The vaginal part of the uterus. The structure of the cervix. The appearance of the cervix in normal and pathological conditions after the test with acetic acid

) - 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 cervix of the cervix, 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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The internal female genital organs are localized in the pelvic cavity and include the vagina, cervix and body of the uterus, uterine (fallopian) tubes, or oviducts, ovaries and surrounding pelvic structures supporting them.

Vagina

The vagina is a tubular, muscular-connective tissue structure between the vulva and uterus, which is located between the urethra and bladder in front and the rectum in the back. The length of the vagina is 6-8 cm along the anterior wall and 7-10 cm along the back. The vagina has many functions: it is the excretory canal of the uterus (excretion of uterine secretions and menstrual blood); female copulatory organ and part of the birth canal.

The blood supply of the cervix and body of the uterus has a close relationship. Arterial blood enters the cervix through the descending branch of the uterine artery. This cervical artery runs from the lateral side of the cervix and forms the coronary arteries that surround the cervix. The odd arteries of the vagina (the vaginal branches of the uterine artery) run longitudinally down the middle of the anterior and posterior parts of the cervix and vagina.

There are numerous anastomoses between these vessels and the vaginal and middle hemorrhoidal arteries. The veins of the cervix accompany the arteries of the same name. The lymphatic drainage of the cervix is ​​complex and contains various groups of lymph nodes. The main regional lymph nodes of the cervix is ​​the obturator; common, internal and external iliac; visceral parametrial nodes. In addition, cervical lymph drainage can be carried out in the upper and lower gluteal, sacral, lumbar, aortic lymph nodes, as well as in the visceral nodes above the posterior surface of the bladder.

Innervation of the cervix

The stroma of the endocervix contains numerous nerve endings. Sensory nerve fibers accompany the parasympathetic fibers to the second, third, and fourth sacral segments.

Clinical correlations

More arterial blood supply to the cervix is ​​observed in the lateral walls of the cervix, in the position at 3 and 9 o'clock. A deep figure-of-eight suture through the vaginal mucosa and cervical stroma at 3 and 9 o'clock can help stop severe bleeding, such as in cone biopsy of the cervix. If this suture is placed too high in the vaginal fornix, there is a risk of injury or trapping of the distal ureter.

The cervical transformation zone (the transition zone between the squamous and columnar epithelium) is an important anatomical landmark for clinicians. The localization of the transformation zone in relation to the longitudinal axis of the cervix depends on the age and hormonal status of the woman. In the transformation zone, dysplasia of the epithelium of the cervix usually begins.

The cervix has many nerve endings. This fact is associated with the possibility of a mass vagal reflex during transcervical procedures. So, when introducing intrauterine device some women may develop bradycardia. Sensory innervation of the exocervix is ​​less pronounced than that of the outer skin. So, treatment procedures on the exocervix (cauterization, cryotherapy, laser exposure) can be performed without significant discomfort for the patient and usually do not require anesthesia.

The uterus is an unpaired abdominal muscular organ, shaped like a flattened pear and located between the bladder in front and the rectum in the back and broad ligaments on the sides. Almost the entire posterior wall of the uterus is covered with peritoneum, the lower part of which forms the recto-uterine cavity (Douglas space). Only the upper part of the anterior wall of the uterus is covered by the peritoneum; the lower one adjoins the posterior wall of the bladder and is separated from it by a clearly separated layer of loose connective tissue. The peritoneum, covering the posterior surface of the bladder, at the level of the isthmus passes to the uterus (vesicouterine fold), forming the vesicouterine cavity.

The uterus has two main unequal parts: the upper body and the lower, cylindrical, spindle-shaped neck, which protrudes into the vagina. In the cervix, the vaginal and supravaginal parts are distinguished. In the lower part of the body of the uterus, between the internal os and the uterine cavity, there is a narrowed area - the isthmus.

