithelium. On ultrasound they are usually visible as hyper- and isoechoic oval-shaped formations that dilate (widen) the cervical canal. As a rule, they have a stalk, when lengthened, polyps that arise in the middle and upper part of the mucous membrane of the cervical canal can appear from the cervical canal. Differential diagnosis is necessary with large endometrial polyps or with polyps emanating from the lower third of the uterine cavity. Modern ultrasound equipment with high resolution makes it possible to diagnose small polyps that do not extend beyond the external pharynx. They look like inclusions of increased or moderate echogenicity in the cervical canal. After the diagnosis of a polyp of the mucous membrane of the cervical canal is established, regardless of the patient’s age, polypectomy with careful removal of the polyp stalk or its coagulation under endoscopic control is indicated. Often, at the same time as a polyp of the cervical canal, a polyp or endometrial hyperplasia is detected. Polyps are a benign disease. However, sometimes cancer (especially adenocarcinoma) can have the appearance of a polyp.

Uterine fibroids, located in the cervix or a “nascent” myomatous node

Cervical fibroids are very rare and account for only 8% of all locations . In some cases, it is possible to detect a “nascent” submucous myomatous node. They can also be subserous, intramural and submucosal. Ultrasound signs of cervical myomatous nodes are generally identical to changes in the body of the uterus. The presence of cervical fibroids in the vast majority of cases is an indication for surgical treatment.

Ectopic pregnancy

Very rarely, implantation of a fertilized egg can be observed in the cervical canal (cervical pregnancy). In these cases, the fertilized egg is visualized in the cervix in the form of a round hypoechoic formation. In fact, it is uterine, / because the cervix is part of the uterus / but is equal in degree of danger to and requires immediate medical attention.

Endometriosis of the cervix or surrounding tissue

Genital endometriosis is a common disease in women of reproductive age. The causes of endometrioid lesions of the cervix are diathermocoagulation of ectopia (cauterization of erosion), damage during surgical , childbirth On the relatively deep wound surface, pieces of endometrial tissue, released during the next menstruation, attach and “take root.” The ultrasound picture is represented mainly by cervical cysts - rounded hypoechoic formations, often with heterogeneous, hyperechoic contents. Distinctive feature endometrioid cysts of the cervix is a thickening of the wall in which this cyst is located. Cervical endometriosis usually manifests itself in the form of bleeding on the eve of menstruation. Endometriosis of the pericervical tissue is visualized in the form of hyperechoic (increased brightness) areas in the adipose tissue, with clear, uneven contours, manifested by periodic pain in the posterior vaginal vault, which is not amenable to conventional, in this case, anti-inflammatory therapy.

Narrowing of the cervical canal, atresia of the cervical canal and vagina

In case of atresia of the cervical canal and vagina, ultrasound examination allows the installation of a hematometer in cases of a functioning uterus. Atresia of the hymen is characterized by the development of hematocolpos, the size of which depends on the height of vaginal obliteration and the amount of accumulated blood. Ultrasound reveals a large number of heterogeneous, hypoechoic fluid in the uterine or vaginal cavity, respectively.

Cicatricial changes in the cervix (post-traumatic changes and strictures, including after abortion and childbirth)

Deformation of the cervix occurs due to traumatic childbirth or surgical interventions on the cervix. During labor, the cervix shortens, flattens, and then dilates to a diameter of 10 cm, allowing the fetal head to pass through the mother's birth canal. Sometimes, during the passage of the head, the cervix ruptures. In such cases, the cervix after childbirth is formed defective - the cervical canal often remains gaping, and the cervix itself can take on the most bizarre shapes

Cervical cancer

This is a dangerous malignant disease. Cervical cancer ranks third among cancer pathologies in women, second only to breast and uterine cancer, and has a tendency to grow rapidly and metastasize. According to the degree of invasion (germination of layers located under the epithelium), cancer is divided into carcinoma in situ, minimally invasive, and invasive cancer. Invasive cancer has 4 stages, depending on invasion into neighboring organs, involvement of regional lymph nodes and the presence of distant metastases (bones, brain). Ultrasound diagnosis of cervical cancer in the early stages of development is not possible, and is usually used to clarify the stage of the malignant disease, the degree of invasion of the oncological process and search for metastases.

Examination of women in order to prepare for pregnancy and childbirth, management of infertility and IVF will be discussed in separate sections.

The uterus is a smooth muscle organ that is located in the pelvic area in women, between bladder and rectum.

The main function of this organ is to preserve the fertilized egg and carry a child during pregnancy.

