The Billings ovulation method is a method in which women use their vaginal mucus to determine their fertility . It does not rely on the presence of ovulation, rather it identifies patterns of potential fertility and obvious infertility within the cycle, whatever its length. Effectiveness, however, is not very clear.
133-470: Evidence of effectiveness is not very clear. Typical use of this method is associated with a pregnancy rate of 1 to 22%. A World Health Organization study found that 15% is caused by a conscious departure from method rules. The percentage of people who stop using the method after a year is 1–24%. Perfect use has been estimated to result in pregnancy in 0.5–3%. Some studies of perfect use excluded those who could not detect secretions that represented fertility. In
266-405: A Pap smear (also called a cervical smear), in which epithelial cells are scraped from the surface of the cervix and examined under a microscope . The colposcope , an instrument used to see a magnified view of the cervix, was invented in 1925. The Pap smear was developed by Georgios Papanikolaou in 1928. A LEEP procedure using a heated loop of platinum to excise a patch of cervical tissue
399-426: A forceps delivery , induction , or Caesarean section should be used in childbirth. Cervical incompetence is a condition in which shortening of the cervix due to dilation and thinning occurs, before term pregnancy. Short cervical length is the strongest predictor of preterm birth . Several methods of contraception involve the cervix. Cervical diaphragms are reusable, firm-rimmed plastic devices inserted by
532-588: A "period" or "monthly") is the regular discharge of blood and mucosal tissue (known as menses) from the inner lining of the uterus through the vagina. The vaginal mucous membrane varies in thickness and composition during the menstrual cycle , which is the regular, natural change that occurs in the female reproductive system (specifically the uterus and ovaries ) that makes pregnancy possible. Different hygiene products such as tampons , menstrual cups , and sanitary napkins are available to absorb or capture menstrual blood. The Bartholin's glands, located near
665-416: A benign overgrowth may be present in the cervical canal. Cervical ectropion refers to the horizontal overgrowth of the endocervical columnar lining in a one-cell-thick layer over the ectocervix. Female marsupials have paired uteri and cervices . Most eutherian (placental) mammal species have a single cervix and a single, bipartite or bicornuate uterus. Lagomorphs , rodents, aardvarks and hyraxes have
798-421: A better understanding of female genitalia can help combat sexual and psychological harm with regard to female development, researchers endorse correct terminology for the vulva. The human vagina is an elastic, muscular canal that extends from the vulva to the cervix. The opening of the vagina lies in the urogenital triangle . The urogenital triangle is the front triangle of the perineum and also consists of
931-404: A cockscomb cervix. Similarly, cockscomb polyps lining the cervix are usually considered or grouped into the same overarching description. It is in and of itself considered a benign abnormality; its presence, however is usually indicative of DES exposure, and as such women who experience these abnormalities should be aware of their increased risk of associated pathologies. Cervical agenesis
1064-408: A distinct structure) is still under dispute because reports of its location can vary from woman to woman, it appears to be nonexistent in some women, and it is hypothesized to be an extension of the clitoris and therefore the reason for orgasms experienced vaginally. The vagina is the birth canal for the delivery of a baby. When labor nears, several signs may occur, including vaginal discharge and
1197-446: A duplex uterus and two cervices. Lagomorphs and rodents share many morphological characteristics and are grouped together in the clade Glires . Anteaters of the family Myrmecophagidae are unusual in that they lack a defined cervix; they are thought to have lost the characteristic rather than other mammals developing a cervix on more than one lineage. In domestic pigs , the cervix contains a series of five interdigitating pads that hold
1330-421: A greater concentration of nerve endings and therefore greater sensitivity near the vaginal entrance (the outer one-third or lower third), some scientific examinations of vaginal wall innervation indicate no single area with a greater density of nerve endings. Other research indicates that only some women have a greater density of nerve endings in the anterior vaginal wall. Because of the fewer nerve endings in
1463-422: A larger cervix vis á vis postmenopausal females; likewise, females who have produced offspring have a larger sized cervix than females who have not produced offspring. In relation to the vagina, the part of the cervix that opens to the uterus is called the internal os and the opening of the cervix in the vagina is called the external os , while between is the conduit of the cervix, commonly referred to as
