Cervical cervical canal

The cervical canal of the cervix is an anatomical formation of the internal genital organs, which has an important function in the process of bearing a pregnancy and giving birth to a child. Various changes and deformations of this canal can contribute to the pathology of bearing a pregnancy, as well as the fertilization process itself. Therefore, it is important to have an understanding of the anatomy and physiological characteristics, as well as possible pathological changes that can cause the disease.

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Anatomy of the cervical canal of the cervix

The cervical canal of the cervix is a formation that is located in the thickness of the cervix and it performs many functions, the main one of which is the connection between the external and internal genital organs. In a girl, it develops gradually, and reaches normal sizes closer to puberty. Normally, the anatomy of the internal female genital organs is located as follows: the vagina passes into the cervix, which begins with the external os, then the cervical canal of the cervix begins, which ends with the internal os and passes into the uterine cavity. This anatomy allows you to regulate the process of opening the cervix in the first period of labor. Thanks to the os, the cervical canal begins to open from the internal os, and then, like an hourglass, the external os opens. During the involution of the uterus in the postpartum period, the internal os closes first on the 5-7th day, and then on the 21st day the external os of the cervical canal closes.

Such anatomical features contribute to these physiological changes already in the postpartum period, while the external os does not close completely after the first birth and this contributes to the fact that repeated births are faster.

As for the histological structure of the cervical canal of the cervix, there are also some peculiarities. The vagina, which is also called the exocervix, is lined with multilayered flat nonkeratinizing epithelium, and the cervical canal, or endocervix, is built of single-layered cylindrical epithelium. Between these zones, there is normally a small border, which is called the transition zone, and it is normally located at the level of the external os. It is necessary to know this structure in order to further understand the concept of "dysplasia" and the real threat of such a condition.

When examining a woman in a mirror, the cervix is visible, or more precisely its external os, and knowing the anatomical features of this area and physiological changes, one can assume one or another dysfunction. It is also important for the woman herself to understand what one or another diagnosis implies, in comparison with normal values.

The cervical canal during pregnancy has its own characteristics, which is associated with both the influence of hormones and further preparation of the birth canal for the birth of the fetus. Normally, the length of the cervix is 35-45 millimeters, and the diameter of the canal is 5 millimeters, any deviations in one direction or another pose a risk of complications. The length of the cervical canal closer to 32-35 weeks of pregnancy can decrease to 35 millimeters, and this is considered a physiological indicator, which is due to preparation for childbirth. If the length of the cervix is less than 35 millimeters, and this is often 20-25, before the 30th week of pregnancy, then they talk about such a concept as isthmic-cervical insufficiency. This is a risk of premature birth, so surgical treatment is carried out in the form of applying an obstetric suture - a pessary - which circularly fixes the cervical canal and prevents its premature opening. At 35-36 weeks, the suture is removed. If not diagnosed in time, this condition can lead to premature birth. If the length of the cervical canal during pregnancy and childbirth is more than 45 millimeters, then we speak of a long cervix, which also has its negative consequences. During pregnancy, the normal attachment of the placenta may be disrupted, since the anatomical structure of the cervical os is disrupted and the placenta may have a central, lateral or low attachment. During childbirth, a number of complications may also occur. One of the manifestations may be prolonged labor, which lasts more than 12-14 hours in primiparous women and more than 9-12 hours in multiparous women. This occurs because the elongated cervix is not prepared before childbirth and opens slowly. A long and hard cervix does not smooth out, which leads to the unpreparedness of the birth canal. Therefore, contractions last a long time, leading to fatigue and exhaustion of the woman, and this condition can lead to secondary weakness of labor, which requires active tactics in the form of stimulation of pregnancy.

There may also be obstacles to the normal passage of the baby through the birth canal, since the elongated cervix is not sufficiently dilated and the baby's head or presenting part may remain in one plane for a long time, which increases the risk of hypoxia and may require additional methods.

Another important feature of the cervical canal during pregnancy is its important protective function: during normal functioning of the epithelium of the cervical canal, the glands secrete a huge amount of secretion, resulting in the formation of a mucous plug that prevents pathogenic microorganisms from entering the uterine cavity. Just before childbirth, this mucous plug comes off.

Thus, it becomes clear that any violations of the anatomical structure of the cervical canal of the cervix can cause complications in the future, and therefore require timely diagnosis and treatment.

