During a gynecological examination, changes in the cervix may be detected. They do not always mean the presence of an oncological process.

If changes are detected in the organ, the doctor will prescribe an additional examination, the results of which will confirm or refute cancer.

Studies have proven that malignant processes in the cervix are caused by the papilloma virus. It is transmitted from person to person through sexual contact. Oncogenic subtypes of the virus lead to severe dysplasia and cancer. A woman can become infected in her youth, and after 10 years, papilloma will lead to cell mutation. The peak incidence of cancer occurs between 40 and 55 years of age.

Photos and descriptions of all types

There are different types of cervical cancer. This affects appearance visible part of the organ. During a gynecological examination, the doctor can observe various pictures of pathological processes.

For a more detailed examination, a colposcopy is performed. The procedure is done like a regular speculum examination, but the doctor looks at the cervix and vagina using a colposcope (a binocular with a light).

Squamous cell carcinoma

The external os is located in the vaginal area. It is covered with non-keratinizing stratified epithelium. Often, squamous cell carcinoma develops at the junction of the epithelium from squamous to columnar.

The appearance of squamous cell pathology depends on its subtype:

Infiltrative-ulcerative

The organ has a reddened, inflamed appearance. Numerous not large sizes the ulcers bleed, their edges have clear boundaries, they are slightly raised above the mucosa. There are areas with yellowish crusts. The pathology is located in the central part of the external pharynx, spreading in all directions.

The central entrance is poorly visible due to the tumor; it is filled with liquid. The part of the cervix not affected by cancer and the visible area of ​​the vaginal walls have a normal color and structure.

Tumor

On the neck, a volumetric formation is clearly visible, which is located on the edge. It grows on a broad base. Protrudes much above the surface of the mucosa. The formation itself has a bumpy and rough surface. In some places of the tumor, bleeding ulcers are visible.

The rest of the organ has the usual color and structure, the walls of the vagina are also unchanged. The central hole is of a regular shape, slightly reddened in the middle.

Adenocarcinoma

The length of the neck is 3-4 centimeters. In addition to the external and internal pharynx, the organ has a cervical canal. It is filled with thick mucus, the purpose of which is to protect against germs.

The inner part of the cervical canal consists of columnar epithelium and tubular glands. A neoplasm is formed from ferrous particles. Therefore, the disease is often called glandular cancer.

Types of adenocarcinoma:

Endometrioid Foma

The tumor grows into the tissue superficially. The pathology is located in the central part of the vaginal area of ​​the cervix. The central hole is strongly compressed by the tumor. It has a red color, papillary growths, and small bruises are visible. The pathogenic area is slightly recessed into the body of the cervix.

On the surface of the external pharynx, small growths and enlarged blood vessels are visible. The vaginal walls are not changed.

Papillary form

The entire vaginal part of the cervix is ​​covered with a white heterogeneous coating. This type of malignant tumor is caused by the papillary growths from which it was formed. Big number papillomas vaguely resemble cauliflower.

The central part of the organ is dark red. The entrance to the cervical canal is clearly visible. The rest is covered with tumor. There are visible bruises and yellowish areas on it. The edges of the neoplasm are not smooth, torn, slightly raised above the mucosa. The entire outer part of the cervix is ​​affected. The visible part of the vagina is not changed by the oncological process.

Mixed cancer

Mixed oncological neoplasms include the following types:

• glandular-squamous;
• adenoid cystic;
• adenoid-basal.

The tumor has a heterogeneous texture, its growth is noticeable above the mucosa. The surface of the neoplasm is lumpy, juicy, with bruises. The pathology is colored red, blood vessels are visible through it. In some parts of the external pharynx, white-yellow formations and ulcers are visible.

The entrance to the cervical canal is practically invisible. It is closed by an overgrown tumor. There is a noticeable dark red spot in its center.

The malignant tumor has spread throughout the mucosa. The surface has a non-uniform color. Multiple blood vessels appear through the pink mucosa.

A whitish coating is smeared throughout the mucous membrane, the contours of which slightly protrude beyond the cervix.

The central entrance is clearly visible, but many blood vessels emanate from it. The neck itself is uneven in shape, its upper part is noticeably swollen.

The tumor is heterogeneous in shape and color. It has a rough structure, with multiple papillary-like processes.

The pathology is covered with a white coating that does not completely cover the neck. Reddened areas and a yellowish coating are visible.

The area of ​​the external pharynx is severely deformed; there is a depression filled with a gray-bloody mass.

The neck is noticeably enlarged and has a rounded shape. The tumor is loose, with bruises in different areas, heterogeneous.

The color ranges from pale pink to red, with some yellow areas. There may be ulcers and small growths resembling papillomas on the surface.

The central entrance is greatly open and has loose, torn edges.

The visible part of the vagina is not affected and has normal color and structure.

The mucous membrane is covered with blood and has an irregular shape. Its lower part is noticeably enlarged and has a loose surface. There is a blurry blood clot in the area of ​​the deformity.

The color of the mucous membrane is pink. The entrance to the cervical canal is displaced due to deformation of the external pharynx; it is filled with bloody discharge.

Photos and descriptions of degrees

Cervical cancer is usually divided into 4 stages, each of which has its own characteristics. Classification into stages is based on the spread of the disease. Depending on this, the appearance of the vaginal area of ​​the organ changes.

Stages of pathology:

• Stage 1– the tumor has penetrated into the stroma of the external pharynx of the organ. It occupies the third or fourth part of the external pharynx.
• Stage 2– significant changes in the structure are visible, the tumor has affected most of the mucosa. The pathology has reached the vagina and uterus.
• Stage 3– the oncological process spreads to the pelvic region, kidneys.
• Stage 4– metastasis has occurred throughout the body.

What does a normal cervix look like?

The surface of the external pharynx is smooth. Painted light pink without any inclusions.

In some cases, the entrance to the cervical canal may have a reddish tint. The mucous secretion is transparent, in the photo it glitters.

The central hole can be of several types:

• round or oval shape– typical for nulliparous women;
• slit-shaped– occurs in women who have given birth several times.

1st degree

At stage 1 of cancer, pathology is noticeable in the central part of the outer region of the cervix. The pathology covers a third of the mucosa. It looks like a reddened area. The contours of the tumor at stage 1 are blurred and not clear.