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#17327912968641596-413: A legal description is that it begins at the vulva (between the labia ). It may be that the incorrect use of the term vagina is due to not as much thought going into the anatomy of the female genitals as has gone into the study of male genitals, and that this has contributed to an absence of correct vocabulary for the external female genitalia among both the general public and health professionals. Because
1729-431: A little after birth. The mucosa thickens and rugae return in approximately three weeks once the ovaries regain usual function and estrogen flow is restored. The vaginal opening gapes and is relaxed, until it returns to its approximate pre-pregnant state six to eight weeks after delivery, known as the postpartum period ; however, the vagina will continue to be larger in size than it was previously. After giving birth, there
1862-538: A predictable pattern through the course of a woman's cycle. He continued his study of the cervix. John Billings (1918–2007) was involved with the development of the Billings ovulation method. Cervix The cervix ( pl. : cervices ) or cervix uteri is a dynamic fibromuscular sexual organ of the female reproductive system that connects the vagina with the uterine cavity . The human female cervix has been documented anatomically since at least
1995-450: A result of antibiotic use) or another form of vaginitis. While vaginitis is an inflammation of the vagina, and is attributed to infection, hormonal issues, or irritants, vaginismus is an involuntary tightening of the vagina muscles during vaginal penetration that is caused by a conditioned reflex or disease. Vaginal discharge due to yeast infection is usually thick, creamy in color and odorless, while discharge due to bacterial vaginosis
2128-427: A type of birth control , or to preserve virginity . Less commonly, they may use non penile-vaginal sexual acts as a primary means of sexual pleasure. In contrast, lesbians and other women who have sex with women commonly engage in fingering as a main form of sexual activity . Some women and couples use sex toys , such as a vibrator or dildo , for vaginal pleasure. Most women require direct stimulation of
2261-407: A way for the body to prepare for true labor. They do not signal the beginning of labor, but they are usually very strong in the days leading up to labor. As the body prepares for childbirth, the cervix softens, thins , moves forward to face the front, and begins to open. This allows the fetus to settle into the pelvis, a process known as lightening. As the fetus settles into the pelvis, pain from
2394-426: A way that they interlock with each other and close the canal. They are often effaced after pregnancy. The ectocervix (also known as the vaginal portion of the cervix) has a convex, elliptical shape and projects into the cervix between the anterior and posterior vaginal fornices . On the rounded part of the ectocervix is a small, depressed external opening , connecting the cervix with the vagina. The size and shape of
2527-445: A woman prior to intercourse that cover the cervix. Pressure against the walls of the vagina maintain the position of the diaphragm, and it acts as a physical barrier to prevent the entry of sperm into the uterus, preventing fertilisation . Cervical caps are a similar method, although they are smaller and adhere to the cervix by suction. Diaphragms and caps are often used in conjunction with spermicides . In one year, 12% of women using
2660-425: A woman's life, and it can measure 8 mm (0.3 inch) at its widest diameter in premenopausal adults. It is wider in the middle and narrower at each end. The anterior and posterior walls of the canal each have a vertical fold, from which ridges run diagonally upwards and laterally. These are known as palmate folds , due to their resemblance to a palm leaf. The anterior and posterior ridges are arranged in such
2793-454: Is acidic , with a pH normally ranging between 3.8 and 4.5. The low pH prohibits growth of many strains of pathogenic microbes. The acidic balance of the vagina may also be affected by semen, pregnancy, menstruation, diabetes or other illness, birth control pills , certain antibiotics , poor diet, and stress. Any of these changes to the acidic balance of the vagina may contribute to yeast infection. An elevated pH (greater than 4.5) of
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#17327912968642926-411: Is colloquially used to refer to the vulva or to both the vagina and vulva. Using the term vagina to mean "vulva" can pose medical or legal confusion; for example, a person's interpretation of its location might not match another's interpretation of the location. Medically, one description of the vagina is that it is the canal between the hymen (or remnants of the hymen) and the cervix , while
3059-473: Is 7.0 in pre-pubertal girls. Although there is a high degree of variability in timing, girls who are approximately seven to twelve years of age will continue to have labial development as the hymen thickens and the vagina elongates to approximately 8 cm. The vaginal mucosa thickens and the vaginal pH becomes acidic again. Girls may also experience a thin, white vaginal discharge called leukorrhea . The vaginal microbiota of adolescent girls aged 13 to 18 years
