Talk:Cervix

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[edit] Indicator of Fertility

Need to do some work on this section, the Cervix goes through a series of changes during the Menstrual cycle and during pregnancy and I think we should document them on this entry for the Cervix. I've found alot of information about it and I am still digesting it.. hoping to combine it all together and rewrite the section dealing with cervical mucus. [1] and [2] are very good resources for this.

Found some more: [3] [4] [5] [6] [7] [8] [9] [10] [11] [12] [13] [14] [15]

And more [16] [17]

Here is the beginning of the section as I have written, culled from the sources for the part on the menstrual cycle:

A typical mature Cervix spends most of the Menstrual cycle blocked by a high viscosity, dense mucus called G mucus. G mucus is an impenetrable gestagenic mucus formed in the lower cervix. It prevents sperm entry to the uterus and protects the reproductive system from infection. [Discuss G-Mucus receding and being replaced by different mucus as hormones change as ovulation begins, discuss what happens after egg is present, dicuss what happens if no fertilization, discuss menstration]

[edit] Menstruation

Need to add some info about the cervix's function during menstruation. Will research and write more later. Celerityfm 19:12, 6 Jun 2005 (UTC)

Added a bit about menstruation...


Okay, seriously, IT IS NOT A CHANGE IN MUCUS. It is a change from mucus to serous fluid. Please make sure you understand the medical methodology of secretion. Serous and mucus are not interchangeable terms. —Preceding unsigned comment added by 71.64.131.102 (talk) 17:17, 10 March 2008 (UTC)

[edit] Mucus vs. Fluid

Most fertility awareness instructors now use the term "cervical fluid" instead of "cervical mucus," because so many found the latter term distasteful, and were more open to talking about fluid. I don't know if that's the common use in medical circles, or if there is a preference either way. Can anyone offer any insight into this? It would certainly make for more comfortable reading of the article if we changed "cervical mucus" to "cervical fluid," but if the most prevalent usage is still "mucus" then it shouldn't change. MamaGeek (Talk/Contrib) 11:39, 15 June 2006 (UTC)

Creighton Model teachers [18], Billings teachers [19], and Couple to Couple League teachers [20] all use mucus. Any one of those organizations is much larger than the secular FA groups I am aware of [21] [22]. Mucus is without a doubt the more widely-used term. Lyrl 23:38, 15 June 2006 (UTC)

Um, hello....it becomes a serous fluid during ovulation so the mucosa will not inadvertently kill sperm. Almost any current histology text will confirm the fluid change, and no, serous is not a form of mucus. —Preceding unsigned comment added by 71.64.131.102 (talk) 17:13, 10 March 2008 (UTC)

The term 'mucus' is widely used and its use in this article is referenced. Because so many large organization use 'mucus', if different sources (such as histology texts) use different terms, this article needs to cover both terms to avoid confusion among readers. Also, please provide a new reference (a specific text) before changing reference information in a Wikipedia article. LyrlTalk C 01:19, 11 March 2008 (UTC)

[edit] Sperm in cervical crypts

Sperm actually all travel to the fallopian tubes starting 1 minute and believed to finish within 30 minutes of ejactulation. They bind to the tube walls, where they wait for ovulation. Any sperm left in the cervical crypts are not going to fertilize an egg. Explanations by Dr. Joanna Ellington, sperm physiologist: [23] [24] Lyrl 23:50, 15 June 2006 (UTC)

[edit] Fornix

Hey, there's a redirect here from the Fornix page in the brain saying that fornix is also a term for part of the cervix. Any chance of a mention of that somewhere on this page?

Confuseddave 09:13, 29 September 2006 (UTC)

It looks like the fornix is actually not part of the cervix, but rather a portion of the vagina - that portion located behind the cervix [25]. As such, it seems like a topic better covered in the vagina page. Lyrl Talk Contribs 13:12, 29 September 2006 (UTC)

[edit] Naboth's gland and cervical crypts?