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Diseases of the cervical canal

Cervical pathology can play a major role in the development of diseases, both during pregnancy and outside of pregnancy, even with possible infertility.

Conventionally, pathologies of the cervical canal can be divided into:

1. anomalies of the structure and composition of the cervical canal;
2. inflammatory diseases;
3. neoplasms of the cervical canal.

Anomalies in the structure and construction of the cervical canal can be both congenital and acquired. Congenital anomalies are usually accompanied by concomitant anomalies of other genital organs - the vagina, uterus. More often in women of reproductive age, acquired anomalies of the structure of the cervical canal occur, which occurs as a result of adhesions, scars, deformations after various surgical interventions. Among such pathologies are the circular canal of the cervix, narrowing of the cervical canal and its obstruction.

Circular canal of the cervix is a pathology in which the canal has a funnel-shaped form due to the incorrect arrangement of muscle fibers in the circular direction. This pathology can occur with ruptures of the internal genital organs due to childbirth and their surgical treatment - suturing, in the future this can be the cause of such a process with improper tissue healing. This pathology may not manifest itself in any way due to its insignificance, that is, all physiological processes in the uterus and ovaries do not suffer. Problems can arise during the next pregnancy, when there may be discoordination of labor due to improper contraction of the muscle fibers of the circular canal of the cervix, which prevents the normal opening of the cervix. Treatment of this pathology, as such, does not exist, since these are structural changes that cannot be corrected. Treatment can be symptomatic when complications occur.

Narrowing of the cervical canal is its size less than 5 millimeters. In this case, a woman of reproductive age may already have symptoms in the form of menstrual cycle disorders such as oligomenorrhea, since a narrow cervical canal can interfere with normal menstruation, which prolongs the period of menstruation with a small amount of discharge. As for pregnancy, this can be a direct threat to normal labor, in the case of poor opening of the cervix and an indication for a cesarean section. But there may also be a sufficient hormonal background with good dynamics of opening of the cervix and labor, then this condition is not dangerous. The extreme degree of narrowing of the cervical canal is its obstruction. Obstruction of the cervical canal of the cervix is a condition that already requires intervention, since there are complications. In this pathology, a mechanical obstruction is formed, which in women of reproductive age can cause a delay in menstrual blood with its accumulation in the uterine cavity and the formation of an acute condition in gynecology - hematometra. Then there is a clinic of acute abdominal pain, tension of the anterior abdominal wall, and anamnesis data indicate a delay in menstruation for several weeks or several times in a row. During examination, tension and soreness of the uterus can be determined. This is a condition that requires immediate surgical intervention.

Among the inflammatory diseases of the cervical canal of the cervix, the most common is endocervicitis - a pathology characterized by focal inflammation of the cervical canal. The etiological cause can be any pathogenic or opportunistic microorganism that enters the cervical canal in an ascending manner. In this case, inflammation with local symptoms in the form of purulent discharge from the vagina, pain during intercourse and at rest, menstrual irregularities occurs in the cervical canal. In addition to local symptoms, general symptoms appear in the form of fever, intoxication, changes in blood tests. Treatment should be comprehensive - local and general. Local treatment is douching with antiseptics, antibiotic suppositories, and genital hygiene. General treatment involves the systemic use of antibiotics for a course of 7-10 days, as well as symptomatic therapy. At the time of the disease and treatment, it is necessary to exclude sexual intercourse and treat the partner at the same time, especially in the case of verification of specific urogenital flora.

Cervical neoplasms can be benign and malignant. Among benign diseases, polyps of the cervical canal of the cervix are the most common. This is a pathology that is characterized by the formation of a characteristic structure in the form of cauliflower on a stalk or a wide base. This structure is visible to the naked eye. The cause of this formation is most often the human papilloma virus, which affects the epithelial cells of the genitals due to high tropism. Cervical polyposis of the cervical canal of the cervix is often multiple and is combined with other localization of polyps - in the cervix, vagina.

Among the benign formations of the cervical canal of the cervix, there is also a cyst. This is a formation with a thin wall, which has a thin capsule, liquid contents inside and a tendency to grow. Since the cervical canal has a limited diameter, complications often arise in the form of a rupture of the cyst or its infection. Then it is also necessary to carry out complex treatment. The course of such a cyst with small sizes can be asymptomatic, then it can just be an accidental finding on ultrasound. Sometimes the contents of the cyst can be menstrual blood, then they talk about an endometrioid cyst. The treatment tactics can be surgical in case of an accidental finding of such a formation.