3192-673: Is a route of administration where the medication is inserted into the vagina as a creme or tablet. Pharmacologically , this has the potential advantage of promoting therapeutic effects primarily in the vagina or nearby structures (such as the vaginal portion of cervix ) with limited systemic adverse effects compared to other routes of administration. Medications used to ripen the cervix and induce labor are commonly administered via this route, as are estrogens, contraceptive agents, propranolol , and antifungals . Vaginal rings can also be used to deliver medication, including birth control in contraceptive vaginal rings . These are inserted into
3325-400: Is a collapsed tube, with the front and back walls placed together. The lateral walls, especially their middle area, are relatively more rigid. Because of this, the collapsed vagina has an H-shaped cross section. Behind, the upper vagina is separated from the rectum by the recto-uterine pouch , the middle vagina by loose connective tissue , and the lower vagina by the perineal body . Where
3458-495: Is a phase of vaginal discharge called lochia that can vary significantly in the amount of loss and its duration but can go on for up to six weeks. The vaginal flora is a complex ecosystem that changes throughout life, from birth to menopause. The vaginal microbiota resides in and on the outermost layer of the vaginal epithelium. This microbiome consists of species and genera, which typically do not cause symptoms or infections in women with normal immunity. The vaginal microbiome
3591-468: Is a rare congenital condition in which the cervix completely fails to develop, often associated with the concurrent failure of the vagina to develop. Other congenital cervical abnormalities exist, often associated with abnormalities of the vagina and uterus . The cervix may be duplicated in situations such as bicornuate uterus and uterine didelphys . Cervical polyps , which are benign overgrowths of endocervical tissue, if present, may cause bleeding, or
3724-415: Is absent of glands. It forms folds (transverse ridges or rugae ), which are more prominent in the outer third of the vagina; their function is to provide the vagina with increased surface area for extension and stretching. The epithelium of the ectocervix (the portion the uterine cervix extending into the vagina) is an extension of, and shares a border with, the vaginal epithelium. The vaginal epithelium
3857-452: Is an abnormally narrow cervical canal, typically associated with trauma caused by removal of tissue for investigation or treatment of cancer, or cervical cancer itself. Diethylstilbestrol , used from 1938 to 1971 to prevent preterm labour and miscarriage, is also strongly associated with the development of cervical stenosis and other abnormalities in the daughters of the exposed women. Other abnormalities include: vaginal adenosis , in which
3990-407: Is called the supravaginal portion of cervix . A central canal, known as the cervical canal , runs along its length and connects the cavity of the body of the uterus with the lumen of the vagina. The openings are known as the internal os and external orifice of the uterus (or external os), respectively. The mucosa lining the cervical canal is known as the endocervix , and the mucosa covering
4123-452: Is common. The introduction of routine screening has resulted in fewer cases of (and deaths from) cervical cancer, however this has mainly taken place in developed countries. Most developing countries have limited or no screening, and 85% of the global burden occurring there. Cervical cancer nearly always involves human papillomavirus (HPV) infection. HPV is a virus with numerous strains, several of which predispose to precancerous changes in
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4256-411: Is determined by the influence of the hormones estrogen and progesterone. At midcycle around the time of ovulation —a period of high estrogen levels— the mucus is thin and serous to allow sperm to enter the uterus and is more alkaline and hence more hospitable to sperm. It is also higher in electrolytes, which results in the "ferning" pattern that can be observed in drying mucus under low magnification; as
4389-418: Is dominated by Lactobacillus species. These species metabolize glycogen, breaking it down into sugar. Lactobacilli metabolize the sugar into glucose and lactic acid. Under the influence of hormones, such as estrogen, progesterone and follicle-stimulating hormone (FSH), the vaginal ecosystem undergoes cyclic or periodic changes. Vaginal health can be assessed during a pelvic examination , along with
4522-464: Is gray-white in color, and discharge due to trichomoniasis is usually a gray color, thin in consistency, and has a fishy odor. Discharge in 25% of the trichomoniasis cases is yellow-green. HIV/AIDS , human papillomavirus (HPV), genital herpes and trichomoniasis are some STIs that may affect the vagina, and health sources recommend safe sex (or barrier method) practices to prevent the transmission of these and other STIs. Safe sex commonly involves
4655-411: Is made up of layers of cells, including the basal cells , the parabasal cells, the superficial squamous flat cells , and the intermediate cells. The basal layer of the epithelium is the most mitotically active and reproduces new cells. The superficial cells shed continuously and basal cells replace them. Estrogen induces the intermediate and superficial cells to fill with glycogen . Cells from