The tumor does not rise above the surface of the mucosa. Several small ulcers are noticeable in the affected area. They don't bleed. The central hole is clearly visible, but slightly deformed due to the impact of the neoplasm. The mucous secretion is transparent, yellowish areas are visible in places.

The cervix and visible part of the vagina are not changed. They have a smooth surface and light pink color.

2nd degree

At stage 2 of the oncological process, most of the vaginal area of ​​the cervix is ​​affected. The malignant formation is white in color and has multiple bruises in different areas. Most of the bruising is concentrated in the central part.

The neoplasm has blurred contours, they are noticeably different from the mucosa unaffected by cancer. The tumor is at the same level as the mucosal surface. The entrance to the cervical canal cannot be seen; it is closed by the tumor. In the place where the hole should be, a small depression is noticeable.

The visible part of the vagina has normal color and structure.

3rd degree

At stage 3, the outer part of the cervix is ​​severely deformed. It has a loose structure; multiple bumps are noticeable throughout its mucosa. The ulcers cover most of the cervix. The central part bleeds heavily, making it impossible to see the opening to the cervical canal.

The mucous membrane is pale in color and covered with a white coating. The entire area of ​​the organ is affected by the tumor. The cancer has affected the walls of the vagina.

4th degree

At stage 4, the oncological process has completely modified the outer part of the cervix. The cancer has spread beyond the mucous membrane, damaging the vagina. The tumor bleeds heavily over the entire surface of the external pharynx.

The surface is uneven, loose, bumpy, multiple ulcers are visible. In some areas you may notice a white-yellow discharge. Bloody indentations are also clearly visible. The entrance to the cervical canal cannot be determined.

The visible walls of the vagina are red with multiple ulcers that bleed. A large amount of blood collects in the vagina.

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Ultrasound of the cervix, polyps, cysts and other pathologies

Cervical diseases a fairly common gynecological pathology, on average up to 55% of women, when visiting a gynecologist, encountered various manifestations. Basically, these are background diseases that are asymptomatic, completely reversible under the influence of appropriate therapy, or often do not require specific treatment and heal on their own. IN last years There has been an increase in the number of cases of cervical disease in young women. The age range from 15 to 24 years is critical in relation to exposure to harmful factors.

Modern diagnosis of cervical pathology is based on a wide range of special studies:

Examination of the cervix in a speculum with various tests performed when a pathological area is detected.
Survey, extended and microcolposcopy - examination of the cervix with tens and hundreds of times magnification using a colposcope or optical system"intravital histological examination".
Cytological studies and biopsy.
Quite rarely, if a malignant process is suspected, cervicoscopy, cervicohysterography, MRI, CT, angio- and lymphography are used.

The capabilities of ultrasound diagnostics are not sufficiently used by gynecologists, despite the high information content and availability of the method in a whole group of cervical diseases. This is due to the relatively recent introduction of the transvaginal pelvic ultrasound method, where the probe is placed directly to the cervix.
Ultrasound can be used as an important additional method in examining patients with cervical pathology, which allows one to assess the thickness and structure of the mucous membrane of the cervical canal, and identify formations and inclusions of the muscular layer of the cervix. In addition, echography gives Additional information about the size, structure of the cervix, characteristics of the blood supply (with digital Doppler mapping and pulse Doppler), the condition of the parametrium, and sometimes the pelvic lymph nodes.

One of the most common reasons for sending patients for ultrasound of the pelvic organs is in cervical examination, are:

Cervical cysts and cervical polyps
Hypertrophy or severe deformation of the cervix
Uterine fibroids and endometriosis
Female sexual dysfunctions, accompanied by pain and contact bleeding during or after sexual intercourse.
Dysmenorrhea (painful menstruation) and pelvic pain of unknown etiology
Stress urinary incontinence due to prolapse of the pelvic organs.
Suspicion of cervix
Preparing for pregnancy and childbirth
Infertility examination
Preparation for IVF (in vitro fertilization)
.
Cervix represents the lower segment of the uterus. The wall of the cervix is ​​a direct continuation of the wall of the uterine body. The place where the body of the uterus passes into the cervix is ​​called isthmus. While the uterine wall is primarily composed of smooth muscle, the cervical wall is primarily composed of connective tissue.
The lower part of the cervix protrudes into the vaginal cavity and is therefore called vaginal part of the cervix, and the upper part lying above the vagina is called supravaginal part of the cervix. Cervical canal located in the cervix, connects the uterine cavity and vagina. Visible on the vaginal part of the cervix external os- a branch leading from the vagina into the cervical canal and continuing into the uterine cavity, where it opens internal throat.

Ultrasound picture

1. The position of the cervix in relation to the body is determined
The cervix is ​​located at a wide angle to the body of the uterus; the narrowing of this space and sharpening of the angle refers to the so-called inflections of the uterus
2. Shape
The cervix has a cylindrical shape, in cross section in the form of an oval
3. Outlines
The contours of the cervix should be smooth and clear. The thickness of the front and rear walls is also assessed here; normally it is the same
4. Dimensions
The size of the cervix varies widely. Not only individual anatomical and physiological characteristics are important, but also resulting in childbirth through the natural birth canal. The maximum size of the cervix/hypertrophy of the cervix/ is 37*30*34 mm and the minimum size/shortening of the cervix/ is 29*26*29 mm, the most important indicator for a successful pregnancy. The physiological ratio of the length of the uterine body to the length of the cervix is ​​assessed (3:1 in reproductive age)
5. Echogenicity
The myometrium of the cervix has a slightly greater echogenicity in relation to the body, due to a more pronounced fibrous component in the muscle tissue
6. Structure
The myometrium of the cervix should have a homogeneous structure. Single round anechoic inclusions up to 5 mm and hyperechoic inclusions in women who have given birth are interpreted as a variant of the norm. Hypoechoic round formations visualized in the wall of the cervix are most often represented by endocervical cysts.
7. The cervical canal of the cervix is ​​assessed separately according to several parameters
The cervical canal is represented by a hyperechoic (bright) linear structure. Its contours are clear and even. The width of the cervical canal, the thickness of the mucosa (endocervix), the assessment of folding, the presence of polypoid formations, the deposition of calcifications, and the identification of other pathological areas are carried out. Much attention, especially in pregnant women, is paid to examining the internal os of the canal.
The external os and superficial structures of the vaginal part of the cervix are in most cases poorly visualized, so their assessment must be treated with extreme caution.