The isthmus has a special obstetric significance: it forms the lower uterine segment during pregnancy. The anterior surface of the uterus is almost flat, the posterior surface is convex. The uterine (fallopian) tubes, or oviducts, depart from the horns of the uterus at the junction of the anterior and lateral surfaces of the uterus. The convex upper segment between the fallopian tubes is called the uterine fundus. The lateral surface of the uterus, below the place of origin of the fallopian tubes, is not directly covered by the peritoneum and is the place of origin of the broad ligament of the uterus.

The uterus varies greatly in size and shape depending on the age and childbearing (number of births) of the woman. Before puberty, the length of the uterus is 2.5-3.5 cm. The uterus of an adult woman who has not given birth has a length of up to 8 cm, a width of up to 5 cm, a thickness of up to 2.5 cm and a mass of 40-50 g. The uterus of a woman, which had 2 or more births, increases by 1.2 times, and its weight increases by 20-30 g, up to a maximum of 110 g during pregnancy. The uterus increases significantly due to hypertrophy of muscle fibers: its mass increases by 10-20 times and reaches 1100 g during full-term pregnancy, and its volume is 5 liters. The bottom of the uterus acquires a domed shape, and the round ligament is located on the border of the middle and upper thirds of the organ. After menopause, the uterus decreases in size and mass due to atrophy of the myometrium and endometrium.

The ratio between the length of the body and the cervix is ​​also very variable. In girls before menarche, the body of the uterus is half the length of the cervix. In adult women who have not given birth, the body of the uterus and the cervix are almost the same in length. In women who have given birth twice or more, the cervix is ​​only 1/3 of the length of the body of the uterus.

Anomalies in the fusion of the Müllerian ducts in the embryonic period (Müllerian anomalies) can lead to the formation of various anomalies in the development of the uterus.

Clearancefallopian tube lined with mucous membrane. The mucous membrane of the tube and the stroma subordinate to it form numerous longitudinal folds, which are most pronounced in the ampullar segment. The mucous membrane of the fallopian tube is represented by three different types cells. Cylindrical epithelial ciliated cells account for about 25% and are most pronounced around the ovarian end of the tube. Secretory cylindrical cells make up 60% and are concentrated mainly in the isthmic region. Narrow pin-like cells are located between the secretory and vyichay cells and, possibly, is a morphological variant of the secretory cells. The stroma is scattered, but a thick lamina propria passes between the epithelial and muscle layers, which contains vascular channels. The presence of diverticula of the fallopian tubes can be the cause of the development of tubal pregnancy.

The smooth muscles of the fallopian tubes are represented by the inner circular and outer longitudinal layers. In the distal part of the fallopian tube, muscle fibers are less pronounced, especially near the fimbrial end of the tube. The tubal muscles undergo rhythmic contractions depending on hormonal changes during the ovarian cycle. The greatest frequency and intensity of contraction of the fallopian tube reaches during the transport of the egg. During pregnancy, these contractions are weak and slow.

Between the peritoneal surface of the fallopian tubes and their muscular layer is located adventitialshell containing blood vessels and nerves.

The arterial blood supply of the fallopian tubes is carried out at the expense of the terminal branches of the uterine and ovarian arteries, anastomosing into the mesosalpinx. Blood from the uterine artery supplies the medial 2/3 of each tube. The veins accompany the arteries of the same name. Lymphatic drainage is carried out to the external iliac and aortic lymph nodes surrounding the aorta and inferior vena cava at the level of the renal vessels.

The fallopian tubes are innervated by sympathetic and parasympathetic nerves from the uterine and ovarian plexuses. Sensitive nerve fibers pass through the T11, T12 spinal segments.

Clinical correlations

Ectopic pregnancy often occurs in the fallopian tubes. Acute abdominal and pelvic pain during ectopic pregnancy is associated with intra-abdominal bleeding. Most cases of catastrophic bleeding during tubal pregnancy are associated with implantation of the ovum in the intramural segment of the fallopian tube.

When inserting a laparoscope, one should remember about the deviation of the vertical axis of the navel in the caudal direction in women with obesity and developed subcutaneous tissue. The operation of sterilization of women is most often performed in the isthmic department of the fallopian tubes (clipping, crossing, etc.). The right fallopian tube and are in close anatomical proximity, which can make it difficult to differentiate between salpingitis and acute appendicitis. Additional openings of the fallopian tubes may occur in the ampulla and always communicate with the lumen of the tube.