4788-463: Is normally obscured by the labia minora (inner lips), but may be exposed after vaginal delivery . The hymen is a thin layer of mucosal tissue that surrounds or partially covers the vaginal opening. The effects of intercourse and childbirth on the hymen vary. Where it is broken, it may completely disappear or remnants known as carunculae myrtiformes may persist. Otherwise, being very elastic, it may return to its normal position. Additionally,
4921-400: Is part of the female reproductive system . Around 2–3 centimetres (0.8–1.2 in) in length, it is the lower narrower part of the uterus continuous above with the broader upper part—or body—of the uterus. The lower end of the cervix bulges through the anterior wall of the vagina, and is referred to as the vaginal portion of cervix (or ectocervix) while the rest of the cervix above the vagina
5054-519: Is present just within the cervical canal. Upon entering puberty, due to hormonal influence, and during pregnancy, the columnar epithelium extends outward over the ectocervix as the cervix everts. Hence, this also causes the squamocolumnar junction to move outwards onto the vaginal portion of the cervix, where it is exposed to the acidic vaginal environment. The exposed columnar epithelium can undergo physiological metaplasia and change to tougher metaplastic squamous epithelium in days or weeks, which
5187-452: Is released as the cervix dilates, either during the first stage of childbirth or shortly before. It is visible as a blood-tinged mucous discharge. The cervix plays a major role in childbirth . As the fetus descends within the uterus in preparation for birth, the presenting part , usually the head , rests on and is supported by the cervix. As labour progresses, the cervix becomes softer and shorter, begins to dilate, and withdraws to face
5320-596: Is stimulated during sexual activity. A G-spot orgasm may be responsible for female ejaculation , leading some doctors and researchers to believe that G-spot pleasure comes from the Skene's glands , a female homologue of the prostate , rather than any particular spot on the vaginal wall; other researchers consider the connection between the Skene's glands and the G-spot area to be weak. The G-spot's existence (and existence as
5453-401: Is supported by research by Acién et al., Bok and Drews. Robboy et al. reviewed Koff and Bulmer's theories, and support Bulmer's description in light of their own research. The debates stem from the complexity of the interrelated tissues and the absence of an animal model that matches human vaginal development. Because of this, study of human vaginal development is ongoing and may help resolve
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5586-405: Is supported by the upper portions of the cardinal ligaments and the parametrium . The middle third of the vagina involves the urogenital diaphragm . It is supported by the levator ani muscles and the lower portion of the cardinal ligaments. The lower third is supported by the perineal body, or the urogenital and pelvic diaphragms . The lower third may also be described as being supported by
5719-417: Is the precursor to the vagina. During development, the vaginal plate begins to grow where the fused ends of the paramesonephric ducts (Müllerian ducts) enter the back wall of the urogenital sinus as the sinus tubercle . As the plate grows, it significantly separates the cervix and the urogenital sinus; eventually, the central cells of the plate break down to form the vaginal lumen . This usually occurs by
5852-426: Is the single external opening for the gastrointestinal, urinary, and reproductive tracts. To accommodate smoother penetration of the vagina during sexual intercourse or other sexual activity , vaginal moisture increases during sexual arousal in human females and other female mammals. This increase in moisture provides vaginal lubrication , which reduces friction. The texture of the vaginal walls creates friction for
5985-402: Is unclear on whether treating cervical cancer with radiation therapy increases the risk of vaginal cancer. Age and hormone levels significantly correlate with the pH of the vagina. Estrogen, glycogen and lactobacilli impact these levels. At birth, the vagina is acidic with a pH of approximately 4.5, and ceases to be acidic by three to six weeks of age, becoming alkaline. Average vaginal pH
6118-474: Is used to treat endometrial , vaginal and cervical cancer. An applicator is inserted into the vagina to allow the administration of radiation as close to the site of the cancer as possible. Survival rates increase with VBT when compared to external beam radiation therapy. By using the vagina to place the emitter as close to the cancerous growth as possible, the systemic effects of radiation therapy are reduced and cure rates for vaginal cancer are higher. Research
6251-456: Is very similar to the original squamous epithelium when mature. The new squamocolumnar junction is therefore internal to the original squamocolumnar junction, and the zone of unstable epithelium between the two junctions is called the transformation zone of the cervix. Histologically, the transformation zone is generally defined as surface squamous epithelium with surface columnar epithelium or stromal glands/crypts, or both. After menopause,
