The Cervix (part 1)

The cervix is the entrance to the womb from the vagina and is often described as looking like a pink doughnut in shape and appearance. The pink doughnut is what can be seen when looking at a cervix with a speculum (the instrument used during cervical screening tests) but the cervix is actually tubular and about 3-4cm long. The opening in the centre of the cervix is called the os (the hole in the doughnut).

The inner canal of the cervix is lined with glands that produce secretions throughout your cycle. The consistency of the fluid, and other factors such as the colour and texture indicate the stages of the hormonal cycle and reveals information on your fertility and sexual health. If you are using hormonal contraception such as the pill, an IUD/IUS or the implant your cervical mucous will be thicker.

The cervix itself can be felt inside the vagina, and depending on the day of your cycle may feel firm like the end of your nose, or slightly softer. Depending on where you are in your cycle there will be variations in the position, firmness and angle of your cervix.

How to feel your cervix

Step 1. Wash your hands

Step 2. It will be easier to find if you have one foot raised on a step/ toilet seat. Or lie on your bed with a pillow under your bum to help tilt your pelvis upward.

Step 3. Insert your finger fairly deep into your vagina and you will find your cervix. It should feel firm and tubular, with a small indentation in the middle (the os). You should be able to circle your finger around the edge of your cervix depending on its position.

When on your period the cervix will be lower and easier to reach (below left). The os can be felt to be more open, so that your menstrual fluid can be lost easily. When ovulating the cervix will be deeper in the vagina and may be harder to reach (below right). Again, the os will be slightly softer and open. Biologically, this is for the purpose of allowing semen into the cervix more easily in order for ejaculate to make its way to the egg, known as the ovum.

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The cervix is constantly producing fluid, and this is responsible for the majority of normal vaginal discharge. After your period finishes, the cervical fluid will be white and sticky. It will then become increasingly runny and watery until ovulation when it begins to resemble a texture like egg white. The fluid becomes stringy and slippery, and can be stretched between your fingers. This illustrates how it assists sperm in swimming up towards the uterus where they will meet an egg, and can also act to preserve the sperm in the vagina. A lecturer of mine literally referred to the fluid as being ‘swimming lanes’ for the sperm!

cervical fluid during ovulation

Why do I need to be able to feel my cervix?

I think it is good to become acquainted with every bit of your body, that is how you will know if something is normal for you or not. Also, if you are using an IUD/IUS as contraception it is important to regularly check that you can feel the strings poking out from the cervix to ensure it is in the correct place. It is possible to monitor your fertility through observing the changes in the cervical fluid combined with other information such as their temperature throughout your cycle.

The website below shows images of a woman’s cervix taken every day of her cycle to show how the cervical fluid and position of the cervix changes. She has not had a baby before or any STIs:

http://beautifulcervix.com/cervix-photo-galleries/photos-of-cervix/

Looking after your cervix

Having regular cervical screening is so important to ensure a healthy cervix. The screening is a method of detecting abnormal cells on the cervix, which are caused by the human papillomavirus (HPV). These cells can be removed before they become cancerous. In the UK screening for cervical cancer starts at 25 years old and is recommended every 3 years until age 49, then every 5 years.

One of the functions of the cervix is to act as a barrier and protect the uterus from infection. The cervix prevents bacteria and viruses that have come into contact with the vagina from infecting the uterus. These organisms can cause inflammation of the cervix, also known as cervicitis. Sexually Transmitted Infections (STIs) are the leading cause of cervicitis.

As a general rule there are two key signs that something is not normal: pain and bleeding. Bleeding between periods and bleeding after sex are abnormal and should always be investigated. Unusual discharge with or without an odour that is yellow, green or grey is also abnormal.

For more information on gynaecological cancers:

https://eveappeal.org.uk/gynaecological-cancers/gynaecological-cancers-brief-explainer/

Glossary:

IUD – Intrauterine device, also known as a copper coil. The IUD is a small T-shaped plastic and copper device inserted into the womb to provide contraception.

IUS – Intrauterine System, also known as the hormonal coil. It is T-shaped device made purely of plastic and releases the hormone progesterone into the womb.

Ovulation – when an egg (ovum) is released from the ovary.

Feeling in control during healthcare interactions

Accessing healthcare whether it’s for a routine check-up, cervical screening (smear test), or because you think something isn’t quite normal can be intimidating and anxiety inducing for many people, especially when it is related to your sexual health. This is often not helped by the unfamiliarity and potential unease of intimate physical examinations.

I have walked out of appointments with my doctor thinking:

• I wish I had asked…
• So what did that mean?
• Am I/ is this normal?

And that is coming from someone who understands medical jargon and has a relatively good knowledge of reproductive health related issues. One of the most important things to remind myself is how it feels to be on the other side of the provider/client dynamic. It is vital to always consider how these interactions can be improved so that one is working in collaboration with people in regards to their health and wellbeing.

When seeking healthcare it is important to remember that YOU are the important person in the room, with questions that need answering and a voice that should be listened to. You deserve a thorough discussion of treatment options, recommendations that are supported by research and a solid evidence base, informed consent for any examinations or procedures and most importantly respect from your healthcare provider. These are all things that should come as standard but unfortunately this is not always the case.