The echographic picture of the cervix does not undergo significant changes during the menstrual cycle. Significant differences during the secretory period (menstruation) are the high echogenicity (brightness) of the endocervix in combination with the heterogeneous internal echostructure of the canal contents, due to the presence of a rejected component (bleeding).

Classification of cervical diseases
. /important for ultrasound diagnostics/

Cervicitis

Cervicitis is a total inflammation of the cervix, including the mucous membrane of the vaginal part of the cervix (exocervicitis) and the mucous membrane of the cervical canal (endocervicitis). In the postmenopausal period, atrophic cervicitis develops due to thinning of the cervical mucosa. Superficial cervicitis and erosions are not examined by ultrasound; the echo signs of endocervicitis are quite conditional and are associated mainly with changes in the ultrasound picture of the cervical canal, which cannot be explained by other reasons. For example, disruption of the contours and expansion of the cervical canal, thickening of the endocevix, multiple cysts or microcalcifications in a nulliparous woman will be classified as this pathology.

Cervical cyst

Cervical cysts are a common pathology, mainly due to inflammatory changes or hormonal imbalance. There are single and multiple cervical cysts. Gynecologists call such cysts “Nabothian cysts” or “Ovulae Nabothii”. Nabotovs arise as the end result of “self-healing” of cervical ectopia/i.e. This is a type of cervical erosion/. There is a blockage of the excretory ducts of the glands of the cervix and a thick grayish secretion in the form of mucus accumulates under the thin transparent capsule. Round anechoic inclusions detected on ultrasound in the cervix are considered to be nabothian gland cysts; the detection of fine suspension in similar inclusions with thickening of the wall in which they are located usually indicates endometriosis of the cervix.

Polyp of the cervical canal and endometrium on a stalk

Polyps of the mucous membrane of the cervical canal are connective tissue growths covered with epithelium. On ultrasound they are usually visible as hyper- and isoechoic oval-shaped formations that dilate (widen) the cervical canal. As a rule, they have a stalk, when lengthened, polyps that arise in the middle and upper part of the mucous membrane of the cervical canal can appear from the cervical canal. Differential diagnosis is necessary with large endometrial polyps or with polyps emanating from the lower third of the uterine cavity. Modern ultrasound equipment with high resolution makes it possible to diagnose small polyps that do not extend beyond the external pharynx. They look like inclusions of increased or moderate echogenicity in the cervical canal. After the diagnosis of a polyp of the mucous membrane of the cervical canal is established, regardless of the patient’s age, polypectomy with careful removal of the polyp stalk or its coagulation under endoscopic control is indicated. Often, at the same time as a polyp of the cervical canal, a polyp or endometrial hyperplasia is detected. Polyps are a benign disease. However, sometimes cancer (especially adenocarcinoma) can have the appearance of a polyp.

Uterine fibroids, located in the cervix or a “nascent” myomatous node

Cervical fibroids are very rare and account for only 8% of all locations . In some cases, it is possible to detect a “nascent” submucous myomatous node. They can also be subserous, intramural and submucosal. Ultrasound signs of cervical myomatous nodes are generally identical to changes in the body of the uterus. The presence of cervical fibroids in the vast majority of cases is an indication for surgical treatment.

Ectopic pregnancy

Very rarely, implantation of a fertilized egg can be observed in the cervical canal (cervical pregnancy). In these cases, the fertilized egg is visualized in the cervix in the form of a round hypoechoic formation. In fact, it is uterine, / because the cervix is ​​part of the uterus / but is equal in degree of danger to and requires immediate medical attention.

Endometriosis of the cervix or surrounding tissue

Genital endometriosis is a common disease in women of reproductive age. The causes of endometrioid lesions of the cervix are diathermocoagulation of ectopia (cauterization of erosion), damage during surgical , childbirth On the relatively deep wound surface, pieces of endometrial tissue, released during the next menstruation, attach and “take root.” The ultrasound picture is represented mainly by cervical cysts - rounded hypoechoic formations, often with heterogeneous, hyperechoic contents. A distinctive feature of endometrioid cysts of the cervix is ​​the thickening of the wall in which the cyst is located. Cervical endometriosis usually manifests itself in the form of bleeding on the eve of menstruation. Endometriosis of the pericervical tissue is visualized in the form of hyperechoic (increased brightness) areas in the adipose tissue, with clear, uneven contours, manifested by periodic pain in the posterior vaginal vault, which is not amenable to conventional, in this case, anti-inflammatory therapy.

Narrowing of the cervical canal, atresia of the cervical canal and vagina

In case of atresia of the cervical canal and vagina, ultrasound examination allows the installation of a hematometer in cases of a functioning uterus. Atresia hymen characterized by the development of hematocolpos, the size of which depends on the height of vaginal obliteration and the amount of accumulated blood. Ultrasound reveals a large amount of heterogeneous, hypoechoic fluid in the uterine or vaginal cavity, respectively.

Cicatricial changes in the cervix (post-traumatic changes and strictures, including after abortion and childbirth)

Deformation of the cervix occurs due to traumatic childbirth or surgical interventions on the cervix. During labor, the cervix shortens, flattens, and then dilates to a diameter of 10 cm, allowing the fetal head to pass through the mother's birth canal. Sometimes, during the passage of the head, the cervix ruptures. In such cases, the cervix after childbirth is formed defective - the cervical canal often remains gaping, and the cervix itself can take on the most bizarre shapes

Cervical cancer

This is a dangerous malignant disease. Cervical cancer ranks third among cancer pathologies in women, second only to breast and uterine cancer, and has a tendency to grow rapidly and metastasize. According to the degree of invasion (germination of layers located under the epithelium), cancer is divided into carcinoma in situ, minimally invasive, and invasive cancer. Invasive cancer has 4 stages, depending on invasion into neighboring organs, involvement of regional lymph nodes and the presence of distant metastases (bones, brain). Ultrasound diagnosis of cervical cancer in the early stages of development is not possible, and is usually used to clarify the stage of the malignant disease, the degree of invasion of the oncological process and search for metastases.

Examination of women in order to prepare for pregnancy and childbirth, management of infertility and IVF will be discussed in separate sections.

A. cylindrical

b. prismatic

V. conical

g. spherical.

The external os of a nulliparous woman has the shape

A. point

b. slit-like

V. T-shaped

g. sickle-shaped.

After the regeneration phase in the uterine mucosa comes the phase

A. desquamation

b. proliferation

V. secretion

g. degeneration.