6384-458: Is when active pushing and contractions push the baby along the birth canal leading to the birth of the baby. The number of past vaginal deliveries is a strong factor in influencing how rapidly the cervix is able to dilate in labour. The time taken for the cervix to dilate and efface is one factor used in reporting systems such as the Bishop score , used to recommend whether interventions such as
6517-468: The Creighton Model and Billings method . Cervical mucus changes in consistency throughout women's menstrual periods , which may signal ovulation . During vaginal childbirth , the cervix must flatten and dilate to allow the foetus to progress along the birth canal. Midwives and doctors use the extent of the dilation of the cervix to assist decision-making during childbirth. The cervix
6650-414: The adventitia . Some texts list four layers by counting the two sublayers of the mucosa (epithelium and lamina propria) separately. The smooth muscular layer within the vagina has a weak contractive force that can create some pressure in the lumen of the vagina; much stronger contractive force, such as during childbirth, comes from muscles in the pelvic floor that are attached to the adventitia around
6783-400: The cervical canal . The lower part of the cervix, known as the vaginal portion of the cervix (or ectocervix), bulges into the top of the vagina. The endocervix borders the uterus. The cervical canal has at least two types of epithelia (lining): the endocervical lining is glandular epithelium that lines the endocervix with a single layer of column-shaped cells ; while the ectocervical part of
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#17327912968646916-485: The clitoris to orgasm. The clitoris plays a part in vaginal stimulation. It is a sex organ of multiplanar structure containing an abundance of nerve endings, with a broad attachment to the pubic arch and extensive supporting tissue to the labia. Research indicates that it forms a tissue cluster with the vagina. This tissue is perhaps more extensive in some women than in others, which may contribute to orgasms experienced vaginally. During sexual arousal, and particularly
7049-470: The combined oral contraceptive pills , work mainly by preventing ovulation . They also thicken cervical mucus and thin the lining of the uterus, enhancing their effectiveness. In 2008, cervical cancer was the third-most common cancer in women worldwide, with rates varying geographically from less than one to more than 50 cases per 100,000 women. It is a leading cause of cancer-related death in poor countries, where delayed diagnosis leading to poor outcomes
7182-470: The menstrual cycle ; mucus is composed of around 93% water, reaching 98% at midcycle. These changes allow it to function either as a barrier or a transport medium to spermatozoa. It contains electrolytes such as calcium, sodium, and potassium; organic components such as glucose, amino acids, and soluble proteins; trace elements including zinc, copper, iron, manganese, and selenium; free fatty acids; enzymes such as amylase ; and prostaglandins . Its consistency
7315-606: The penis during sexual intercourse and stimulates it toward ejaculation , enabling fertilization . Along with pleasure and bonding, women's sexual behavior with other people can result in sexually transmitted infections (STIs), the risk of which can be reduced by recommended safe sex practices. Other health issues may also affect the human vagina. The vagina has evoked strong reactions in societies throughout history, including negative perceptions and language, cultural taboos , and their use as symbols for female sexuality , spirituality, or regeneration of life. In common speech ,
7448-473: The pudendal nerve . Vaginal secretions are primarily from the uterus , cervix, and vaginal epithelium in addition to minuscule vaginal lubrication from the Bartholin's glands upon sexual arousal. It takes little vaginal secretion to make the vagina moist; secretions may increase during sexual arousal, the middle of or a little prior to menstruation , or during pregnancy . Menstruation (also known as
7581-430: The rupture of membranes (water breaking). The latter results in a gush or small stream of amniotic fluid from the vagina. Water breaking most commonly happens at the beginning of labor. It happens before labor if there is a premature rupture of membranes , which occurs in 10% of cases. Among women giving birth for the first time, Braxton Hicks contractions are mistaken for actual contractions , but they are instead
7714-429: The sciatic nerves , increased vaginal discharge, and increased urinary frequency can occur. While lightening is likelier to happen after labor has begun for women who have given birth before, it may happen ten to fourteen days before labor in women experiencing labor for the first time. The fetus begins to lose the support of the cervix when contractions begin. With cervical dilation reaching 10 cm to accommodate