It is of course the responsibility of the healthcare professional to ensure all of the above, but there are some practical things you can do or request to optimise your experience:

1. Have a friend/ family member/ advocate present. Having someone there with you who you trust can be beneficial for many reasons. But often they will know what is important to you and will be able to support you in the interaction. If you are receiving lots of new information it can be overwhelming and having someone to discuss it with afterwards can be incredibly helpful.
2. If English is not your first language it is your right to have access to an interpreter or interpreting service. Your healthcare provider should not be using your family member or friend to translate. Even if you understand English to a high standard generally, don’t be afraid to request an interpreter for clarity with unfamiliar medical terminology.
3. If you are on your own and an intimate examination is recommended you should be given the option of having a chaperone present. A chaperone is usually another healthcare professional familiar with routine intimate examinations and their role is to protect your dignity, provide reassurance if you are in distress or discomfort, and be prepared to raise concerns about the healthcare provider’s behaviour if necessary.
4. If you are feeling very nervous and tense tell your healthcare provider at the beginning of the appointment. It is completely normal to feel anxious and need reassurance in these situations. Vocalising anxieties can help you to observe them rather than experience them.
5. In terms of treatment and a plan of care there are always options and choices to be made. Your healthcare provider will make a recommendation, which should be based on latest available research and evidence, but that does not mean that is the only option available to you. And one of your options is to decline the proposed plan of care. Saying ‘no’, or asking for more time to make a decision is an option. * It is always ok to ask for more information before making a decision regarding your health.

I hope this provides some helpful tips and considerations. It is by no means an easy thing to be assertive but knowing your rights is the first step. Remember: it is the privilege of the healthcare professional to provide care to you!

 

 

 

*Rare circumstances where there is exception to this (UK) https://www.citizensadvice.org.uk/health/nhs-healthcare/nhs-patients-rights/#h-consent

The basics.

Let’s start with the basics, because really and truly knowing the parts that make up your body is beyond valuable. Everyone has different shaped noses, varying shades of eye colour, non-symmetrical faces (the list goes on…), and our genitals are no different. All bodies are unique and beautiful. The best way to get to know yourself is with a hand mirror. Here are some examples of lovely, normal vulvas:

The vulva is the name to the external area of female genitals, including the clitoral hood and clitoris, labia minora (inner lips) and majora (outer lips), the urethra and the vaginal opening. Most people refer to their ‘vagina’ when they actually mean their vulva, as this is the external area of the female genitals. You may need to part the labia to reveal the inner features of the vulva:

The Mons Pubis is the spongy mound where your pubic hair grows at the top (unless you’ve removed it!)

Below this is the clitoral hood and clitoris. The bit of the clitoris that you can actually see is called the glans clitoris. The glans clitoris varies in size between individuals, all shapes and sizes are healthy and normal. The majority of the clitoris is largely internal and extends into the body and around the vagina. The clitoris has one job: sensation.

The outer and inner labia have the job of protecting your clitoris, urethra and vagina. The outer ‘lips’ are usually darker in colour and have pubic hair. The inner lips are smooth, hairless and more delicate skin. The size and shape of the labia vary greatly. It is completely normal for the inner labia to be completely hidden by the outer labia when the legs are together, and equally normal for them to still be visible. The labia are not necessarily symmetrical either. All variations are normal and beautiful!

The urethra is the tube connecting the bladder to the urinary meatus (the opening that can be seen) and allows urine to leave the body.

The vagina is the tubular muscle leading to your uterus. When nothing is inside the vagina its walls touch, it is not open like a tunnel! There are folds of stretchy muscle called rugae. These allow the vagina to stretch when something is inserted into the vagina (a finger, tampon/ menstrual cup, a penis, sex toy etc) or when a baby leaves the body during childbirth.

The vagina is able to self-lubricate and the lubrication comes from glands just inside the vagina called the Bartholins glands. Skene’s glands are nearer the urethral opening and form part of the tissue that swells during sexual arousal, which also includes the clitoris. It is thought that they are the gland responsible for female ejaculation.

The hymen – most people think they know what a hymen is…. it’s the membrane that breaks when you have sex right? That’s why a woman may bleed when she has penetrative sex for the first time. I definitely imagined the hymen as a ‘seal’ to my virginal vagina as a teenager… But this is all wrong! The hymen is indeed a thin membrane that surrounds the opening of the vagina. It actually has no function but is taken by many cultures as a significant marker of virginity. However, as with all other aspects of genitalia it varies greatly between women. Some women will have a thick, rigid hymen; others will have no hymen at all. The size and appearance of the hymen will not necessarily be altered by penetration but may become more flexible if stretched regularly. There is no way of definitively knowing a woman has had intercourse by examining her hymen and that is that.

If you have never looked at your vulva in the mirror I hope this has made it all seem a bit less scary or a more interesting prospect! If you know what is normal for you, you will feel confident in knowing when something isn’t right and seeking advice.

 

Illustrations by the talented and wonderful Jasmine Hortop http://www.jasminehortop.co.uk/