The wide mesosalpinx of the ampullar part of the tube contributes to the distortion and ischemic necrosis of the fallopian tube. Paratubal and paraovarian cysts usually have a diameter of 5-10 cm; they are often mistaken for ovarian cysts during preoperative examination.

Although there is no anatomical sphincter at the utero-tubal junction, temporary spasm of the fallopian tube openings can be detected by hysterosalpingography. Temporary spasm can be relieved with sedation, glucagon, or a paracervical block.

Ovary

The ovary is a female gonad that produces female sex cells and female sex hormones. This is a paired oval organ of a somewhat grayish color, which in shape and size resembles a large almond. The surface of the ovary of an adult woman shows signs of previous ovulations. The ovaries contain 1-2 million oocytes at the birth of a girl. During the reproductive period of a woman's life, about 8,000 follicles begin to develop.

Growth of many follicles is interrupted at various stages of development, but 300-500 follicles may mature. The size and position of the ovaries depend on the age of the woman and the presence of childbirth. During the reproductive period, the size of the ovaries usually does not exceed 1.5 cm x 2.5 cm x 4 cm, and the weight varies from 3 to 6 g. As a woman ages, the ovaries become smaller and harder.

In a woman who has not given birth, in a standing position, the long axis of the ovary is vertical. In women who have not given birth, the ovaries are located in the upper part of the abdominal cavity in the deepening of the peritoneum - the ovarian fossa. The external iliac vessels, ureter, obturator vessels and nerves are directly adjacent to the ovarian fossa.

Two surfaces are distinguished in the ovary - the medial, returned towards the abdominal cavity, and the lateral, returned to the pelvic wall; two ends - uterine and tubal; two edges - convex free and mesenteric. In the mesenteric region are the gates of the ovary, through which the vessels and nerves pass into the ovary.

There are three important connections that determine the anatomical mobility of the ovaries. The back of the broad ligament of the uterus forms the mesentery of the ovary - the mesovarium, which is attached to the anterior edge of the ovary. The mesovarium contains vascular anastomoses of the ovarian and uterine arteries, venous plexuses, and the lateral end of the ovarian proper ligament. The proper ligament of the ovary is a narrow, short, fibrous ridge extending from the lower pole of the ovary to the uterus.

The leukotase ligament forms the upper lateral part of the broad ligament of the uterus. The leukotase ligament contains the ovarian artery, vein, and nerves and runs from the superior pole of the ovary to the lateral wall of the pelvis.

Histologically, the ovary is divided into an outer cortex (cortex) and an inner medulla (brain). Outside, the ovary is lined with a single layer of superficial coelomic cuboidal (cylindrical) epithelium (the old name is "germinal" or "germinal" epithelium). The epithelium is separated from the subordinate stroma by a basement membrane and a protein coat. The stroma of the ovarian cortex consists of densely packed cells that surround the follicles and form their theca sheath. Theca cells synthesize ovarian androgens (dehydroepiandrosterone, androstenedione, testosterone).

The medulla contains the ovarian vessels and. The stroma shows multifaceted hilus cells, which are analogous to the interstitial cells (Leydig cells) in the testicles.

Embryonic remains

The ovarian appendage is located in the connective tissue of the broad ligament of the uterus near the mesosalpinx and contains numerous narrow vertical tubes lined with ciliated epithelium. These tubules at their upper end gather into a longitudinal canal that runs under the fallopian tube and further along the lateral edge of the uterus and ends at the internal os. Sometimes this canal, which is the remnant of the Wolffian (mesonephric) duct in women and is called the Gartner duct, can continue laterally along the side wall of the vagina and end at the level of the girl's membrane.

The ovary is also a remnant of the Wolffian duct and is embryologically analogous to the head of the supratesticle in men. The cranial part of the epididymis is called the supraovary or Rosenmüller's organ. Usually in adult women, the ovary disappears, but it can be a source of cyst formation.