On its sides there are ligaments necessary to avoid prolapse and allow it to move slightly under the influence of changes in neighboring organs. The lower end of this organ has its own name - the cervix. Bottom part it attaches to the upper end of the vagina and connects it to the body of the organ.

What do organs look like and their sizes?

The uterus is pear-shaped and slightly tilted forward. The size of the uterus is considered normal if its length is 7-8 cm, and the maximum width of its body in normal condition is up to 5 cm; during ovulation and depending on the day of the cycle, the size changes.

Its weight depends on many factors; it is believed that in normal conditions in nulliparous women it is within 50 g; in women with children, the weight can reach 100 g. It can also vary slightly by day of the cycle.

If you look at it, you can imagine it as a conical or cylindrical shape. When examined by a gynecologist, not the entire cervix is visible, but only half of it. The rest is located deep in the vagina. The dimensions of the cervix are as follows - the length does not exceed 3 cm, and the width can reach 2.5 cm.

IN different days During the menstrual cycle, the size of the uterus may change, and the cervix is also subject to minor changes. Specific changes depend on the period of the cycle:

If it happens that the body of the organ does not decrease after menstruation, pain or unusual discharge occurs, you should contact a gynecologist for examination, since this is not a normal option.

An open cervix during menstruation creates the risk of various bacteria entering its cavity. In nulliparous women, the opening of the cervix during the cycle is insignificant and looks like a round hole. If a woman has already given birth, the opening looks like a gap, and rarely closes tightly after the end of her period.

Changes in the uterus and cervix during pregnancy and after childbirth

Conception, pregnancy and childbirth are the main purpose of the uterus.

After fertilization has occurred, the eggs, the size of the uterus and its structure undergo serious changes associated with the birth of a new life.

If conception has occurred, then this unique organ is capable of increasing in size tens of times during pregnancy, while after childbirth it shrinks back within a short period of time.

By the end of pregnancy, the volume of the uterus increases approximately 500 times, and its weight can be more than a kilogram, excluding the weight of the fetus.

The parameters at the end of pregnancy should be as follows:

length approximately 37-38 cm;
width 25-26 cm;
Length from front to back approximately 24 cm.

The sizes can be different, depending on the characteristics of the woman’s body and the size of the fetus. When pregnancy occurs, the structure of the uterus becomes loose, this is necessary for its normal growth. At the beginning of pregnancy, the endometrial layer reaches 15 mm, which corresponds to the thickness at ovulation.

Various changes also occur in the cervix after conception:

the color changes from soft pink to purple-blue. This is due to the fact that blood vessels grow and blood circulation increases;
the density changes from hard to soft;
Immediately after pregnancy, cervical prolapse occurs. As the period increases, it rises higher and higher.

Changes also occur in the shape of the cervix, and they depend on whether the woman has given birth or not.

Pathologies of the uterus and cervix

The pelvic organs, like any other, are susceptible to various diseases. The uterus and cervix are no exception. Pathologies that occur in the female organs affect their size and shape, and therefore their functioning.

Young girls need to especially closely monitor their health, because the possibility of having a child depends on the pathologies of the female organs.

Uterine diseases

All pathologies can be divided into 2 groups:

congenital;
acquired.

The following pathologies are considered congenital:

Congenital pathologies do not always prevent pregnancy and bearing a child, but require closer monitoring by a doctor.

There are many more acquired pathologies that affect the reduction in the size of the uterine body; they are often diagnosed in infertile women.

Such diseases include:

uterine polyp and endometrial polyposis;
bend of the uterus;
endometritis and adenomyosis;
sumbucous fibroid;
uterine prolapse;
the appearance of adhesions and others.

Most acquired pathologies can be cured. In some cases, surgery is required to get rid of the pathology.

Cervical diseases

A healthy cervix has a smooth, uniform structure. When various pathologies appear, it changes, which can lead to a change in its size and other serious consequences. Often, pathologies are very dangerous and can develop into a malignant tumor if left untreated. Pathologies of the cervix that affect its size, and therefore patency, include:

These diseases are dangerous because they rarely manifest themselves in the form of any symptoms. A doctor can notice their appearance during an examination or after conducting the necessary examination or taking tests.

Every woman must undergo a smear for oncocytology and flora once a year, this will allow the most serious diseases to be identified in time and timely treatment to begin. A blood test and ultrasound examination can identify all pathologies at an early stage of development.

Visiting a gynecologist twice a year significantly reduces the risk of serious diseases of the uterus and cervix, helping to maintain reproductive function and women's health.

The formation of the cervix along with the uterus occurs at 12-16 weeks of pregnancy.

