Cervix
Schematic frontal view of female anatomy
1: fallopian tube, 2: bladder, 3: pubic bone, 4: g-spot, 5: clitoris, 6: urethra, 7: vagina, 8: ovary, 9: sigmoid colon, 10: uterus, 11: fornix, 12: cervix, 13: rectum, 14: anus
Latin	cervix uteri
	subject #268 1259
Artery	vaginal artery, uterine artery
Precursor	Müllerian duct
MeSH	Cervix+uteri
Dorlands/Elsevier	c_22/12229212

The cervix (from Latin "neck") is the lower, narrow portion of the uterus where it joins with the top end of the vagina. It is cylindrical or conical in shape and protrudes through the upper anterior vaginal wall. Approximately half its length is visible with appropriate medical equipment; the remainder lies above the vagina beyond view. It is occasionally called "cervix uteri", or "neck of the uterus".

Anatomy

Ectocervix

The portion projecting into the vagina is referred to as the portio vaginalis or ectocervix. On average, the ectocervix is 3 cm long and 2.5 cm wide. It has a convex, elliptical surface and is divided into anterior and posterior lips.

External Os

The ectocervix's opening is called the external os. The size and shape of the external os and the ectocervix varies widely with age, hormonal state, and whether the woman has had a vaginal birth. In women who have not had a vaginal birth the external os appears as a small, circular opening. In women who have had a vaginal birth, the ectocervix appears bulkier and the external os appears wider, more slit-like and gaping.

Endocervical canal

The passageway between the external os and the uterine cavity is referred to as the endocervical canal. It varies widely in length and width, along with the cervix overall. Flattened anterior to posterior, the endocervical canal measures 7 to 8 mm at its widest in reproductive-aged women.

Internal Os

The endocervical canal terminates at the internal os which is the opening of the cervix inside the uterine cavity.

Cervical crypts

There are pockets in the lining of the cervix known as cervical crypts. They function to produce cervical fluid.^[1]

Histology

The epithelium of the cervix is nonkeratinized stratified squamous epithelium at the ectocervix, and simple columnar epithelium at the cervix proper.^[2][3] At certain times of life, the columnar epithelium is replaced by metaplastic squamous epithelium, and is then known as the transformation zone.

Nabothian cysts are often found in the cervix.

Cervical mucus

After menstruation ends, the external os is blocked by a thick acidic mucus that prevents infection. The mucus thins and its pH increases (closer to neutral) several days prior to ovulation, allowing spermatazoa to pass through the cervix to the fallopian tubes where they wait for an ovum to be released. Shortly after ovulation occurs, the cervical mucus reverts to a thicker form with lower pH.

Fertility awareness methods rely on observing the qualities of the cervical mucus to determine the periods of fertility and infertility during a woman's cycle. It can be categorized by the amount of mucus present, the quality of spinnbarkeit (German for spinnability; the stringy elastic character of cervical mucus during the ovulatory period), the degree of opening of the cervical canal, the presence of ferning (the branching pattern appearance of the mucus), and the clarity of mucus versus the presence of cellular debris or leukocytes.

Most methods of hormonal contraception work primarily by preventing ovulation, but their effectiveness is increased because they prevent the cervical mucus from thinning. The thickened cervical mucus blocks spermatozoa from entering the uterus.

During pregnancy the cervix is completely blocked by a special antibacterial mucosal plug which prevents infection, somewhat similar to its state during the infertile portion of the menstrual cycle. The mucus plug comes out as the cervix dilates in labor or shortly before.

Cervical position

After menstruation and directly under the influence of estrogen, the cervix undergoes a series of changes in position and texture.

• During most of the menstrual cycle, the cervix remains firm, like the tip of the nose, and is positioned low and closed.
• However, as a woman approaches ovulation, the cervix becomes soft and mushy, and rises and opens in response to the high levels of estrogen present at ovulation.<ref name="Weschler" /> This change, accompanied by the production of fertile-quality cervical mucus, supports the survival and movement of sperm.

Functionality

During menstruation the cervix stretches open slightly to allow the endometrium to be shed. This stretching is believed to be part of the cramping pain that many women experience. Evidence for this is given by the fact that some women's cramps subside or disappear after their first vaginal birth because the cervical opening has widened.

During childbirth, contractions of the uterus will dilate the cervix up to 10 cm in diameter to allow the child to pass through.

During orgasm, the cervix convulses and the external os dilates. Dr. R. Robin Baker and Dr. Mark A. Bellis, both at the University of Manchester, first proposed that this behavior worked in such a way as to draw any semen in the vagina into the uterus, increasing the likelihood of conception. Later researchers, most notably Elisabeth A. Lloyd, have questioned the logic of this theory and the quality of the experimental data used to back it.

Cervical cancer

In humans the cervix may be affected by cervical cancer, a particular form of cancer which is detectable by cytological study of epithelial cells removed from the cervix in a process known as the pap smear. Evidence now shows that those with exposure to HPV, (human papilloma virus), are at increased risk for cervical cancer. These viruses are related to the viruses that causes warts.

Lymphatic drainage

The lymphatic drainage of the cervix is along the uterine arteries and cardinal ligaments to the parametrial, external iliac vein, internal iliac vein, and obturator and presacral lymph nodes. From these pelvic lymph nodes, drainage then proceeds to the paraaortic lymph nodes. In some women, the lymphatics drain directly to the paraaortic nodes.

Additional images

Organs of the female reproductive system.	Ovary	Uterus and uterine tubes.	Posterior half of uterus and upper part of vagina.

References

•  • [ e] Female reproductive system
Ovaries/Oogenesis	Germinal epithelium • Tunica albuginea • cortex (Cumulus oophorus, Stroma) • Medulla
Follicles/Folliculogenesis	corpus (hemorrhagicum, luteum, albicans) • Theca folliculi (externa, interna) • Follicular antrum (Follicular fluid) • Corona radiata • Zona pellucida • Membrana granulosa (Granulosa cells)
Ligaments	Proper • Suspensory • Round • Broad (Mesovarium, Mesosalpinx, Mesometrium) • Cardinal
Fallopian tubes	Isthmus • Ampulla • Infundibulum • Fimbria
Uterus	cervix/neck (External orifice, Canal of the cervix, Internal orifice) • corpus/body (Cavity of the body, Fundus) • layers (Endometrium, Myometrium, Perimetrium)
Vulva	Mons pubis • Labium  (Labial commissures, Frenulum labiorum pudendi, Labia majora, Cleft of venus, Labia minora, Vulval vestibule, interlabial sulci) • Clitoris  (Clitoral hood , Clitoral glans, Frenulum clitoridis, Clitoral crura, Corpus cavernosa, Vestibular bulbs) • Vagina (Bartholin's glands, Bartholin's ducts, Skene's glands, Skene's ducts, Fossa of vestibule of vagina, Vaginal fornix, Hymen)
Breast	Mammary glands • Nipple • Areola • Lactiferous duct
Other	G-spot • Urethral sponge