The blood supply to the ovaries is provided by the ovarian arteries, which originate directly from the aorta below the level of the renal arteries. The ovarian artery passes retroperitoneally, then crosses the anterior surface of the psoas major muscle and the internal iliac vessels, enters the leukocyte ligament and the hilum of the ovary, and reaches the mesovarium at the broad ligament of the uterus.

The left ovarian vein drains into the left renal vein, and the right into the inferior vena cava. Lymph from the ovaries flows to the para-aortic lymph nodes at the level of the renal vessels, but ovarian cancer metastases can also occur in the iliac lymph nodes. Sympathetic and parasympathetic nerve fibers run adjacent to the ovarian vessels and are associated with the ovarian, hypogastric, and aortic plexuses.

Clinical correlations

The dimensions of a "normal" ovary during the reproductive and postmenopausal periods are great importance in clinical practice. Before menopause, the length of a "normal" ovary should not exceed 5 cm, and in the presence of physiological cysts - 6-7 cm. In postmenopause, "normal" ovaries should not be palpated during a gynecological examination.

The ovaries and the peritoneum surrounding them are not devoid of pain and tactile receptors, therefore, during a bimanual gynecological examination and palpation of the ovaries, the patient may experience discomfort.

Ovarian denervation surgery by transection or ligation of the leukotase junction has been suggested to reduce the symptoms of chronic pelvic pain. But in the future, this operation was abandoned due to cases of cystic degeneration of the ovaries due to a violation of their blood supply associated with neurectomy.

The close anatomical relationships of the ovary, ovarian fossa, and ureter are of particular importance in the surgical treatment of severe endometriosis or pelvic inflammatory disease. It is important to follow the course of the ureter to facilitate removal of the ovarian capsule that is connected to the adjacent peritoneum and surrounding structures to prevent damage or future residual ovarian syndrome (with retroperitoneal remnants of part of the ovary).

Prophylactic oophorectomy is usually performed during gynecological surgery in postmenopausal women. Bilateral vaginal oophorectomy may be technically more difficult than abdominal hysterectomy. Vaginal spaying can be facilitated by identifying anatomical landmarks, as in abdominal surgery, and by separating the round and leukotase ligaments.

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

The formation of the cervix occurs by the fusion of the Mullerian canals at the 12-16th week of embryogenesis. As you know, in the cervix, a vaginal part is distinguished, protruding into the lumen of the vagina, and a supravaginal part, located above the attachment of the walls of the vagina to the uterus, consisting mainly of connective and muscle tissue, in which vessels and nerves are located. The vaginal part of the cervix, covered with stratified squamous epithelium, is called the 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 fusiform shape, its length from the external os to the isthmus is no more than 4 cm, the width is not more than 4 mm, the external os is round or in the form of a transverse slit. The cervical canal is covered with a single-row high columnar epithelium and is called 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 Ya.V., 1989; Vasilevskaya L.N., Vinokur M.L., 1971; and others).

The stratified 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 varying sizes. The basement membrane separates the squamous stratified epithelium from the underlying connective tissue;
2) is located above the basal cells parabasal cell layer arranged in several rows. The 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 It is represented by 2-3 rows of superficial cells that tend to become keratinized and are easily desquamated depending on the phase of the menstrual cycle.

The blood supply of the stratified squamous epithelium is carried out by blood vessels, which are located under the basement membrane. The formation of terminal loops of capillaries is directly dependent on the level of sex hormones in the blood (estrogen and progestogen).

The main function of the 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 thus 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 high cylindrical epithelium with a basally located nucleus.

As is known, in the cervix, the border of two genetically different types of epithelium is the transition area 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 of squamous multilayered and cylindrical epithelium has a complex histoarchitectonics.

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

The area of ​​transition between the high cylindrical and squamous stratified epithelium in women of reproductive age in most cases coincides with the area of ​​the external os. 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; and others).