Rejection occurs during menstruation

A. the entire mucosal layer

b. total endometrium

V. functional layer of the endometrium

d. basal layer of the endometrium.

Duration of normal menstruation

A. 3-5 days

b. 7-8 days

V. 6-10 days

The widest part of the fallopian tube is called

A. isthmic

b. interstitial

V. intramural

d. ampullary

The part of the tube farthest from the uterus is called

A. ampullary

b. isthmic

V. intramural

d. intrastitial

External dimensions of a normal pelvis

V. 25-28-31-21

28-28-32-17.

The true conjugate of a normal pelvis is equal to

b. 11 cm

The diagonal conjugate of a normal pelvis is equal to

V. 13 cm

g. 21 cm.

The distance between the lower edge of the symphysis and the most prominent point of the promontory is called the conjugate

A. true

b. diagonal

V. outdoor

anatomical.

The distance between the upper edge of the symphysis and the upper corner of the Michaelis rhombus is called

A. Solovyov index

b. distance cristarum

V. external conjugate

d. true conjugate.

To calculate the true conjugate you need

A. subtract 1.5-2 cm from the outer conjugate

b. subtract 1.5-2 cm from the diagonal conjugate

V. add 1.5-2 cm to the diagonal conjugate

d. subtract 9 cm from the diagonal conjugate.

Muscle and bone tissue of the fetus are formed from

A. ectoderm

b. endoderm

V. mesoderm

g. trophoblast.

Progesterone during pregnancy, in addition to the ovaries, is also produced

A. pituitary gland

b. placenta

V. hypothalamus

g. thyroid gland.

Diseases and functional disorders of the fetus that occur after three months of pregnancy are called

A. gametopathies

b. fetopathy

V. embryopathies

zygotopathy.

Embryopathies occur under the influence of damaging factors

A. at any stage of pregnancy

b. after 30 weeks of pregnancy

V. up to 8 weeks of pregnancy

from 16 to 28 weeks of pregnancy.

Nausea is a sign of pregnancy

A. reliable

b. probable

V. dubious

g. obligatory.

A possible sign of pregnancy is

A. salivation

b. delay of menstruation

V. vomit

d. taste quirks.

A reliable sign of pregnancy is

A. enlarged uterus

b. delay of menstruation

V. breast enlargement

d. listening to the fetal heartbeat.

A diagnostic pregnancy test (urine test) is based on the detection

A. acetone

b. squirrel

V. human chorionic gonadotropin

d. leukocytes.

Circulating blood volume during pregnancy

A. goes down

b. rises

V. does not change

increases only in the 1st trimester.

Blood clotting properties at the end of normal pregnancy

A. increased

b. demoted

V. not changed

may not be taken into account for the prognosis of childbirth.

Stretch marks on the skin during pregnancy

A. are a reliable sign of pregnancy

b. very pronounced in all pregnant women

V. indicate lack of skin elasticity

g. disappear completely after pregnancy.

A urine test for examining a pregnant woman in the gastrointestinal tract is prescribed

A. three times during pregnancy

b. only in the presence of dysuric phenomena

V. once every 1-2 months

for each appearance

Every healthy woman gets tested three times during pregnancy.

A. blood for hemoglobin, ESR and leukocytosis

b. blood group and Rh factor

V. smears for hidden infections

d. smears for hormonal threats

In the second trimester, a pregnant woman visits a residential complex

A. 1 time per month

b. 1 time every 2 weeks

V. every week

2 times a week

IN last month uncomplicated pregnancy

A. a pregnant woman may not attend a residential complex

b. you need to visit the residential complex every 7-10 days

V. visit to the residential complex in 2-3 weeks

The uterus is recognized as the main organ reproductive system women. Its structure determines its functions, the main of which is gestation and subsequent expulsion of the fetus. The uterus plays a direct role in the menstrual cycle and is capable of changing size, shape and position, depending on the processes occurring in the body.

Anatomy and size of the uterus: photo with description

Unpaired reproductive organ characterized by a smooth muscle structure and pear-shaped shape. What is the uterus, its structure and description of individual parts are presented in the picture.

In gynecology, the organ departments are distinguished:

• bottom- area above the fallopian tubes;
• body- middle cone-shaped area;
• neck- a narrowed part, the outer part of which is located in the vagina.

The uterus (in Latin matricis) is covered on the outside with perimeter - a modified peritoneum, and on the inside - with endometrium, which acts as its mucous layer. The muscular layer of the organ is the myometrium.

The uterus is supplemented by ovaries, which are connected to it through the fallopian tubes. The peculiarity of the physiology of the organ is mobility. The uterus is held in the body by the muscular and ligamentous apparatus.

An expanded and detailed cross-sectional image of the female organ of reproduction is presented in the picture.

The size of the uterus changes throughout the cycle, depending on age and other characteristics.

The parameter is determined by ultrasound examination of the pelvic organs. The norm is 4-5 cm in the period after the end of menstruation. In a pregnant girl, the diameter of the uterus can reach 26 centimeters, length - 38 centimeters.

After childbirth, the organ decreases, but remains 1-2 centimeters larger than before conception, the weight becomes 100 grams. The normal average sizes of the uterus are shown in the table.

A newborn girl has an organ length of 4 cm; from the age of 7 it gradually increases. During menopause, the intact uterus shrinks, the walls become thinner, and the muscular and ligamentous apparatus weakens. 5 years after the end of menstruation, it becomes the same size as at birth.

The figure shows the development of an organ throughout life.

The thickness of the uterine walls varies from 2 to 4 cm, depending on the day of the cycle. The weight of the organ in a nulliparous woman is about 50 grams; during pregnancy, the weight increases to 1-2 kilograms.

Neck

The lower narrow segment of the uterus is called the cervix (in Latin, cervix uteri) and is a continuation of the organ.

Connective tissue covers this part. The area of ​​the uterus leading to the cervix is ​​called the isthmus. The entrance to the cervical canal from the side of the cavity opens the internal os. The section ends with the vaginal part, where the external os is located.

The detailed structure of the neck is shown in the figure.

In the cervical canal (endocervix), in addition to folds, there are tubular glands. They and the mucous membrane produce mucus. This section is covered by columnar epithelium.

In the vaginal part of the cervix (exocervix) there is a multilayered squamous epithelium, characteristic of this area. The area where one type of mucosal cell is replaced by another is called transition zone(transformation).

