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JANUARY BLOG

 

CERVICAL HEALTH

 

January is Cervical Health Awareness Month.  According to the American Cancer Society this campaign is to increase public awareness for cervical cancer screenings.  Early detection is key in identifying pre-cancerous changes in the cervix, as well as initiating early treatment.  The cervical cancer death rate has declined by 74% between 1955 – 1992.   If treated in early stages, the death rate for this disease can decrease by 50%.   

 

Who knows more about our bodies than we do???  As a former athlete, I can tell when something is amiss with my body or identifying when something is not quite right.   

 

Let’s talk about the cervix, types of problems it may encounter and the importance of overall pelvic health.   Think of the cervix as the gatekeeper to the rest of the female reproductive system.  The cervix is located at the lowest part of the uterus and forms the junction between the uterus and the vagina – providing the separation of these two structures.  

 

The cervix is quite small structure, measuring only an inch in length is very important.   It is muscle and connective tissue and consists of 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 the endocervical canal.  The endocervix and ectocervix are made 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?   The cervix 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.  As the passage between the uterus and the vagina, it plays a role in the monthly sloughing of endometrial cells or menstruation.   The cervix also dilates during childbirth, to allow the baby passage between the womb and the birth canal.  

 

What disorders affect the cervix?  Disorders range from mild irritation to fatal cancers.  Here is a short list:   

 

  • Cervicitis – or inflammation of the cervix which is often caused by a sexually transmitted infection such as:  gonorrhea, chlamydia, genital herpes or trichomoniasis, genital warts or due to bacterial infection such as bacterial vaginosis or an allergic reaction to condoms or feminine hygiene products.   Symptoms include unusual vaginal discharge, bleeding, painful urination and painful intercourse or dyspareunia.

 

  • Cervical polyps – are growths on the cervix and usually benign.  They may be the result of untreated inflammation of the cervix.  Most often they cause no symptoms, but may result in bleeding or vaginal discharge.

 

  • Cervical stenosis – or the narrowing of the cervical canal.   Several conditions can cause this including cancer, menopause, radiation and surgical procedures that affect the uterus and cervix.  This may have serious implications, including backflow of endometrial cells during menstruation, leading to endometriosis.  It can also lead to pus in the uterus, a lack of a menstrual cycle or amenorrhea, infertility and pelvic pain.

 

  • Cervical Cancer – one of the most successfully, treatable cancers and a leading cause for cancer death in women.  If dysplasia or precancerous cells are detected early and removed, cervical cancer can be prevented.  Cells in the transformation zone of the cervix may show pre-cancerous changes, such as dysplasia, lesions, and neoplasia which can be detected in a pap smear.  Certain risk factors may increase the risk of pre-cancerous changes and cervical cancer which include:   

 

  • Human Pamillomavirus or HPV infection,
  • smoking,
  • chlamydia infection,
  • a weakened immune system due to HIV infection,
  • began having sex at an early age (16 years or younger),
  • you or your partner has had several partners,
  • taking birth control pills for five or more years,
  • giving birth to three or more children,
  • taking immunosupressing drugs,
  • poor fiber intake,
  • high body mass index or (BMI, or
  • family history

 

 

 

 

Signs and symptoms may include vaginal bleeding, abnormal discharge, painful intercourse and dyspareunia.  Once diagnosed, doctors stage the disease determinant of the size of the tumor, involvement of local lymph nodes and metastases or spread to other sites in the body.  Treatment is dependent on the stage, type cancer and may include surgery, chemotherapy, radiation and targeted therapy.  A pelvic floor physical therapist can also be a crucial part of the team both during and after treatment for cervical cancer.

 

  • Cervical dysplasia - refers to cell changes on the surface of the cervix that are deemed abnormal, most likely caused by HPV, but not always.  Catching abnormal cell changes is key to attacking cervical cancer before it forms.  These cell changes are discovered through a Pap test.  Once discovered, more tests will need to be done to find more conclusive information.

 

Current Cervical Cancer Screening Guidelines.   According to the American Cancer Society, over 13,000 new cases of cervical cancer were diagnosed in 2018, 99% of those cases were caused by human papillomavirus, or HPV, a sexually transmitted virus that affects an estimated 80% of the population. 

 

Cancer screening involves a pap test, performed by a gynecologist or family medicine practitioner that can detect pre-cancerous and cancerous cells in the cervix.  Cells collected can also be used in testing for HPV.  According to the CDC, screening for cervical cancer should start at age 21 for all women, regardless of risk factors. Between ages 21 - 29 years, screening should occur every three (3) years.   Between ages 30 - 65, screening should occur every five (5) years.  Screenings can cease after age 65 or if a hysterectomy has been performed removing the cervix.  