The shift of the transition zone to the exocervix in the prenatal period is considered a normal stage in the development of the cervix and is explained by hormonal effects, in particular, estrogens produced by the mother's body. At the same time, the so-called "congenital erosions" or ectopia that arose during fetal development can persist until prepubertal age.

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

As the woman's body grows and develops, the transition zone shifts to the area of ​​​​the external pharynx, and the ectopia disappears. In reproductive age, cyclic changes occur in the cervix during the normal menstrual cycle associated with the influence of ovarian hormones. The opening of the cervical canal from the 8-9th day of the cycle begins to expand, and transparent vitreous 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, rounds, becomes shiny, and when the naked cervix is ​​illuminated with the help of vaginal mirrors, it resembles a pupil. In the following days of the cycle, the amount of mucus decreases again, it disappears, the neck becomes dry. The functional significance of cervical mucus lies in the fact that it is actually a barrier between the vagina and the uterine cavity, plays a protective role against the penetration of bacteria into the uterine cavity.

In the menopause, against the background of age-related changes in the whole organism, involutive processes primarily capture the reproductive system. They are characterized first by the cessation of the childbearing, and then the 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.

In the postmenopausal period, due to involutional processes in the reproductive system, there is a shift of the transition zone to the lower third of the endocervix. 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, degenerative changes develop in the underlying stroma, associated with a deterioration in trophism, a decrease in blood flow microcirculation 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 influence not only ovarian hormones, but also hormones produced compensatory by the adrenal glands.

The listed age-related features of the cervix predispose to a certain topographic and anatomical localization of pathological processes: for example, girls are more likely to have vulvovaginitis, women of reproductive age have endocervicitis, inflammatory and proliferative processes of the exocervix mucosa, localization of cancer on the exocervix is ​​typical. For postmenopausal women, degenerative-dystrophic processes of the exocervix are specific, localization of cancer in the endocervix is ​​typical, 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 the female genital tract contains three "ecological niches" (Rusakevich P.S., 2000): 1) flat epithelium of the vagina; 2) prismatic epithelium of the cervix (crypts); 3) the unique environment of the cervical glands (if any). Each "niche" has its own microbial ecosystem. The nature of microcenosis is influenced by a number of factors (acidic pH in the vagina and alkaline in the endocervix). Only a slightly greater variety of species is noted in the vagina. It was revealed that 1 ml of vaginal secretion of healthy non-pregnant women contains 108-1010 microbial cells (mc/ml). The share of aerobes is 105-108 microns/ml, anaerobes - 108-109 microns/ml. The microbial landscape of the vagina and cervix is ​​dominated by lactobacilli (Doderlein sticks). In 71 - 100% of women they are found 106-109 microns / ml.

Other microflora is represented by staphylococci (golden in 4 - 33% of women, epidermal - in 10-74% - up to 107 microns / ml), bifidobacteria (in 10% of women up to 107 microns / ml), lactic acid bacteria and streptococci (14%), bacteroids (6%), peptostreptococci (14% of cases). Enterobacteria, 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 microns / ml of secretion; they are dominated by Doderlein sticks (lactobacilli), gardnerella make up 5-37%, mycoplasmas 15-30% (Rusakevich P.S., 2000).

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

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

The humoral system of the genital organs is quite independent. In this case, the cervix is ​​the site of the greatest immunological activity. There are several types of humoral protective factors. Immunoglobulins (Ig) are represented mainly by Ig A and Ig G, to a lesser extent by Ig M. They are found in the cervical mucosa and are secreted by plasma cells. The amount of immunoglobulins G and A in the cervical mucus changes cyclically in the phases of the menstrual cycle (increases at the beginning and at the end of the cycle). Progesterone (endo- and exogenous) is also able to enhance the secretion of immunoglobulins. An increase in the number 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. The cervical and vaginal contents 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

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)

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 less 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 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 ( 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 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 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 visual examination of the cervix is ​​to identify patients with changes appearance cervix, erosion and the selection of 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 simply examining the cervix to obtain additional information in some cases, an examination is performed after treatment of the cervix with a 3-5% solution of acetic acid.

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)

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 less 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 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 ( 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 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 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.