7847-460: The uterine artery . The vaginal arteries anastamose (are joined) along the side of the vagina with the cervical branch of the uterine artery; this forms the azygos artery , which lies on the midline of the anterior and posterior vagina. Other arteries which supply the vagina include the middle rectal artery and the internal pudendal artery , all branches of the internal iliac artery. Three groups of lymphatic vessels accompany these arteries;
7980-509: The uterus ). The vaginal introitus is normally partly covered by a thin layer of mucosal tissue called the hymen . The vagina allows for copulation and birth . It also channels menstrual flow , which occurs in humans and closely related primates as part of the menstrual cycle . Although research on the vagina is especially lacking for different animals, its location, structure and size are documented as varying among species. Female placental mammals usually have two external openings in
8113-455: The vaginal epithelium are derived from Müllerian duct tissue and that phenotypic differences might be due to other causes. The endocervical mucosa is about 3 mm (0.12 in) thick and lined with a single layer of columnar mucous cells. It contains numerous tubular mucous glands, which empty viscous alkaline mucus into the lumen. In contrast, the ectocervix is covered with nonkeratinized stratified squamous epithelium, which resembles
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#17327912968648246-402: The vulva ; these are the urethral opening for the urinary tract and the vaginal opening for the genital tract. This is different from male placental mammals, which have a urethral opening in the glans penis . The vaginal opening is much larger than the nearby urethral opening, and both are protected by the labia in humans. In amphibians , birds , reptiles and monotremes , the cloaca
8379-561: The Greek word for "head" ( ‹See Tfd› Greek : κορυφή koruphe ), and the Welsh and Romanian words for "deer" ( Welsh : carw , Romanian: cerb ). The cervix was documented in anatomical literature in at least the time of Hippocrates ; cervical cancer was first described more than 2,000 years ago, with descriptions provided by both Hippocrates and Aretaeus . However, there was some variation in word sense among early writers, who used
8512-607: The adjective cervical may refer either to the neck (as in cervical vertebrae or cervical lymph nodes ) or to the uterine cervix (as in cervical cap or cervical cancer ). Latin cervix came from the Proto-Indo-European root ker- , referring to a "structure that projects". Thus, the word cervix is linguistically related to the English word " horn ", the Persian word for "head" ( Persian : سر sar ),
8645-459: The anterior of the body. The support the cervix provides to the fetal head starts to give way when the uterus begins its contractions . During childbirth, the cervix must dilate to a diameter of more than 10 cm (3.9 in) to accommodate the head of the fetus as it descends from the uterus to the vagina. In becoming wider, the cervix also becomes shorter, a phenomenon known as effacement . Along with other factors, midwives and doctors use
8778-444: The back wall, approximately 9 cm (3.5 in) long. During sexual arousal, the vagina expands both in length and width. If a woman stands upright, the vaginal canal points in an upward-backward direction and forms an angle of approximately 45 degrees with the uterus. The vaginal opening and hymen also vary in size; in children, although the hymen commonly appears crescent -shaped, many shapes are possible. The vaginal plate
8911-554: The boar's corkscrew-shaped penis during copulation. The word cervix ( / ˈ s ɜːr v ɪ k s / ) came to English from the Latin cervīx , where it means "neck", and like its Germanic counterpart, it can refer not only to the neck [of the body] but also to an analogous narrowed part of an object. The cervix uteri (neck of the uterus) is thus the uterine cervix, but in English the word cervix used alone usually refers to it. Thus
9044-532: The caudal part of the Müllerian duct, while the lower part of the vagina develops from the urogenital sinus. Other views are Bulmer's 1957 description that the vaginal epithelium derives solely from the urogenital sinus epithelium, and Witschi's 1970 research, which reexamined Koff's description and concluded that the sinovaginal bulbs are the same as the lower portions of the Wolffian ducts . Witschi's view
9177-614: The cervical and uterine contractions during orgasm draw semen into the uterus. Although the "upsuck theory" has been generally accepted for some years, it has been disputed due to lack of evidence, small sample size, and methodological errors. Some methods of fertility awareness , such as the Creighton model and the Billings method involve estimating a woman's periods of fertility and infertility by observing physiological changes in her body . Among these changes are several involving
9310-406: The cervical epithelium, particularly in the transformation zone, which is the most common area for cervical cancer to start. HPV vaccines , such as Gardasil and Cervarix , reduce the incidence of cervical cancer, by inoculating against the viral strains involved in cancer development. Potentially precancerous changes in the cervix can be detected by cervical screening , using methods including
