When to worry about your cervix

You may never, in your entire life, see your own cervix. Yes, you can see it on a monitor perhaps during an examination, but usually, it remains hidden from you. 

It isn’t too hard to see your own cervix if you are interested enough and a little flexible – you can actually check out your own cervix for changes if you want to.

But if you’re not that keen, you’ll need a doctor or gynaecologist to do the heavy lifting during your regular pelvic examinations.

So what are they looking for when your cervix is examined? It can pay to be informed so when you are getting your next pap test, you can ask questions – it’s interesting stuff!

Things that can go wrong with a cervix

Cellular abnormalities of the cervix include:

Cervical ectropion (cervical erosion)

Cervical ectropion is a condition whereby the cells in the neck of the cervix that produce mucous overgrow to the outer portion of the cervix, resulting in symptoms such as excessive discharge.

Nabothian cysts

Nabothian cysts are a normal cervical finding and do not present a concern unless they are very large. 

The cysts look like blisters and are caused by a blockage in the columnar epithelial cells of the cervix, which produce cervical mucous and are responsible for fertile cervical fluid. In non-ovulatory times of the menstrual cycle, the mucous is thicker, acting as a physical barrier.

Cervical polyps

Cervical polyps have no known cause and are usually benign growths on the cervix. Removal is typically straightforward.

Cervicitis (cervical inflammation)

Inflammation of the cervix can occur for many reasons, including infections.

Abnormal or precancerous cells (HPV)

Human papillomavirus (HPV), a common sexually transmitted virus, can result in abnormal or precancerous cells on the cervix, which is what a pap smear/pap test is used to detect.

Maternal exposure to diethylstilbestrol (DES, a synthetic oestrogen)

In the 1950s and ’60s, a synthetic oestrogen called diethylstilbestrol (DES) was used to prevent pregnancy disorders. In 1970, research was published that reported young women with vaginal cancers, with the type of tumour (clear-cell carcinoma) very rare in anyone young.

Clear-cell carcinomas are almost exclusively found in elderly women. The cause was drawn back to those young women whose mothers had been given DES during their pregnancy.

There was initially a great fear of the malignant outcomes, but this largely has not come to fruition, with the chances of vaginal malignancy small, and with frequent checks, treatable.

Anatomical abnormalities

Other cervical findings include anatomical abnormalities.

Cervical peek-a-boo – when the cervix is hard to see

There are some circumstances where your cervix might be difficult to see, which could be due to:

• If you have a retroverted uterus which causes your uterus to be displaced
• After menopause
• In women who are nulliparous, which means ‘a female that has not borne offspring’ (meaning, never had a baby, though unclear if this just means never been pregnant, never carried a baby to term, never given birth to a live baby, or never given birth vaginally – take your pick)
• After vaginal surgery
• If your bladder is full
• During an episode of constipation
• With uterine enlargement
• With a pelvic mass or growth
• Amongst scarring
• When obese or a high body mass index (BMI)

What could be found on your cervix

• Blue, black or red lesions, combined with discharge, painful periods, pelvic pain or deep pain on penetration (could indicate endometriosis or adenomyosis)
• ‘Strawberry cervix’ associated with cervicitis – could be caused by a sexually transmitted infection, may be asymptomatic or come with discharge or bleeding after sex
• Bleeding after sex, from the genitals or the cervix – can be caused by some cancers, cervical ectropion and other issues
• Abnormal lesions on vagina or cervix, vaginal adenosis, cockscomb cervix or a cervical collar hood may appear in daughters of women given DES in the 70s