The types of epithelium are shown large in the picture.

The vaginal part of the organ is accessible to visual inspection.

Regular examination by a doctor allows you to identify and eliminate pathologies at an early stage: erosion, dysplasia, cancer and others.

A special instrument, a colposcope, is used to conduct a detailed examination of the organ on a gynecological chair. The photo shows a close-up of a healthy cervix and one with pathological changes.

An important indicator is the length of the cervix. The normal value is 3.5-4 centimeters.

The structure of the cervix is ​​given special attention during pregnancy. Narrow or small (short) increases the risk of miscarriage. With isthmic-cervical insufficiency, it becomes difficult for the cervix to withstand the load created by the fetus.

Bottom

The structure of the uterus includes its body and cervix. These 2 parts are connected by an isthmus. The highest region of the body of the reproductive organ is convex in shape and is called the bottom. This area extends beyond the line of entry of the fallopian tubes.

An important indicator is the height of the uterine fundus (UFH) - the distance from the pubic bone to the top point of the organ. It is taken into account when assessing fetal development during pregnancy. The size of the uterine fundus shows the growth of the organ, and the normal value ranges from 10 centimeters at 10 weeks to 35 centimeters at the end of the gestation period. The indicator is determined by the doctor by palpation.

Body

This part is recognized as the main one in the structure of the uterus. The body consists of a cavity triangular shape and its walls.

The lower segment is connected to the neck at an obtuse angle with a normal structure, the upper segment passes into the bottom, directed towards the abdominal cavity.

The fallopian tubes are adjacent to the lateral areas, and the wide uterine ligaments are attached to the right and left edges. The anatomical parts of the body also include the anterior or vesicular surface, which is adjacent to the bladder, and the posterior - borders the rectum.

Ligaments and muscles

The uterus is a relatively mobile organ, since it is held in the body by muscles and ligaments.

They perform the following functions:

• hanging- attachment to the pelvic bones;
• fixing- giving the uterus a stable position;
• supporting- creating support for internal organs.

Hanging apparatus

The function of organ attachment is performed by ligaments:

• round- 100-120 millimeters long, located from the corners of the uterus to the inguinal canal and tilt the fundus anteriorly;
• wide- resemble a “sail” stretched from the pelvic walls to the sides of the uterus;
• suspensory ligament of the ovaries- originate from the lateral part of the broad ligament between the ampulla of the tube and the pelvic wall in the area of ​​the sacroiliac joint;
• ownovarian ligaments- attach the ovary to the side of the uterus.

Fixing apparatus

This includes links:

• cardinal(transverse)- consist of smooth muscle and connective tissues, are reinforced by broad ligaments;
• uterovesical (cervicovesical)- directed from the cervix and around the bladder, preventing the uterus from tilting back;
• sacrouterine ligaments- do not allow the organ to move towards the pubis, they come from the posterior uterine wall, go around the rectum and are attached to the sacrum.

Muscles and fascia

The supporting apparatus of the organ is represented by the perineum, which includes the genitourinary and pelvic diaphragms, which consist of several muscle layers and fascia.

Anatomy pelvic floor includes muscles that perform a supporting function for the organs of the genitourinary system:

• ischiocavernosus;
• bulbous-spongy;
• external;
• superficial transverse;
• deep transverse;
• pubococcygeus;
• iliococcygeus;
• ischiococcygeus.

Layers

The structure of the uterine wall includes 3 layers:

• serous membrane (perimetry) - represents the peritoneum;
• internal mucous tissue - endometrium;
• muscular layer - myometrium.

There is also a parametrium - a layer of pelvic tissue, which is located at the level of the cervix at the base of the broad ligaments of the uterus, between the layers of the peritoneum. The location between the organs provides the necessary mobility.

Endometrium

The structure of the layer is shown in the figure.

The mucous epithelium is rich in glands, characterized by good blood supply, and is sensitive to damage and inflammatory processes.

The endometrium has 2 layers: basal and functional. The thickness of the inner shell reaches 3 millimeters.

Myometrium

The muscular layer is composed of intertwined smooth muscle cells. Contractions of myometrial sections on different days of the cycle are regulated by the autonomic nervous system.

Perimetry

The serous outer membrane is located on the anterior wall of the uterine body, completely covering it.

At the border with the cervix, the layer bends and is transferred to the bladder, forming the vesicouterine space. In addition to the posterior surface of the body, the peritoneum covers a small area of ​​the posterior vaginal vault and the rectum, forming a rectal-uterine pouch.

These depressions and the location of the uterus in relation to the peritoneum are marked in the figure depicting the topography of the female genital organs.

Where is

The uterus is located in the lower abdomen, its longitudinal axis parallel to the axis of the pelvic bones. At what distance it is located from the entrance deep into the vagina depends on the structural features, usually it is 8-12 centimeters. The diagram shows the position of the uterus, ovary, and tubes in the female body.

Since the organ is mobile, it easily moves in relation to others and under their influence. The uterus is located between the bladder in front and the loop of the small intestine, the rectum in the posterior region; its location can be determined using ultrasound.

The organ of reproduction is to some extent tilted forward and has a curved shape. In this case, the angle between the neck and the body is 70-100 degrees. The nearby bladder and intestines affect the position of the uterus. The body deviates to the side, depending on the filling of the organs.

If the bladder is empty, the anterior surface of the uterus is directed forward and slightly downward. In this case, between the body and the neck a sharp corner, open anteriorly. This position is called anteversio.

When the bladder fills with urine, the uterus deviates posteriorly. In this case, the angle between the neck and the body becomes widened. This condition is defined as retroversion.

There are also types of organ bends:

• anteflexio - an obtuse angle is formed between the cervix and the body, the uterus deviates forward;
• retroflexio - the neck is directed forward, the body is directed backward, an acute angle is formed between them, open back;
• lateroflexio - bend towards the pelvic wall.

Uterine appendages

The female organ of reproduction is complemented by its appendages. The detailed structure is shown in the figure.

Ovaries

Paired glandular organs are located along the lateral ribs (sides) of the uterus and are connected to it through the fallopian tubes.

The appearance of the ovaries resembles a flattened egg; they are fixed with the help of the suspensory ligament and mesentery. The organ consists of an outer cortex, where follicles mature, and an inner granular layer (medullary substance), containing the egg, blood vessels and nerves.