 

Everyone with a cervix needs to be tested.  The discussion of cervical cancer has focused mainly on cisgender women or women whose gender identity aligns with the biological sex assigned at birth.   But the risk of cervical cancer also extends to female-to-male (FTM) transgender individuals.  Some FTM patients will choose to undergo surgical interventions such as a hysterectomy, oophorectomy or phalloplasty, while other patients may not.  Although FTM patients with a cervix still need to follow the above listed guidelines for cervical cancer screenings, this can be difficult for transgender patients.  FTM patients already face barriers receiving medical treatment, discrimination, financial barriers and a lack of healthcare providers who are educated in delivering culturally competent healthcare to this population.  These factors may lead FTM individuals to defer cancer screenings.   

 

Cervical Health and the Pelvic Floor.   Any condition that causes pain in the pelvic organs such as:  the bladder, urethra, uterus, cervix, vagina or rectum can cause the pelvic floor to become unregulated, tight, and painful.  Treatment for cervical cancer, hysterectomy and radiation, can lead to pelvic floor symptoms including pelvic pain, urinary incontinence, overactive bladder, constipation and fecal incontinence.  Scar tissue from surgery and tissue changes from radiation affect the ability of the pelvic floor to function normally and can lead to chronic pelvic pain.  

 

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.  Early detection and treatment of lymphedema can improve quality of life, decrease risk of infection and potentially impact bladder function and overall pelvic health.  

 

The HPV vaccine.   There are 200 strains of HPV and not all are dangerous.  But there are several strains that can cause gynecologic disease.  Currently there is no HPV screening method for men and the virus can lie dormant in women for years.  

 

There are three (3) HPV vaccines available that can help prevent HPV-related cancers like cervical cancer.   So far one vaccine has the potential to eradicate the most dangerous strains of HPV:  Gardasil.  The newest vaccine is Gardasil-9, approved by the FDA in 2014.  This latest vaccine protects against nine whole strains of HPV -- five (5) more than the Gardasil vaccine and seven (7) more than the Cervarix vaccine.  

 

Dr. Marcia Hernandez, gynecologic oncologist at Mercy Hospital Springfield, stated “the current Gardasil-9 vaccine targets nine (9) of the most dangerous strains of HPV.  This vaccine is truly a cancer vaccine.  It’s not just preventing cervical cancer—it prevents all cancers that are related to the HPV virus, that includes head and neck cancer, male genital cancers, vulvar cancer and cervical cancer.”

 

The HPV vaccine is recommended for boys and girls ages 11 or 12 years, but it can be given starting at age 9 years and through age 26 years.  It’s most effective before any sexual activity has taken place.

 

What lifecycle changes affect the cervix?   Female cervical cells are most vulnerable to abnormal cell growth at puberty, during a first pregnancy and a few weeks following the birth of a child.   At these vulnerable times the junction extends further out into the vagina so the cells are more susceptible to changes and carcinogens, cancer causing substances.  This vulnerable area is also exposed in many younger women, especially during their teens.

 

What are the factors that I need to think about for prevention?  There are a number of things that can affect your overall health as well as your cervix, including:

  • Lifecycle changes

 

  • The immune system - a healthy immune system contributes to the ability to clear HPV naturally from our bodies.  Take care of yourself, get enough sleep to feel rested, eat well and check with your health practitioner or pharmacist for suggestions of ways to boost your immune system.  Your immune system can be especially weak if you have:

 

  • HIV/AIDS
  • chronic fatigue syndrome
  • used steroids/corticosteroids
  • had an organ transplant or kidney dialysis
  • had chemotherapy.

 

  • Smoking and second hand smoke - is definitely linked with the development of cervical cancer.  Nicotine and other by-products of smoking concentrate in the cervical mucus of smokers.  Women who smoke, especially women who also have HPV, are much more likely than non-smokers to develop abnormal changes or cancerous changes in the cervix.  Even former smokers are more likely to develop abnormal changes.

 

  • Stress – Many women lead lives that include lots of daily stress, some incidents are worse than others.  Some experience abnormal Pap results after major negative life events.  Researchers think that how we cope with stressful events is related to abnormal Pap results.  Being positive about life is not always easy.

 

  • Diet - Eating nutritiously can help us feel well, but it is especially important during times of high stress.  A nutritious diet is low in fatty meats, red meat, cheeses and white bread, but high in soy products, fruits, dark green vegetables, tomatoes, whole grains and yogurt.  

