The vaginal part of the uterus. Internal reproductive organs. Vagina. Uterus. What does a normal neck look like?
) - the outer part of the uterus, which all around protrudes into the back of the vagina, forming at the junction with its walls the so-called vaginal vaults. The surface of the vaginal part of the cervix is covered with pink stratified squamous epithelium. In the center of its rounded surface there is a so-called external cervical os, where spermatozoa penetrate after semen liquefaction from an elongated posterior fornix, which acts as a reservoir for seminal fluid. During childbirth, the vaginal part of the cervix, as well as the cervix itself, stretches up to 10 cm. In some mammals (for example, in pigs), the cervix is absent, which means there is no vaginal part of it. During medical examinations, examinations c. hours of the cervix can be examined with a mirror. Such a need arises in cases where a diagnosis of cervical dysplasia is made.
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An excerpt characterizing the vaginal part of the cervix
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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 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 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 cells of the epithelium 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 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:
Some possible options for violations that are detected during a doctor's examination:
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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).
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For more information about the condition of the cervix, a simple examination of the cervix can be supplemented acetic acid test. This enables the doctor to more accurately differentiate the normal and pathological condition of the cervix. The test is especially useful in situations where a colposcopy or Pap smear is not available.
The cervix is treated with a 3-5% solution of acetic acid using a syringe or cotton swab. Approximately 1 minute after treatment, the cervix is examined. Under the influence of acetic acid, there is a short-term spasm of the vessels of the cervix, swelling of the epithelium, swelling of the cells of the spiny layer of the epithelium. This allows you to identify pathological areas of the epithelium.
The acetic acid test is not performed during menstruation and during treatment with topical forms of drugs. The test should not be used if there is a large area of damage on the cervix that is suspicious of malignancy.
The test is considered negative if there are no white areas on the surface of the cervix after treatment with acetic acid. And positive when detecting white areas on the cervix ( acetowhite areas), distinct from the rest of the cervix.
The appearance of the cervix in normal and pathological conditions after the test with acetic acid:
Normal cervix. On the posterior lip of the cervix, an area treated with acetic acid. | |
Normal cervix. Negative acetic acid test result. Small genital warts on the left wall of the vagina. | |
Normal cervix. Negative acetic acid test result. A zone of small ectopia and a small area of keratinization are visible. Clear boundary between columnar and stratified squamous epithelium. Light cervical mucus. | |
Atrophic stratified squamous epithelium of the cervix in menopause. Negative acetic acid test result. | |
Polyp of the cervical canal. Negative acetic acid test result. | |
Normal cervix. Negative acetic acid test result. Ectopia in combination with metaplasia of the epithelium (open crypts of the glands) on the anterior lip of the cervix. On the posterior lip there is an area of metaplastic epithelium. On the sides of the pharynx in the form of a white rounded zone, a transformation zone is visible. | |
pronounced ectopia. Negative acetic acid test. | |
Naboth cyst on the posterior lip of the cervix. Atypical acetowhite area on the anterior lip, continuing into the cervical canal - visualized during colposcopy. | |
Atypical area on the anterior lip of the cervix. Leukoplakia. Positive test with acetic acid - re-examination after 6 months. | |
Acetowhite metaplastic epithelium on the anterior and posterior lip. Leukoplakia. Mosaic. | |
Pointed condyloma. | |
Against the background of metaplastic acetowhite epithelium, open crypts of the glands of the Nabot's cyst (yellow). False negative acetic acid test. | |
Normal cervix with acetowhite area of metaplasia in the transformation zone. False positive acetic acid test. | |
Genital condyloma on the posterior lip. On the anterior lip of the cervix, there is an acetowhite area of metaplasia. | |
Atypical acetowhite area extending into the cervical canal. A colposcopy and biopsy is required. | |
Positive test with acetic acid. Perhaps the condition of the cervix is normal, but to rule out pathology, a biopsy of the cervix is \u200b\u200brequired. | |
Positive test with acetic acid. Perhaps the condition of the cervix is normal, but the violation of the location of the blood vessels requires a biopsy. | |
Mild dysplasia (CIN I) on the anterior lip of the cervix, metaplastic epithelium on the posterior lip. | |
Positive test with acetic acid. Mild dysplasia (CIN 1), genital warts. | |
Positive test with acetic acid. Moderate degree of dysplasia on the anterior lip of the cervix (CIN II). | |
Positive acetic acid test, severe cervical dysplasia (CIN III). Plot of metaplastic epithelium on the anterior lip of the cervix. | |
Leukoplakia before treatment with acetic acid; possibly severe cervical dysplasia (CIN III). | |
infiltrative cancer. | |
infiltrative cancer. |
Everything cervical diseaseare divided into background, precancerous and cervical cancer.