9443-473: The cervix . Cervical cytology tests can detect cervical cancer and its precursors, and enable early successful treatment. Ways to avoid HPV include avoiding heterosexual sex, utilising penile condoms, and receiving the HPV vaccination . HPV vaccines, developed in the early 21st century, reduce the risk of developing cervical cancer by preventing infections from the main cancer-causing strains of HPV. The conduit of
9576-401: The cervix becomes softer and rises to open in response to the higher levels of estrogen present. These changes are also accompanied by changes in cervical mucus, described below. As a component of the female reproductive system , the cervix is derived from the two paramesonephric ducts (also called Müllerian ducts), which develop around the sixth week of embryogenesis . During development,
9709-446: The cervix by the descending branch of the uterine artery and drains into the uterine vein . The pelvic splanchnic nerves , emerging as S2 – S3 , transmit the sensation of pain from the cervix to the brain. These nerves travel along the uterosacral ligaments , which pass from the uterus to the anterior sacrum . Three channels facilitate lymphatic drainage from the cervix. The anterior and lateral cervix drains to nodes along
9842-421: The cervix is referred to as cervicitis . This inflammation may be of the endocervix or ectocervix. When associated with the endocervix, it is associated with a mucous vaginal discharge and sexually transmitted infections such as chlamydia and gonorrhoea . As many as half of pregnant women having a gonorrheal infection of the cervix are asymptomatic. Other causes include overgrowth of the commensal flora of
9975-467: The cervix is the organ that allows for blood to flow from a woman's uterus and out through her vagina at menstruation , which occurs in the absence of pregnancy. Several methods of contraception aim to prevent fertilization by blocking this conduit, including cervical caps and cervical diaphragms , preventing the passage of sperm through the cervix. Other approaches aiming to prevent contraception include methods that observe cervical mucus, such as
10108-413: The cervix travels to different sets of pelvic nodes in some people. This has implications in scanning nodes for involvement in cervical cancer. After menstruation and directly under the influence of estrogen , the cervix undergoes a series of changes in position and texture. During most of the menstrual cycle, the cervix remains firm, and is positioned low and closed. However, as ovulation approaches,
10241-414: The child, and is without significant complications. Vaginal infections or diseases include yeast infection , vaginitis , sexually transmitted infections (STIs) and cancer . Lactobacillus gasseri and other Lactobacillus species in the vaginal flora provide some protection from infections by their secretion of bacteriocins and hydrogen peroxide . The healthy vagina of a woman of child-bearing age
10374-399: The conduit contains squamous epithelium. Squamous epithelium line the conduit with multiple layers of cells topped with flat cells . These two linings converge at the squamocolumnar junction (SCJ). This junction changes location dynamically throughout a woman's life. Cervical infections with the human papillomavirus (HPV) can cause changes in the epithelium, which can lead to cancer of
10507-431: The conflicting data. The vaginal wall from the lumen outwards consists firstly of a mucosa of stratified squamous epithelium that is not keratinized , with a lamina propria (a thin layer of connective tissue ) underneath it. Secondly, there is a layer of smooth muscle with bundles of circular fibers internal to longitudinal fibers (those that run lengthwise). Lastly, is an outer layer of connective tissue called
10640-493: The days leading up to ovulation the cervix responds to oestrogen by producing mucus capable of sustaining sperm survival. This mucus leaves the vagina as the woman is in an upright position. The mucus is observed through the sensation at the vulva and by looking at any cervical secretions. Daily charting of these observations will reveal either an unchanging pattern indicating infertility or a changing pattern of sensation and discharge indicating fertility. Both of these patterns follow
10773-523: The diaphragm will undergo an unintended pregnancy, and with optimal use this falls to 6%. Efficacy rates are lower for the cap, with 18% of women undergoing an unintended pregnancy, and 10–13% with optimal use. Most types of progestogen-only pills are effective as a contraceptive because they thicken cervical mucus, making it difficult for sperm to pass along the cervical canal. In addition, they may also sometimes prevent ovulation. In contrast, contraceptive pills that contain both oestrogen and progesterone,
10906-409: The ectocervix and the external opening (external os) can vary according to age, hormonal state, and whether childbirth has taken place. In women who have not had a vaginal delivery, the external opening is small and circular, and in women who have had a vaginal delivery, it is slit-like. On average, the ectocervix is 3 cm (1.2 in) long and 2.5 cm (1 in) wide. Blood is supplied to
