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:
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.
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:
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:
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’
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