The background diseases include erosion (it is more correct to call ectopia), simple leukoplakia, polyps of the mucous membrane of the cervical canal, erythroplakia and other diseases of the cervix.
Precancerous include dysplasia, which can be mild, moderate or severe.
Cervical erosion - a diagnosis known to many women. Erosion is a cellular change in the mucosa around the pharynx of the cervix. This phenomenon is observed in 40% of women, in half of the cases in young women under 25 years of age. Often it is detected in women who consider themselves perfectly healthy.
The causes of erosion are manifold. . These are inflammatory processes, and hormonal disorders, and cervical injuries during abortions and childbirth. Erosion can exist for a long time until the processes that caused its occurrence are eliminated. At the same time, she herself supports the inflammatory process in the cervix. Often, erosion itself does not cause any complaints, symptoms are usually determined by concomitant gynecological diseases.
Leukoplakia of the cervix- this is excessive keratinization of the epithelium, which looks like a white plaque when viewed.
Erythroplakia of the cervix
- this is a thinning of the epithelium, which, when viewed, looks like a red spot.
All of them can be a background for the occurrence of cervical cancer. Therefore, it is imperative to undergo an examination by a gynecologist and choose a method of treatment.
Treatment of pathologies of the cervix
Currently, there are different methods of treating diseases of the cervix:
· chemical degradation carried out using a mixture of various acids that have a coagulating effect. This method is quite simple to use and does not require special equipment. However, the effect of the drug is superficial, so a relapse of the disease is possible.
· diathermoelectrocoagulation (DEC) is widely available and often used in practice. However, with this method, the surrounding healthy tissues are severely damaged, and rough scars can form. The procedure is quite painful, the healing is long, chronic inflammatory processes of the appendages may become aggravated, bleeding may occur when the scab is rejected. Relapses are possible. Scarring after DEC can cause complications in subsequent births and lead to the need for a caesarean section.
· cryodestruction - this is the destruction of the pathological focus by low temperatures. Liquid nitrogen is used as a cooling agent. The advantages include: painlessness, bloodlessness of the method, carrying out on any day of the menstrual cycle, no scarring after healing, economy, safety. The disadvantages are: shortening of the cervix after cryotherapy, abundant liquid discharge during healing, shallow depth of exposure, the possibility of recurrence of the disease, especially in women with menstrual irregularities
· R radio wave destruction pathological formations of the cervix - the procedure is performed on an outpatient basis, in the first phase of the menstrual cycle. After removal of the pathologically altered cervical tissue, a zone of superficial necrosis is formed within healthy tissues. This contributes to the rapid rejection of the scab and the early onset of healing. Scarring and narrowing of the neck are not observed.
The advantages are: painlessness, asepsis, bloodlessness, the formation of a thin coagulation film that prevents the penetration of infection into tissues, and most importantly, the almost complete absence of relapses.
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 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 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 cells of the epithelium 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 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.
Forming at the junction with its walls the so-called vaginal vaults. The surface of the vaginal part of the cervix is covered with pink stratified squamous epithelium. In the center of its rounded surface there is the so-called external os of the cervix, where spermatozoa penetrate after liquefaction of the sperm from the elongated posterior fornix, which acts as a reservoir for the seminal fluid. During childbirth, the vaginal part of the cervix, as well as the cervix itself, stretches up to 10 cm. In some mammals (for example, in pigs), the cervix is absent, which means there is no vaginal part of it. During medical examinations, examinations c. hours of the cervix can be examined with a mirror. Such a need arises in cases where a diagnosis of cervical dysplasia is made.
Notes
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- Vagina (tributary of Strelna)
- Waging am See
See what the "Vaginal part of the cervix" is in other dictionaries:
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uterine prolapse- prolapse of the uterus, vagina, a very common disease. There are prolapse of the uterus (descensus uteri), when the latter is below the place of its normal attachment, without leaving the genital gap, and prolapse of the uterus (prolapsus uteri), ... ... Big Medical Encyclopedia
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Uterine prolapse- I Prolapse of the uterus (prolapsus uteri) displacement of the uterus outside the genital gap. There are partial V. m, in which only part of the body of the uterus is outside the genital slit, and complete, in which the entire body of the uterus is determined outside the genital slit. Under the term ... ... Medical Encyclopedia
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Woman's uterus- This article is about the organ of the human reproductive system. For other meanings of this term, see Uterus Uterus of a woman and ovaries 1 mouth of the fallopian tube (ostium uterinum salpingis); 2, 5, 6 fallopian tube (tuba uterina); 8, 9, 10 ... ... Wikipedia
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Genital organs female- Distinguish between internal and external female genital organs. The internal genital organs include the ovaries, fallopian tubes, uterus and vagina; The ovaries and fallopian tubes are often referred to as the uterine appendages. The ovaries are female sex glands located in ... ... Medical Encyclopedia
Sexual organs female- Women's genitals. There are internal and external female genital organs. The internal genital organs include the ovaries, fallopian tubes, uterus and vagina; The ovaries and fallopian tubes are often referred to as the uterine appendages. The female sex ovaries ... ... First aid - popular encyclopedia
The uterus (uterus) is a pear-shaped smooth muscle hollow organ located in the pelvic cavity of a woman. During (see) the uterus is a fruit-place.