 

  • Vitamins - It's best to get vitamins from foods we eat.  If you have an abnormal Pap result you can consider taking extra vitamins.  Some naturopaths have a vitamin pack that is applied directly to the cervix on a sponge or cervical cap.

 

Using female and male condoms.  Condoms provide protection to the cervix from sexually transmitted infections or STI’s.  It is highly recommended to use a female condom for intercourse, as it provides better coverage than a regular condom because it protects both the inside of the vagina and the vulva from Human Papillomavirus (HPV) and other sexually transmitted infections like chlamydia, both linked with cervical cancer.  Male condoms provide protection for your cervix.  Sex toys and hands need covering with condoms or latex gloves as well because HPV and other STI’s may still be present on them.  Some studies find that women whose male partners use condoms for 3 to 6 months have their abnormal Pap result reversed (CIN 1 and CIN2) and HPV cleared.  Female condoms are more expensive than male condoms, but several clinics sell female condoms for less than they cost at pharmacies.

 

You may want to check into herbal medicines, supplements and vitamins.

Some foods contain vitamins that are known to nourish the cervix and our immune system, such as:

 

  • Beta-carotene - is one of a group of red, orange and yellow pigments called carotenoids. Beta-carotene and other carotenoids provide approximately 50% of the vitamin A needed in the American diet.  It is also used to prevent certain cancers. 
  1. yellow-orange vegetables or fruits like carrots, cantaloupe, peaches or squash,

 

  • Folic acid – used in combination with B vitamins may aid in the prevention of cervical cancer.
  1. dark green leafy vegetables (spinach, broccoli and lettuce), okra, asparagus, fruits (bananas, melons and lemons) beans, yeast, mushrooms, meat (beef liver and kidney), orange juice and tomato juice.

 

  • Vitamin A – uses include preventing and treating cancer, including non-Hodgkin's lymphoma and to reduce side effects during cancer treatment.
  1. many fruits, vegetables, eggs, whole milk, butter, fortified margarine, mea, and oily saltwater fish. 

 

  • B vitamin – a combination of B vitamins (thiamine, riboflavin, niacin/niacinamide, vitamin B6vitamin B12folic acid and pantothenic acid), used in conjunction with folic acid can aid in prevention and reverse precancerous changes in cervical cells

 

  • Vitamin C - people must get this vitamin from food and other sources. 
  1. fresh fruits and vegetables, especially citrus fruits.

 

  • Vitamin E -is an antioxidant that dissolves in fat, it also helps to slow down processes that damage cells.
  1. found in many foods including vegetable oils, cereals, meat, poultry, eggs, fruits, vegetables, whole-grain cereals, breads and wheat germ oil.

 

  • Lycopene - is a powerful antioxidant that may help protect cells from damage.  Some evidence suggests that higher lycopene blood levels or higher lycopene intake in the diet is linked to a lower risk of cervical cancer.
  1. found in tomato products like puree and paste, watermelons, red oranges, pink grapefruits, apricots, rosehips, watermelon and guavas. 
  • Shitake mushrooms – a dark brown, umbrella-shaped fungus stem from a concentration of lentinan, which may help prevent and treat cancerlower cholesterol, and stimulate the immune system.  It has eight amino acids as well as vitamins and minerals including B6, B2 (riboflavin), niacin, and selenium.  A good source of protection.

Facebook Live.  The HPV vaccine is now approved for males and females through age 45 and NCCC hosted a Facebook live discussion to cover what you need to know about the expanded age range.  You can help NCCC promote the importance of cervical health and cervical cancer prevention by sharing prevention messages throughout the month that cervical cancer is preventable on social media.

 

Warriors in Teal.  The GYNCA began in 2001 as a small gynecologic cancer support group in Springfield, a cancer nonprofit connecting patients to other survivors, financial resources and most importantly, hope.  GYNCA serves patients in 26 counties and offers everything from care packages with teal nail polish—the official color of gynecologic cancers—to car repairs and gas money to help patients get to treatments.

 

‘Early detection with treatment saves lives’

 

ALWAYS CONSULT YOUR PERSONAL HEALTH CARE PROFESSIONAL

 

https://www.webmd.com/food-recipes/features/shake-up-dishes-with-shiitake-mushrooms

 

 

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Comments

  • Barbra Rose Meyer (Tuesday, January 10 17 06:52 pm EST)

    Great blog! I left my position in brilliant hands! Very Informational!

  • Joe Felix (Sunday, December 03 17 07:06 pm EST)

    I found your COPD comments interesting. Would you consider doing a leaky gut syndrome segment?

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