The cervix has many functions:

Protective is a biological barrier to the penetration of infection into a woman’s genital tract. Described in detail here.
Reproductive– mucus that forms in the cervical canal facilitates the penetration of sperm into the uterine cavity.
Childbearing– during pregnancy, due to the closed state of the cervix, gestation occurs.
During childbirth, the cervix shortens, flattens, opens and becomes part of the birth canal through which the baby moves.
Sexy – it is believed that there are points on the cervix that contribute to the onset of orgasm.

Cervical shape for girls - conical, in adults who have given birth - cylindrical.

1 - external os of the cervical canal, 2 - internal os of the cervical canal, 3 - vaginal part of the cervix, covered with MPE, 4 - cervical canal, covered with columnar epithelium.

Inside the cervix there is a cervical canal, it has a spindle shape, 4 cm long, the internal pharynx opens into the uterine cavity, and the external pharynx opens into the vagina.

Muscle tissue is mainly contained in the upper third of the cervix and is represented by circularly arranged muscle fibers with layers of elastic and collagen fibers. Muscle tissue provides the obturator function of the cervix. During childbirth, it forms the lower segment of the birth canal.

Vaginal part of the cervix covered with stratified squamous epithelium (MSE). The MPE of the cervix, like the vaginal mucosa, undergoes cyclic changes throughout the menstrual cycle. Under the influence of estrogens, cell maturation processes occur with the accumulation of glycogen and keratin in them.

In the MPE of the cervix there are 4 layers of cells:

basal,
parabasal,
intermediate,
surface.

Basal cells are located on the basement membrane. These are small cells with a large nucleus. Basal cells ensure the growth and regeneration of stratified squamous epithelium under physiological conditions; under pathological conditions, they are a source of pathological proliferation.

In smears of a healthy woman, basal cells appear only during postmenopause. The presence of these cells in smears in young women is a consequence of endocrine diseases or inflammatory processes.

The parabasal layer is represented by 2-3 rows of larger cells with large nuclei and cytoplasm that does not contain glycogen. They also ensure the growth and regeneration of the epithelium.

Parabasal cells are found in cervical smears in postmenopausal women and in small quantities in women of reproductive age during menstruation.

The intermediate layer consists of 6-12 rows of large polygonal cells with a small nucleus. The cytoplasm contains glycogen. This layer is well defined in the proliferative phase of the menstrual cycle.

Superficial cells predominate in cervical smears in the first phase of the menstrual cycle. Their maximum number is observed during ovulation. In the 2nd phase, the upper rows peel off on their own.

Under the MPE there is a stroma - a network of collagen and elastic fibers, among which are blood vessels, lymphatic vessels, and nerve structures.

Between the stroma and the MPE there is a basement membrane.

The main function of MPE is protective. This is determined by the presence in cells keratin, which causes strength mucous membrane and glycogen, which provides an acidic vaginal environment with the participation of lactobacilli.

Endocervix – mucous membrane of the cervical canal covered with tall columnar epithelium.

Cyclic changes in the epithelium of the endocervix are weakly expressed. The main function of columnar epithelium is secretory. The quantity and physicochemical properties of mucous secretion depend on the phase of the menstrual cycle. The secretion is essential for fertilization and is a barrier to infection.

On the basement membrane under the columnar epithelium, undifferentiated cubic cells, the so-called reserve cells, can be located. Under physiological conditions of the menstrual cycle, reserve cells ensure the process of regeneration of the columnar epithelium.

Under the influence of hormonal imbalances or inflammation, reserve cells turn into squamous epithelial cells. These changes underlie the formation of pseudo-erosions.

External os- the area at the junction of stratified squamous and columnar epithelium.

Otherwise called the transition zone. This site is the most common location for cancer. The border between the MPE and the cylindrical epithelium is located in premature newborns outside the external os, in full-term newborns and girls up to 8-11 years old inside the cervical canal.

In the reproductive period, the border is located at the level of the external pharynx. During menopause, it shifts to the outer third of the cervical canal. Pathological processes of the cervix also have age-related characteristics.

In girls, these are most often common inflammatory processes (vulvovaginitis).

In women of the reproductive period, limited inflammatory processes, endocervicitis, and inflammatory-proliferative processes more often occur. Cervical cancer in women of the reproductive period is localized in transition zone.

Women in menopause more often develop atrophic processes. Cervical cancer in menopausal women is localized in the cervical canal.

Between the cervix and the body of the uterus there is a formation - the isthmic part of the cervix, in which the anatomical internal os is located. This is the narrowest part of the cervical canal. The area between the cervical canal mucosa and the endometrium is called the histological internal os. In the cervical canal there is a mucous plug, which has bactericidal and proteolytic activity due to the presence of lysozyme, lactoferrin, and the presence of Ig of all classes, which play an important role in local protection against infection.