Rice. 1. Sagittal section of the uterus of a woman giving birth: 1 - bottom; 2 - cavity; 3- body; 4 - supravaginal part; 5 - isthmus; b - middle part; 7 - vaginal part.
Rice. 2., fixing the uterus in the small pelvis: 1 - sacro-uterine ligament; 2 - cardinal ligament; 3 - pubovesical ligament and vesico-uterine ligament; 4-bladder; 5 - cervix; 6 - .
The uterus (Fig. 1) consists of the body (corpus), neck (cervix) and isthmus (isthmus). The cavity of the body of the uterus on the frontal section has the shape of a triangle, in the upper corners of which the mouths open, in the lower - the internal opening of the cervical canal. The wall of the uterus consists of three layers: the mucous membrane (endometrium), the muscular membrane (myometrium) and the serous (peritoneal) cover ().
The mucous membrane of the uterine cavity is lined with a cylindrical epithelium. The endometrium consists of two layers: a superficial (functional) layer that changes during different phases of the menstrual cycle, and a deep (basal) layer that does not undergo significant changes. There are numerous glands in the thickness of the mucous membrane, the shape and function of which change depending on the phases of the menstrual cycle: in phase they have a tubular shape, in the phase of secretion, the glands become convoluted and secrete a secret (see).
The muscular layer is the most powerful layer of the uterus. It consists of intertwining smooth muscle fibers, forming spiral turns, located obliquely to the axis of the uterus.
The serous (peritoneal) cover from the uterus passes to the bladder and the upper part of the rectum. Between the bladder and the uterus, the peritoneum forms the vesicouterine cavity, and between the uterus and the rectum, the recto-uterine cavity.
In the cervix, the vaginal part is distinguished, protruding into the lumen and therefore accessible to inspection with the help of mirrors, and the supravaginal part, located above and inaccessible to direct inspection. The vaginal part of the cervix is covered with stratified squamous epithelium of a whitish-pink color. The external uterine os in a nulliparous woman has a rounded shape. In those who gave birth due to lateral tears of the cervix, the external pharynx has the form of a transverse slit. This sign is very constancy and is used in forensic practice. The cervical canal has a spindle shape, its inner surface is lined with a mucous membrane with numerous folds. The mucous membrane is covered with cylindrical cells. The border between the cylindrical epithelium of the cervical canal and the stratified epithelium of the vaginal part of the cervix is located in the area of the external uterine os at the beginning of the cervical canal and therefore is not visible when examining a woman with the help of mirrors. In inflammatory diseases (, septic infection), traumatic injuries of the cervix, as well as as a result of hormonal disorders, so-called ones can form, in which the stratified squamous epithelium is replaced by a cylindrical epithelium at the site of injury.
The mucous membrane of the cervical canal produces a mucous secretion of an alkaline reaction, which has pronounced bactericidal properties, which prevents the penetration of infectious agents from the vagina into the uterus. The alkaline reaction of the secret is of some importance in the process of fertilization, since it contributes to the activation of movements.
There is an isthmus between the body and the cervix. During pregnancy, the isthmus, together with part of the lower uterus, forms the lower uterine segment, which is part of the fetus. The length of the entire uterus outside of pregnancy is about 8 cm. 2/3 of the length falls on the body of the uterus and 1/3 on the cervix. The length of the isthmus is 0.5 - 1 cm. With underdevelopment of the uterus (infantilism), the length of the cervix can approach the length of the body of the uterus and even exceed it.
The uterus is located in the small pelvis and does not protrude beyond the plane of the entrance of the small pelvis, and the vaginal part of the cervix is at the level of the ischial spines. The uterus is tilted anteriorly, its bottom is directed towards the bosom. Between the body and the cervix, an angle of 70-100 ° is formed, open anteriorly (anteversio-flexio position). This physiological position of the uterus is due to the presence of the ligamentous apparatus and muscles of the pelvic floor (Fig. 2). Round ligaments extend from the uterus somewhat anteriorly and below the place where the tubes exit, which enter the internal openings of the inguinal canals. The round ligaments of the uterus are held in an oblique position anteriorly. Descent of the uterus is prevented by the cardinal ligaments at the base of the broad ligaments, the sacro-uterine ligaments (between the isthmus of the uterus and the sacrum), the uterovesical ligaments (between the isthmus of the uterus and the bladder), and the pelvic floor muscles (mainly the levator ani muscle).