Are these two terms for the same thing? "Naboth's glands" and "cervical crypts" are both described as mucus-producing areas of the cervix (sounds like the same thing...), but a Google search for (cervical crypt naboth) turns up no information (mostly foreign language articles or ad pages listing every word they could think of to get search engine hits). If they are the same thing, it might be helpful to note that in the article. Lyrl Talk Contribs 00:55, 11 December 2006 (UTC)

[edit] Transition/transformation zone

A note on the transition zone. It is always present, it just migrates througout life and during pregnancy. It represents the junction of squamous epithelium and columnar epithlium - the transition of one cell type to the another. It is also the area where most cervical cancers originate. [26] --Name8318 15:33, 19 August 2007 (UTC)

[edit] Incorrect Information

Editors should be aware that the user Drsavard (and apparently 71.224.215.219) who proposed these changes does consulting work for QIAGEN pharmaceutical company, which is the owner of Digene, maker of the HPV test. Therefore they have a potential WP:COI regarding HPV testing. Zodon (talk) 06:05, 11 May 2008 (UTC)

I am a medical doctor specializing in internal medicine with 25 years of experience. I found the following information in this article to be incorrect and I’d like to update it to include the correct information. If no one protests the updates below within 48 hours, I’d like to go ahead and make these edits to ensure that Wikipedians receive the correct information as soon as possible. All references are included below.

Existing Text
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.

Updated Text
In humans, cells on the cervix may become cancerous. Detection usually occurs following cytological study of epithelial cells removed from the cervix (a process known as the Pap smear), and – in an increasingly common practice – testing for HPV (human papillomavirus). If one or both of these tests are abnormal, a colposcopy exam and biopsy are used to confirm the diagnosis. Evidence now shows that women who have persistent infections with ‘high-risk’ types of HPV are at increased risk of developing cervical cancer[1]. Of the approximately 40 types of HPV that affect the genital area,[2] there are about 15 such ‘high-risk’ (oncogenic) strains[3]. Approximately 12 other types are ‘low-risk’;[4] they cannot cause cervical cancer, but can cause genital warts or minor cell changes on the cervix that disappear on their own.[5]

Drsavard (talk) 14:18, 10 March 2008 (UTC)

I like the types of changes you are proposing. I don't know that the level of detail on exactly how many strains of HPV exist is needed in this article (it could just say "Women with high-risk strains have an increased the risk of developing cervical cancer, although some strains of HPV can cause genital warts or minor cell changes but not cancer" or something along those lines). But it's not something I feel strongly about. LyrlTalk C 01:25, 11 March 2008 (UTC)
Agree that don't need quite so much detail on types here (obscures the main points). (Especially since keep seeing different numbers of each type, the fewer places these numbers get to the better.) Now putting some sources to some of the numbers of HR/etc. types in the HPV article - that would definitely help. Lyrl's suggested wording for this seems fine, or other wording you prefer.
Suggest leave out the HPV testing portion. That is still evolving and the benefits are questionable. It is being heavily marketed by the manufacturer, but evidence of clinical benefit except in special cases (triage, follow-up) is lacking. Is its use as noted growing significantly everywhere, or is this a local perspective? Zodon (talk) 08:42, 11 March 2008 (UTC)


Thank you for inspiring me to review the copy and my suggested edits once again. I now realize that the wording somewhat implies that the presence of HPV is not necessary to the development of cervical cancer. However, the experts now agree that it is - although other factors such as smoking can then make it more likely that HPV infections become persistent and evolve into cancer.

Thus, I would review my edit this way:

In humans, cells on the cervix may become cancerous. Detection usually occurs following cytological study of epithelial cells removed from the cervix (a test known as the Pap smear), and - in an increasingly common practice- testing for HPV. If one or both of these tests are abnormal, a colposcopy exam and biopsy are used to confirm the diagnosis. Research now has documented that persistent infection with high risk types of HPV must be present for cervical cancer to develop. However, it's also true that most women with high-risk HPV do not develop serious disease. Contributing factors such as smoking can make it more likely that an HPV infection persists and evolves into cervical cancer -- that is, if the resultant abnormal cells are not treated early. Of the approximately 30-40 types of HPV that affect the genital area, there are about 15 such high-risk strains. Approximately 12 other types of "low-risk"; they do not cause cervical cancer, but can cause genital warts or minor cell changes on the cervix that disappear on their own.
Regarding your opinion that the benefits of HPV testing for cervical cancer screening in older women are "questionable," consider that in its most recent practice bulletin, ACOG said: "Because HPV DNA testing is more sensitive than cervical cytology, women with negative concurrent test results (negative cytology and negative HPV DNA) can be reassured that their risk of unidentified CIN 2 and CIN 3 or cervical cancer is approximately 1 in 1,000." In addition, in a letter supporting a proposed bill to require insurance coverage of routine HPV testing, the CA chapter of ACOG said: "Pap tests are not as useful as HPV DNA diagnostic techniques in detecting the virus HPV. Early detection using the latest technology will lead to better outcomes." In fact, a study in the JNCI found that nearly one-third of cervical cancer cases can be attributed to Pap detection failure. Although many physicians believe that the use of liquid-based cytology reduces that failure rate, several recent studies - including on in The Lancet - found no significant difference compared to conventional Paps. This is the basis for combining cytology with HPV testing, which is much better able to identify women at risk.
There is a wealth of clinical data supporting the use of routine HPV testing of women age 30+ in conjunction with cytology. Below is just a sampling of these studies, beginning with the most recent:
- Study results suggest that, in women age 30+ years, co-testing with a Pap smear and HPV DNA test was more sensitive than reflex HPV testing for the detection of high-grade cervical lesions (91% vs. 54%), provided women with a positive hc2 test and negative Pap were referred to colposcopy and biopsy
Janet G. Baseman, Ph.D., Department of Epidemiology, University of Washington (American Journal of Obstetrics & Gynecology, March 2008)

-For both vaccinated and unvaccinated women, age-based screening by use of HPV DNA testing as a triage test for equivocal results in younger women and as a primary screening test in older women is expected to be more cost-effective than current screening recommendations.
Sue J. Goldie, MHP, Department of Health Policy and Management, Harvard School of Public Health (Journal of the National Cancer Institute, Feb. 26, 2008)

-Compared with cytology, HPV testing has greater sensitivity for the detection of cervical intraepithelial neoplasia. The sensitivity of HPV testing for CIN grade 2 or 3 was 94.6% whereas the sensitivity of cytology alone was 55.4%. The sensitivity of both tests used together was 100%, and the specificity was 92.5%
Human Papillomavirus DNA versus Papanicolaou Screening Tests for Cervical Cancer. New England Journal of Medicine 2007; 357; 1579-1588.

-Implementation of HPV DNA testing in cervical screening led to a substantial increase in the number of CIN 2/3+ lesions detected at the baseline screening round. At the subsequent round, combined HPV DNA and cytological testing was used in both study groups and significantly fewer CIN 2/3+ lesions were seen in the women who received both tests at the baseline round than in the control group. Therefore, the results show that implementation of HPV DNA testing in cervical screening leads to earlier detection of clinically relevant cervical lesions.
Meijer, C. et al. Human papillomavirus DNA testing for the detection of cervical intraepithelial neoplasia grade 3 and cancer: 5-year follow-up of a randomized controlled implementation trial. The Lancet 2007; DOI:10.1016/SO140-6736(07)61450-0.

-HPV testing in primary screening and HPV vaccination against the most common types have the potential to reduce the incidence of invasive adenocarcinoma.
Castellsague, X. et al. Worldwide Human Papillomavirus Etiology of Cervical Adenocarcinoma and Its Cofactors: Implications for Screening and Prevention. Journal of the National Cancer Institute 2006; 98:303-315.

-HPV testing is substantially more sensitive in detecting CIN 2+ than cytology (96.1% vs. 53%) but is less specific (90.7% vs. 96.3%). In this analysis, the sensitivity of HPV testing was similar in all studies carried out in different areas of Europe and North America, whereas the sensitivity of cytology was highly variable. These results support the use of HPV testing as the sole primary screening test, with cytology reserved for women who test HPV-positive
Cuzick, J. et al. Overview of the European and North American SZtudies on HPV testing in Primary Cervical Cancer Screening. International Journal of Cancer 2006; 98:765-74.

