Author: Lisa Cheek, PT, DPT, CLT-LANA
In case you didn’t hear, January is Cervical Health Awareness Month. According to the American Cancer Society 1, the purpose of this campaign is to increase the public’s awareness of cervical cancer screening. Early detection of cervical cancer is key in identifying pre-cancerous changes in the cervix, as well as initiating treatment as soon as possible. If treated in its early stages, the death rate for this disease can decrease by 50%1 or more…so clearly this is a very important topic for us to discuss!
As a physical therapist, I firmly believe that the more we know about our own bodies, the better able we are to identify when something is not quite right. Let’s talk about the cervix, the types of problems it may encounter, and its implications for overall pelvic health.
Meet your cervix 1
The cervix lives at the lowest part of the uterus. It forms the junction between the uterus and the vagina, and provides separation for these two structures. While very important, the cervix is quite a small structure, measuring in at about an inch long. It is made up of muscle and connective tissue, and has two parts: the ectocervix which protrudes into the vagina, and the endocervix which opens up to the uterus. The passageway between the uterus and the vagina is called the endocervical canal. The endocervix and ectocervix are made up of two different types of cells, and the area where the columnar cells of the endocervix change into the squamous cells of the ectocervix is called the transformation zone. This is important because precancerous cells are usually identified in this zone.
What does the cervix do?2
As previously stated, the cervix forms the connection between the uterus and the vagina. It houses glands that secrete mucus, which plays an important role in the menstrual cycle and conception. It also protects the uterus, ovaries, and fallopian tubes from bacteria. Being that it is the passage between the uterus and the vagina, it plays a role in the monthly sloughing of endometrial cells (menstruation). The cervix also dilates during childbirth in order to allow the baby passage between the womb and the birth canal. Think of the cervix as the gatekeeper to the rest of the female reproductive system.
What disorders affect the cervix?
Like every body structure, there are a number of ways that the cervix can turn on you. These disorders range from mild irritation all the way to fatal cancers. Here is a short list of some of the things you might want to look out for:
- Cervicitis 3– This means inflammation of the cervix. Cervicitis is often caused by a sexually transmitted infection (gonorrhea, chlamydia, genital herpes, trichomoniasis, etc.) or may also be due to bacterial infection (bacterial vaginosis) or allergic reaction to condoms or feminine hygiene products. Symptoms include unusual vaginal discharge, bleeding, painful urination, and painful intercourse (dyspareunia).
- Cervical polyps 4– These are growths on the cervix, but are usually benign. They may be the result of untreated inflammation of the cervix. Often, they cause no symptoms, but may result in bleeding or vaginal discharge.
- Cervical stenosis 5– This means the narrowing of the cervical canal. A number of conditions can cause this, including cancer, menopause, radiation, and certain surgical procedures that affect the uterus and cervix. This can have serious implications, including backflow of endometrial cells during menstruation, leading to endometriosis. It can also lead to pus in the uterus, lack of a menstrual cycle (amenorrhea), infertility, and pelvic pain.
- Cervical Cancer 6– Cervical cancer is a leading cause for cancer death in women. Cells in the transformation zone of the cervix may show pre-cancerous changes, such as dysplasia, lesions, and neoplasia. These changes may be detected in a pap smear. There are certain risk factors that may increase your risk of pre-cancerous changes and cervical cancer. These include Human Pamillomavirus (HPV) infection, smoking, chlamydia infection, a weakened immune system (due to HIV infection or immunosupressing drugs), poor fiber intake, high body mass index (BMI), family history, and many others 7. Signs and symptoms of cervical cancer may include vaginal bleeding, abnormal discharge, and dyspareunia8. Once cervical cancer is diagnosed, doctors stage the disease, determined by the size of the tumor, involvement of local lymph nodes, and metastases or spread to other sites in the body. Treatment for cervical cancer depends on the stage and type of cancer, and may include surgery, chemotherapy, radiation, and targeted therapy 9. As with any type of cancer, early detection and treatment is crucial. It is also important to have a team of trusted professionals, including a gynecologic oncologist, radiation oncologist, and gynecologist. A pelvic floor physical therapist can also be a crucial part of the team both during and after treatment for cervical cancer.