How much the ovary weighs and size depends on the day of the menstrual cycle. The average weight is 7-10 grams, length - 25-45 millimeters, width - 20-30 millimeters.

The hormonal function of the organ is to produce estrogens, gestagens, and testosterone.

During the cycle, the mature follicle in the ovary bursts and transforms into the corpus luteum. In this case, the egg travels through the fallopian tubes into the uterine cavity.

If pregnancy has occurred, the corpus luteum performs intrasecretory functions; in the absence of fertilization, it gradually disappears. How the ovary works and its structure are visible in the picture.

The fallopian tubes

A paired muscular organ connects the uterus to the ovaries. Its length is 100-120 millimeters, diameter from 2 to 10 millimeters.

Sections of the fallopian tube:

• isthmus (isthmic part);
• ampoule;
• funnel - contains a fringe that guides the movement of the egg;
• uterine part - connection with the organ cavity.

The wall of the fallopian tube is predominantly composed of myocytes and has contractility. This determines its function - transporting the egg into the uterine cavity.

Sometimes a life-threatening complication occurs - an ectopic pregnancy. In this case, the fertilized egg remains inside the tube and causes rupture of its wall and bleeding. In this case, it is necessary to urgently operate on the patient.

Structural features and functions

The structure and location of the uterus are subject to frequent changes. She is influenced internal organs, the period of bearing a child, the processes that occur every menstrual cycle.

The onset of ovulation is determined by the condition of the cervix. During this period, its surface becomes loose, the mucus becomes viscous, and it drops lower than on other days of the cycle.

In the absence of conception, menstruation occurs. At this time, the upper layer of the uterine cavity, the endometrium, is separated. In this case, the internal pharynx expands to allow blood and part of the mucous membrane to escape.

After the cessation of menstruation, the pharynx narrows and the layer is restored.

The functions of what the uterus is needed for are defined:

• reproductive- ensuring the development, gestation and subsequent expulsion of the fetus, participation in the formation of the placenta;
• menstrual- the cleansing function removes part of the unnecessary layer from the body;
• protective- the neck prevents the penetration of pathogenic flora;
• secretory- mucus production;
• supporting- the uterus acts as a support for other organs (intestines, bladder);
• endocrine- synthesis of prostaglandins, relaxin, sex hormones.

Uterus during pregnancy

The female organ undergoes the most significant changes during pregnancy.

On initial stage the appearance of the uterus remains the same, but already in the second month it becomes spherical in shape, its size and weight increase several times. By the end of pregnancy, the average weight is approximately 1 kilogram.

At this time, the volume of the endometrium and myometrium increases, blood supply increases, ligaments stretch during pregnancy and sometimes even hurt.

An indicator of the health and proper development of the fetus is the height of the uterine fundus, depending on the period. The standards are given in the table.

Also an important indicator is the length of the cervix. It is assessed to avoid the development of pregnancy complications and premature birth. The norms for cervical length by week of pregnancy are shown in the table.

By the end of the gestation period, the uterus stands high, reaches the level of the navel, has the shape of a spherical muscular formation with thin walls, slight asymmetry is possible - this is not a pathology. However, due to the advancement of the fetus towards the birth canal, the organ gradually begins to descend.

Muscular contractions of the uterus are also possible during pregnancy. The reasons are the tone of the organ (hypertonicity with the threat of miscarriage), training contractions.

Strong contractions occur during labor to expel the fetus from the uterine cavity. The gradual opening of the cervix releases the baby out. The placenta comes out next. After stretching, the cervix of a woman who has given birth does not return to its original shape.

Circulation

The genitals have an extensive circulatory network. The structure of the blood circulation of the uterus and appendages with a description is presented in the figure.

The main arteries are:

• Uterine- is a branch of the internal iliac artery.
• Ovarian- originates from the aorta on the left side. The right ovarian artery is more often considered a branch of the renal artery.

Venous outflow from the upper parts of the uterus, tubes, and ovaries on the right occurs into the inferior vena cava, on the left into the left renal vein. Blood from the lower uterus, cervix, and vagina enters the internal iliac vein.

The main lymph nodes of the genital organs are the lumbar ones. The iliac and sacral muscles provide drainage of lymph from the neck and lower body. Minor drainage occurs in the inguinal lymph nodes.

Innervation

The genital organs are characterized by sensitive autonomic innervation, which is provided by the pudendal nerve, which is a branch of the sacral plexus. This means that uterine activity is not controlled by volitional efforts.

The body of the organ has predominantly sympathetic innervation, the neck - parasympathetic. The contractions are caused by the influence of the nerves of the superior hypogastric plexus.

Movements occur under the influence of neuro-vegetative processes. The uterus is characterized by innervation from the uterovaginal plexus, the ovary from the ovarian plexus, and the tube from both types of plexus.

Action nervous system cause severe pain during childbirth. The innervation of the genital organs of a pregnant woman is shown in the figure.

Pathological and abnormal changes

Diseases change the structure of the organ and the structure of its individual components. One of the pathologies why a woman’s uterus can be enlarged is fibroids - a benign tumor that can grow to impressive sizes (over 20 centimeters).

If the volume is small, such formations are subject to observation; large ones are removed through surgery. The symptom of a “dense uterus”, in which thickening of its walls occurs, is characteristic of adenomyosis - internal endometriosis, when the endometrium grows into the muscle layer.

Also, the structure of the organ is changed by polyps, cysts, fibroids, and cervical pathologies. The latter include erosion, dysplasia, and cancer. Regular examination significantly reduces the risk of their development. For grade 2-3 dysplasia, conization of the neck is indicated, in which its cone-shaped fragment is removed.

“Rabies” of the uterus (hypersexuality) can also be a symptom of problems in the reproductive system. Pathologies, anomalies, and characteristics of the body can cause infertility. For example, with a “hostile uterus” (immunoactive), the immune system prevents the fertilization of the egg, destroying sperm.

In addition to pathological phenomena that change the structure of the organ, there are anomalies in the structure of the uterus:

• small (children's) - its length is less than 8 centimeters;
• infantile - the neck is elongated, the size of the organ is 3-5 centimeters;
• one-horned and two-horned;
• double;
• saddle and so on.

Doubling

In addition to the presence of 2 uteruses, doubling of the vagina occurs. In this case, fetal development is possible in two organs.