Normal and pathological appearance of the cervix

based on materials international organization Cervical Disease Control (INCGC)

Examination of the cervix is a mandatory stage of a 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 uterine body. The place where the body of the uterus passes into the cervix is called isthmus. While the uterine wall is mainly composed of smooth muscle, the cervical wall is mainly composed of connective tissue with a high content of collagen fibers and a smaller amount of 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 possible to examine exactly vaginal part of the cervix. Visible on the vaginal part of the cervix external os- 15, 18) - opening leading from the vagina into 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 throat.

Fig. 1: 1 - the mouth of the fallopian tube; 2, 5, 6 - oviduct; 8, 9, 10 - ovary; 13 - uterine cavity; 12, 14 - blood vessels; 11 - round ligament of the uterus; 16, 17 - vaginal wall; 18 - external os of the cervix; 15 - vaginal part of the cervix; 19 - cervical canal; 20 - cervix.

Fig. 2: 1 - uterus (fundus of the uterus); 2, 6 - uterine cavity; 3, 4 - anterior surface of the uterus; 7 - isthmus of the uterus; 9 - cervical canal; 11 - anterior vaginal vault; 12 - anterior lip of the cervix; 13 - vagina; 14 - posterior vaginal fornix; 15 - posterior lip of the cervix; 16 - external pharynx.

The mucous membrane of the cervical canal consists of 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, the cervical canal contains numerous branching tubular glands. Both the mucosal epithelium of the canal and the epithelium of the glands consist of tall columnar cells that secrete mucus. Such epithelium called cylindrical. Under the influence of hormonal changes occurring 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 ( Nabothian follicles or nabothian gland cysts).

The vaginal part of the cervix is covered stratified squamous epithelium. This same type of epithelium lines the walls of the vagina. The place of transition of the columnar epithelium of the cervical canal into the multilayered squamous epithelium of the surface of the cervix is called transition zone. Sometimes the transition zone 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 so-called pseudo-erosions (the stratified squamous epithelium that normally covers the vaginal part of the cervix is pinkish-gray, and the cylindrical epithelium of the cervical canal is red; hence the term erosion or pseudo-erosion).

Medical examination

The purpose of visual examination of the cervix is to identify patients with changes appearance cervix, erosion and selection of women requiring more in-depth examination and appropriate treatment. An important point is the timely identification of women with pre-cancer changes in the cervix early stages. When conducting a screening examination, in addition to a doctor’s examination, a colposcopy and PAP smear may be recommended.

Examination of the cervix is performed on a gynecological chair in the patient's position for a gynecological examination. After examining the external genitalia, a speculum is inserted into the vagina and the cervix is exposed. Excess mucus and leucorrhoea are removed from the cervix with a cotton swab. Examination of the cervix is usually not performed during menstruation and during treatment with local vaginal forms of drugs.

Inspection results:

Normal appearance of the cervix

The surface of the cervix is smooth, pink; mucous secretion is transparent. The central opening - the external os of the cervix - is round or oval in shape in nulliparous women and slit-like in multiparous women. There is no need for medical procedures. It is recommended to carry out a preventive Pap smear once a year.

View of the cervix in the postmenopausal period:

The cervix in postmenopausal women is atrophic. There is no need for medical procedures. It is recommended to carry out a preventive Pap smear 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 nabothian gland cysts. Nabothian glands (Nabothian follicles) are formed when the excretory ducts of the cervical glands are blocked and secretions accumulate in them. This can cause the formation of cysts and local protrusion of the surface of the cervix. An examination for urogenital infections, anti-inflammatory therapy, PAP smear, and colposcopy are recommended.

Polyp of the cervical canal

This is a benign formation. The causes are chronic inflammatory processes, trauma to the cervix, hormonal imbalance. PAP smear and colposcopy are indicated. The polyp is removed in combination with treatment of concomitant diseases.

In addition to the listed disorders, upon examination by a doctor, a benign tumor of the cervix (papilloma) may be detected; cervical hypertrophy; cervical deformity; redness (hyperemia of the cervix); simple erosion (does not bleed when touched); uterine prolapse; abnormal cervical secretions (foul-smelling; dirty/greenish in color; or white caseous discharge, stained with blood).

Changes in the cervix suspicious for malignancy(eg, cervical erosion that bleeds or crumbles when touched, with an uneven or loose surface). Cervical erosion (defect of the mucous membrane) is one of the most common gynecological diseases among 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 a gynecological oncologist.

In addition to simply examining the cervix to obtain additional information in some cases, an examination is carried out after treating the cervix with a 3-5% solution of acetic acid.