Among malignant tumors there may be cancer of the cervical canal of the cervix. This pathology is not as common as cancer of other localizations, but it is quite dangerous in terms of asymptomatic course. Therefore, such cancer is often diagnosed already at the stage of metastasis to other organs. At the first-second stage of the disease, the treatment is radical surgical with extirpation of the uterus and regional lymph nodes, as well as preoperative and postoperative radiation therapy. At later stages, the treatment is combined.

These are the main diseases that can be localized in the cervical canal of the cervix.

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Diagnosis of pathology of the cervical canal of the cervix

Diagnosis of these pathologies should be comprehensive to exclude other conditions and provide correct treatment.

First of all, it is necessary to listen to complaints with full detailing of symptoms. It is also necessary to clarify the anamnestic data with determination of the date of the last menstruation. Examination in mirrors allows you to see only the external os of the cervical canal, but if there are polyps in the vagina, then it can be assumed that there is also polyposis of the cervical canal of the cervix. There may also be bloody discharge when a cyst of the cervical canal of the cervix ruptures or purulent discharge when it suppurates.

An important stage of vaginal examination of a woman in speculums is taking smears of two types - for bacterial flora and for histological examination. A smear from the cervical canal is taken for screening from each woman with a special brush. The correct technology must be followed - a smear is taken from three zones of the cervix - the endocervix, the intermediate zone and the cervical canal, that is, all three types of epithelium must be present. Then all smears are sent to the laboratory for cytology and histology.

Cytological examination of the cervix and cervical canal allows diagnosing such a dangerous condition as cervical metaplasia – a background precancerous disease. The results of histology are used to judge the possible disease. There are six main types of smears:

1. histological picture of a healthy woman;
2. inflammatory and benign changes in the smear;
3. cervical intraepithelial neoplasia
   1. mild metaplasia (CIN-I) – altered dysplastic cells extend into no more than one third of the epithelial layer;
   2. moderate metaplasia (CIN-II) - altered dysplastic cells extend in depth by no more than two-thirds;
   3. severe metaplasia (CIN-III) - altered dysplastic cells extend into the tissue by two-thirds or more, but without invasion of the basement membrane;
4. suspected cancer;
5. Cancer;
6. uninformative smear (not all types of epithelium are represented).

If metaplasia is suspected, that is, if the smear is of the third type, then additional research methods are carried out. During pregnancy, during the third planned ultrasound, all women undergo a special ultrasound examination - cervicometry - measuring the length and thickness of the cervical canal of the cervix. If the indicators are outside the norm, then a decision is made on possible correction tactics.

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Cervical canal surgeries

Surgical interventions on the cervical canal are not performed very often, since this is a very hard-to-reach place. Minimally invasive interventions are more often performed for specific indications. In case of anomalies in the structure of the cervical canal of the cervix, such as narrowing or obstruction of the cervical canal, a special procedure is performed - bougienage of the cervical canal. This intervention consists of widening the canal with a special instrument - a bougie. This is most often a metal instrument, which is selected by number, which corresponds to its size, and they start from the smallest to the widest. It is often necessary to repeat the procedure several times, since once is not enough. Such intervention is effective with small degrees of narrowing.

Among the surgical methods of treating pathologies of the cervical canal of the cervix of the uterus, in this case with polyps of the canal, cryodestruction, cauterization with liquid nitrogen, laser cauterization are used. The cryodestruction method involves the use of cold, which freezes the polyps and they fall off. This procedure is repeated 1-2 times a week until the polyp completely disappears. Cauterization with liquid nitrogen works on the same principle.

Laser therapy is the use of a laser beam with a scalpel-like mechanism of action.

Curettage of the cervical canal can be performed for both diagnostic and therapeutic purposes. Diagnostic curettage of the cervical canal is performed if there is a suspicion of an ectopic pregnancy or a foreign body. It is important to send all the obtained material for histological examination. Therapeutic curettage of the cervical canal is performed in the postpartum period if complications occur or if there is a suspicion of an inflammatory focus in the uterus. This treatment method can also be performed if more minimally invasive methods are ineffective in treating polyposis or if it is multiple.

The cervical canal of the cervix is a formation that has important functions in the process of fertilization, gestation and birth of a child, as well as in the pathology of the female reproductive system. It is necessary to know some features of the anatomical structure of the cervical canal of the cervix for timely diagnosis of pathology and determination of possible treatment tactics.