Two-horned

Outwardly it resembles a heart; in the fundus, the horned uterus is divided in two and united in the cervix. One of the horns is underdeveloped.

Saddle (arched)

A variant of a bicornuate uterus, the bifurcation of the fundus is minimally expressed in the form of a depression. It is often asymptomatic.

Intrauterine septum

The uterus is completely divided in two. With a complete septum, the cavities are isolated from each other; with an incomplete septum, they are connected in the cervical area.

Omission

Displacement of the uterus below the anatomical border due to weakness of the muscles and ligaments. It is observed after childbirth, during menopause, and in old age.

Elevation

The organ is located above the upper pelvic plane. The causes are adhesions, tumors of the rectum, ovary (as in the photo).

Turn

In this case, a distinction is made between rotation of the uterus, when the entire organ with the cervix rotates, or torsion (twisting), in which the vagina remains in place.

Eversion

An inverted uterus is rare in real gynecological practice and is usually a complication of childbirth.

A completely inverted organ is characterized by the cervix and body of the vagina being brought out. Partial inside-out reversal is manifested by incomplete descent of the uterine fundus beyond the boundaries of the internal opening.

Bias

The anomaly is characterized by displacement of the organ forward, backward, right or left. The figure schematically shows a crooked uterus, tilted in opposite directions.

Dropping out

Pathology occurs when muscles and ligaments are weak and is characterized by displacement of the uterus down to the vagina or exiting through the labia.

During reproductive age, the position of the organ is restored by surgical intervention. If it falls out completely, removal is indicated.

Uterus removal

Extirpation of an organ (hysterectomy) is performed for serious indications: large fibroids, uterine cancer, widespread adenomyosis, heavy bleeding, and so on.

During the operation, it is possible to preserve the ovaries and uterine cervix. In this case, hormone replacement therapy is not prescribed; eggs from the ovaries are suitable for use in surrogacy.

Options for removing the uterus are briefly presented in the photo; after the operation, the bladder moves back, the intestines move downwards.

The rehabilitation period is characterized by pain in the area of ​​the excised organ and bleeding, which gradually disappear. Not only physical but also moral discomfort is possible. Negative consequences are associated with displacement of organs due to the removed uterus

The organs of a woman’s reproductive system are designed in such a way that an infection that enters the vagina quickly spreads throughout the system. Damage to the ovaries leads to hormonal imbalances, which can have serious consequences for the entire body. The cervix is ​​a barrier that prevents infection from entering the internal genital organs. It depends on her condition whether a woman can get pregnant and bear a healthy child, and whether there will be complications during childbirth. Timely treatment of pathologies is necessary for the full functioning of all body systems.

1. Background, associated with changes in the shape of the cervix, displacement of the layers of its mucous membrane (ectopia, erosion). In this case, the tissue structure is not disturbed. The appearance of such pathologies is usually facilitated by changes in hormonal levels. They often occur in girls during puberty and in women after 50 years of age, although they can appear at other periods of life. These diseases do not turn into cancer, but against their background the likelihood of its occurrence increases.
2. Precancerous, associated with changes in the structure of cervical tissue. At the same time, atypical cells can form in them, which can degenerate into cancer cells (cervical dysplasia).
3. Cancerous tumors. They form only on the cervix itself or spread to neighboring tissues.

Video: Types of cervical diseases, their complications, causes

Causes of pathological changes in the cervix

The causes are hormonal imbalances, infection or damage to the cervix. Changes in the ratio of sex hormones are associated with natural processes that sequentially occur in a woman’s life (maturation, pregnancy, childbirth, lactation, decline of sexual function). Disorders occur due to organ diseases endocrine system, as well as as a result of artificial termination of pregnancy, early start sexual activity or its absence in adulthood, refusal of breastfeeding, hormonal contraception or treatment of diseases with hormonal drugs.

The causes of inflammatory and infectious processes are most often non-compliance with personal hygiene rules and unprotected sex, which creates the possibility of the spread of sexually transmitted diseases. The infection also gets into the cervix during surgical procedures during abortion or cleaning the uterus. Inflammation and infection occur due to damage to the cervix during sexual intercourse or during childbirth.

Symptoms of cervical pathologies

Most cervical diseases are not accompanied by pronounced symptoms. Even if there is a precancerous condition or the initial stage of cancer, a woman may not feel much discomfort. That is why a preventive visit to the doctor and a gynecological examination is of great importance.

In inflammatory diseases, a woman experiences discharge that is yellow-green, brown, or black and has an unpleasant odor. At the same time, I am worried about pain in the lower back, a burning sensation in the vagina in the cervical area. Often the inflammation spreads to genitourinary system. In this case, the woman experiences symptoms of cystitis.

If the infection has spread to the uterus and appendages, then menstrual irregularities occur (in terms of duration and volume of bleeding). Nagging pain appears in the lower abdomen and back. Body temperature may rise.

Diagnostics

In some cases, due to the absence of obvious symptoms, cervical diseases may not be detected immediately. Sometimes the reason for visiting a doctor is a delay in menstruation due to pregnancy or a preventive examination. In this case, a woman accidentally discovers pathological changes on the cervix.

Before treatment, an examination is required. The following methods are used for diagnosis:

1. Colposcopic examination of the cervix. Optical magnification and illumination makes it possible to examine the vaginal part of the cervix, as well as the cervical canal, and detect areas of inflammation or polyp formation.
2. Biopsy is the removal of pieces of cervical tissue for examination under a microscope, where atypical and cancerous cells can be seen (histological method).
3. Examination under a microscope of a smear taken from the surface of the cervix and from the cervical canal. Cytological examination allows you to detect the type of infectious agent, as well as determine what changes have occurred in the epithelial tissues of various parts of the cervix.

As a rule, an ultrasound of the pelvic organs is performed, as well as a PCR examination of a smear to determine hidden infections (chlamydia, mycoplasmosis, herpes and others).

Video: Methods for diagnosing cervical diseases. When is treatment applied?

Background diseases

The mucous membrane of the cervix consists of two types of epithelial cells. The cervical canal is covered with a single-layer epithelium, the cells of which are cylindrical in shape. The vaginal part around the cervical os is covered with several layers of squamous epithelial cells. Diseases occur if the order of arrangement is violated, due to which the patency of the cervix, the production of protective mucus, and the integrity of the tissues deteriorate.