Current Cervical Cancer Screening Guidelines
According to the CDC10 , screening for cervical cancer should start at age 21 for all women, regardless of risk factors. Between the ages on 21 and 29 years, screening should take place every three years. Between the ages of 30-65, screening should occur every every five years. Screening can stop after age 65, or if a hysterectomy has been performed involving removal of the cervix. Screening involves a pap test, which is typically performed by a gynecologist or family medicine practitioner11. This test can detect pre-cancerous and cancerous cells in the cervix. Cells collected during the pap test can also be used to test for HPV.
Everyone with a cervix needs to be tested 12
Thus far, the discussion of cervical cancer has focused mainly on cisgender women, or women whose gender identity aligns with the biological sex assigned at birth. However, the risk of cervical cancer also extends to female-to-male (FTM) transgender individuals as well. Gender expression exists on a spectrum, and while some FTM patients will choose to undergo surgical interventions (hysterectomy, oophrectomy, phalloplasty, etc.), other patients will not. FTM patients who still have a cervix still need to follow the above listed guidelines for cervical cancer screenings. This can be a difficult experience for transgender patients, who already face a number of barriers to receiving medical treatment, including discrimination, financial barriers, and lack of healthcare providers who are educated in delivering culturally competent healthcare to this population. These factors and others may lead FTM individuals to defer cancer screenings, which can in turn lead to late detection of any pre-cancerous or cancerous changes in the cervix. Resources exist to help FTM patients find healthcare providers who are trans-friendly and knowledgeable about providing services to this population. Here in Denver, the Gender Identity Center of Colorado and The Center can guide patients in finding the right providers to perform cervical cancer and other health screenings.
Cervical Health and the Pelvic Floor
At N2 Physical Therapy, we are passionate about the pelvic floor. We’ve been talking a lot about the cervix, but how does it relate to the pelvic floor? We know that any condition that causes pain in the pelvic organs (bladder, urethra, uterus, cervix, vagina, rectum) can cause the pelvic floor to become upregulated, tight, and painful. Treatment for cervical cancer, such as hysterectomy and radiation, can lead to pelvic floor symptoms including pelvic pain, urinary incontinence, overactive bladder, constipation, fecal incontinence, and others 13,14. Scar tissue from surgery and tissue changes from radiation affect the ability of the pelvic floor to function normally, and can also lead to chronic pelvic pain. These symptoms can have a huge impact on patient’s quality of life and participation in daily activities.
Additionally, patients who have undergone lymph node dissection are at risk for lymphedema, or accumulation of protein-rich fluid in the lower limbs, genitals, or abdomen. One study 15 suggested that lymphedema caused by radical hysterectomy in the case of cervical cancer is associated with difficulty emptying the bladder. Early detection and treatment of lymphedema can improve quality of life, decrease risk of infection, and potentially impact bladder function and overall pelvic health.
Love your cervix
Your cervix serves an important function in pelvic and reproductive health, and we should care for it like we do for other parts of our bodies. In the spirit of Cervical Health Awareness Month, we hope you will share this information with your friends and family….and don’t hesitate to book an appointment with any of our providers to address any pelvic health or lymphedema- related concerns.
- Potter et al. J Gen Intern Med. 2015 Dec; 30(12): 1857–1864. Published online 2015 Jul 10. doi: 10.1007/s11606-015-3462-8
- Hazewinkel et al. Int J Gynecol Cancer. 2012 Jan;22(1):154-60. doi: 10.1097/IGC.0b013e3182332df8.
- Hzewinkel et al. Gynecol Oncol. 2010 May;117(2):281-6. doi: 10.1016/j.ygyno.2010.01.034. Epub 2010 Feb 18.
- Bergmark K, Avall-lundqvist E, Dickman PW, Henningsohn L, Steineck G. Lymphedema and bladder-emptying difficulties after radical hysterectomy for early cervical cancer and among population controls. Int J Gynecol Cancer. 2006;16(3):1130-9.