-
Because HPV DNA testing is more sensitive than cervical cytology in detecting CIN 2 and CIN 3, women with negative concurrent test results can be reassured that their risk of unidentified CIN 2 and CIN 3 or or cervical cancer is approximately 1 in 1,000.
G Practice Bulletin No. 61, "Human Papillomavirus. Clinical Management Guidelines for Obstetrician-Gynecologists." April 2005

-The negative predictive value of combined HPV/Pap testing is 99.21% for CIN 3.
Sherman M.E., et al. Human Papillomavirus Testing, and Risk for Cervical Neoplasia: A 10-Year Cohort Analysis. Journla of the National Cancer Institute, 2003; 95:46-52.

-In another study of more than 11,000 women, the digene HPV Test was shown to be 97% sensitive for CIN2+, compared to 77% for conventional Paps resulting in ASC-US or abnormal results. The study also documented that women infected with high-risk HPV and who have normal or borderline cytology can be managed as effectively with repeat testing after 12 months with immediate colposcopy.
Cuzick, J. et al. Management of women who test positive for high-risk types of human papillomavirus: the HART study. The Lancet 2003; 362:1871-76.

-Still another study demonstrated that HPV testing is a more sensitive indicator of high-grade CIN than either conventional or liquid cytology alone. Screening with both an HPV and Pap test offered a sensitivity and negative predictive value of almost 100%. Twenty one percent of women who were persistently positive for high-risk HPV DNA types when tested with hc2 were diagnosed with CIN 2/3 within 36 months, compared to only 0.08% of women who were initially HPV-negative.
Lorincz, A., Richart, R. Human Papillomavirus DNA Testing As An Adjunct To Cytology In Cervical Screening Programs. APLM 2003; 127:959-968>.

-A study of 8,466 women undergoing routine cervical cancer screening showed that when used in conjunction with a Pap, the sensitivity of the digene HPV Test was 100% for detection of CIN2+, while that of the Pap alone was 43.5%.
Petry K., et al. Inclusion of HPV testing in routine cervical cancer screening for women above 29 years in Germany: results for 8,466 patients, British Journal of Cancer, 2003, 88:1570-1577.

-Women with persistent HPV infection are more than 300 times more likely than HPV-negative women to develop high-grade cervical disease.
Bory J., et al. Recurrent Human Papillomavirus Infection Detected with the Hybrid Capture 2 Assay Selects Women with Normal Cervical Smears at Risk for Developing High Grade Cervical Lesions:A Longitudinal Study of 3,091 Women. Int. J. Cancer, 2002; 102:519-525.

-In an ASC-US population, the senstivity of the digene HPV Test for detecting high-grade precursors and cervical cancer is 96%, compared to 85% for a repeat liquid-based Pap test.
Solomon, D. et al. Comparison of Three Management Strategies for Patients with Aytpical Squamous Cells of Undetermined Significance: Baseline Results from a Randomized Trial, J. Nat Cancer Inst, 2001; 93:293-299.

-A cohort analysis of 5,671 women older than 30 (conducted within a larger study of 7,932 women) showed that conventional cytology was 57% sensitive for HSIL; liquid cytology was 84% sensitive, and the digene HPV Test was 100% sensitive.
Clavel C. et al. Human Papillomavirus Testing in Primary Screening for the Detection of High-Grade Cervical Lesions: A Study of 7,932 Women. Brit J Cancer, 2001; 89 (12): 1616-1623.

- High-risk HPV types have been detected in 99.7% of cases of cervical cancer, confirming that the virus must be present for cervical cancer to develop.
Walboomers J.M.M. et al. Human Papillomavirus is a Necessary Cause of Invasive Cervical Cancer Worldwide. Journal of Pathology 1999; 189:12-19

71.224.215.219 (talk) 17:30, 25 April 2008 (UTC)

I think much of this information is simply outside the scope of an anatomy article. You might try cervical cancer, human papillomavirus, vulvovaginal health, etc. LyrlTalk C 12:23, 26 April 2008 (UTC)