Cervical erosion occurs due to damage to the mucous membrane during childbirth, abortion, or sexual intercourse. Cracks and sores appear in the changed area, inflammation occurs, after which scars remain. This leads to complications during pregnancy, unexpected dilatation of the cervix and miscarriage. Scars make the cervix less elastic. During childbirth, it will not be able to stretch normally, and ruptures may occur. Erosion with damage to the mucous membrane is called true. Its treatment is mandatory, as it can turn into a precancerous form. Apply different kinds cauterization. Women of reproductive age planning to give birth to a child usually do not undergo such operations, since cauterization results in scarring. A radio wave treatment method is used, which is safe and does not injure the neck (non-contact).

Video: What is the danger of cervical erosion

Ectopia. It is called pseudo-erosion. There is no damage to the mucous membrane. But columnar cells move into the area of ​​squamous epithelium. This is possible if they begin to spontaneously develop in that part of the cervix where they should not be. The second option for ectopia is the movement of cells into the vaginal area during childbirth, abortion and other operations.

Ectopia is a physiological norm in girls before reaching puberty. In this case, no treatment is required. If ectopia appears later, it is treated if the area of ​​change is significant. With minor ectopia, only periodic monitoring of its condition is carried out so as not to miss the appearance of more serious changes, such as the reverse movement of squamous epithelium, in which cysts appear on the cervix.

The danger is the spread of the endometrium (the inner lining of the uterus) to the cervical area (hyperplasia), in which the cervical canal becomes overgrown. Such complications cause infertility and lead to cancer.

Cervicitis. Inflammation of the cervix in the vaginal area (endocervicitis) or cervical canal (exocervicitis). Characteristic is the appearance of nagging pain in the lower abdomen, as well as cloudy discharge from the genitals. The disease can occur in an acute form, and if left untreated, it becomes chronic. There are several types of cervicitis:

1. Purulent. Inflammation is usually associated with gonorrhea. The causative agent is gonococci. The infection is transmitted sexually. The process spreads to the area of ​​the uterus, tubes and ovaries, causing deformation of the mucous membranes.
2. Viral cervicitis. Occurs when genital herpes or infection with other sexually transmitted viruses.
3. Bacterial. Appears as a result of a violation of the vaginal microflora. It is not transmitted sexually.
4. Cystic. The growth of columnar epithelium into the outer region of the cervix with the formation large quantity cysts and inflammation.
5. Atrophic cervicitis occurs as a result of diseases of the reproductive and urinary systems (after cystitis, with sexually transmitted diseases). It often occurs in women during menopause, when the body's defenses are weakened and hormonal imbalance occurs. With this form of the disease, the mucous membrane of the cervix becomes thin, increasing the likelihood of damage and infection.

Depending on the severity, treatment with antiviral drugs or cauterization using various methods is used.

Cervical polyps. They grow on the surface of the cervical canal. The cause is usually hormonal imbalances. They are removed by scraping the mucous membrane, and then the removal site is cauterized. Polyps are benign formations; they do not degenerate into cancer, but can lead to precancerous conditions. If there are polyps, a woman experiences uterine bleeding, as well as brown discharge between menstruation. Polyps often appear in postmenopausal women. Since menstruation is no longer possible at this time, any discharge of blood from the genitals may be a sign of the formation of polyps or a cancerous tumor.

Cervical cyst. When the cervical epithelium grows, the glands that penetrate it become blocked. The mucus produced by the glands, having no outlet, overwhelms them and stretches them. Cystic voids form in the tissues of the cervical canal and the vaginal part of the cervix (Nabothian cysts). There are usually no symptoms. Small cysts do not pose a threat and are not removed. If the cysts increase, the affected epithelium is destroyed using a laser or radio wave therapy. Sometimes hormonal treatment or physical therapy is used.

Precancerous pathologies

Leukoplakia. With this disease, white spots appear on the cervix, which are keratinized areas of the epithelium. Spots appear in any part of the cervix. A woman is bothered by copious discharge with an unpleasant odor. The disease occurs if amenorrhea (prolonged absence of menstruation associated with cycle disruption) is observed after cauterization of erosion. If the damaged areas are not removed in time, then cancer cells form under the keratinized epithelium. Chemical cauterization, cryotherapy, and laser coagulation are used for treatment.

Cervical dysplasia. Unlike erosion, in this case there is not only a movement of epithelial cells to the neighboring area, but also a change in their structure. Such changes lead to malignant degeneration within 2-10 years. Depending on the degree of change in the cellular structure, there are 3 stages of disease development. At stage 1 there may be no symptoms. Then pain appears in the lower abdomen, bleeding, burning and itching in the vagina.

Papillomas(warts on the cervix). They occur when the human papillomavirus is present in the body. The papilloma virus is one of the main causes of cervical cancer. Papillomas are removed by cauterization, laser or radio waves.

Types of cervical cancer

Squamous cell carcinoma. In 80% of cases this form occurs. The cells of the squamous epithelium of the cervix are affected. In most cases, cancer occurs in the area of ​​​​contact between the squamous epithelium and the columnar epithelium.

Adenocarcinoma. The tumor affects the cylindrical cells of the cervical canal. The appearance of cancer is promoted by the formation of dysplasia and papillomas. Cancer appears at the site of injuries to the cervix caused by abortion or childbirth. Hormonal disorders and smoking contribute to its occurrence. If it is possible to recognize the tumor at an early stage, then it is removed. Basically, this requires removing the entire uterus. For young nulliparous women, the method of radio wave tumor destruction with preservation of the uterus is sometimes used.

Video: Diagnosis and treatment of cervical cancer

Methods of treating diseases

Warning: When treating women's diseases, one should not rely on traditional methods, since they are ineffective, and wasting time on their use can cost lives.

Main methods drug treatment is hormone replacement therapy, the use of anti-inflammatory and antibacterial drugs. If necessary, treatment of small affected areas is carried out chemicals(Solkovagin, for example). In this case, diseased cells are destroyed, but healthy tissue is not affected.

Diathermocoagulation is the cauterization of diseased tissues electric shock. Applicable only to women who are not planning pregnancy. After cauterization, scars remain. For nulliparous women, more gentle laser beam treatment is used. Cold treatment (cryodestruction) and cauterization with liquid nitrogen are also used.

Knife conization (surgical removal of part of the cervix using a scalpel) or complete amputation of the cervix is ​​used. This operation is performed in the early stages of cancer, when the uterus and ovaries can be saved.