11039-401: The ectocervix is known as the exocervix. The cervix has an inner mucosal layer, a thick layer of smooth muscle , and posteriorly the supravaginal portion has a serosal covering consisting of connective tissue and overlying peritoneum . In front of the upper part of the cervix lies the bladder , separated from it by cellular connective tissue known as parametrium , which also extends over
11172-400: The effects of progesterone. Thick mucus also prevents pathogens from interfering with a nascent pregnancy. A cervical mucus plug , called the operculum, forms inside the cervical canal during pregnancy. This provides a protective seal for the uterus against the entry of pathogens and against leakage of uterine fluids. The mucus plug is also known to have antibacterial properties. This plug
11305-453: The epithelium remains thin with only a few layers of cuboidal cells without glycogen. The epithelium also has few rugae and is red in color before puberty. When puberty begins, the mucosa thickens and again becomes stratified squamous epithelium with glycogen containing cells, under the influence of the girl's rising estrogen levels. Finally, the epithelium thins out from menopause onward and eventually ceases to contain glycogen, because of
11438-401: The extent of cervical dilation to assist decision making during childbirth . Generally, the active first stage of labour, when the uterine contractions become strong and regular, begins when the cervical dilation is more than 3–5 cm (1.2–2.0 in). The second phase of labor begins when the cervix has dilated to 10 cm (4 in), which is regarded as its fullest dilation, and
11571-500: The female condom fits less tightly than the male condom or because it can slip into the vagina and spill semen. The vaginal lymph nodes often trap cancerous cells that originate in the vagina. These nodes can be assessed for the presence of disease. Selective surgical removal (rather than total and more invasive removal) of vaginal lymph nodes reduces the risk of complications that can accompany more radical surgeries. These selective nodes act as sentinel lymph nodes. Instead of surgery,
11704-413: The head of the fetus, the head moves from the uterus to the vagina. The elasticity of the vagina allows it to stretch to many times its normal diameter in order to deliver the child. Vaginal births are more common, but if there is a risk of complications a caesarean section (C-section) may be performed. The vaginal mucosa has an abnormal accumulation of fluid ( edematous ) and is thin, with few rugae,
11837-637: The health of most of the organs of the female reproductive system. Such exams may include the Pap test (or cervical smear). In the United States, Pap test screening is recommended starting around 21 years of age until the age of 65. However, other countries do not recommend pap testing in non-sexually active women. Guidelines on frequency vary from every three to five years. Routine pelvic examination on women who are not pregnant and lack symptoms may be more harmful than beneficial. A normal finding during
11970-437: The hormonal patterns which control sperm survival and conception. The first recorded observations of the relationship between cervical mucus and survival of spermatozoa come from the mid-19th century. The topic was not systematically studied, however, for almost another century. In 1948, Erik Odeblad was studying mycoplasms in the female genital tract. During the course of his studies, he noticed that cervical mucus changed in
12103-446: The hymen may be lacerated by disease, injury, medical examination , masturbation or physical exercise . For these reasons, virginity cannot be definitively determined by examining the hymen. The length of the vagina varies among women of child-bearing age. Because of the presence of the cervix in the front wall of the vagina, there is a difference in length between the front wall, approximately 7.5 cm (2.5 to 3 in) long, and
12236-514: The lack of estrogen. Flattened squamous cells are more resistant to both abrasion and infection. The permeability of the epithelium allows for an effective response from the immune system since antibodies and other immune components can easily reach the surface. The vaginal epithelium differs from the similar tissue of the skin. The epidermis of the skin is relatively resistant to water because it contains high levels of lipids. The vaginal epithelium contains lower levels of lipids. This allows
12369-487: The lower basal layer transition from active metabolic activity to death ( apoptosis ). In these mid-layers of the epithelia, the cells begin to lose their mitochondria and other organelles . The cells retain a usually high level of glycogen compared to other epithelial tissue in the body. Under the influence of maternal estrogen, the vagina of a newborn is lined by thick stratified squamous epithelium (or mucosa) for two to four weeks after birth. Between then to puberty ,
12502-470: The lymph nodes of concern are sometimes treated with radiation therapy administered to the patient's pelvic, inguinal lymph nodes, or both. Vaginal cancer and vulvar cancer are very rare, and primarily affect older women. Cervical cancer (which is relatively common) increases the risk of vaginal cancer, which is why there is a significant chance for vaginal cancer to occur at the same time as, or after, cervical cancer. It may be that their causes are
12635-436: The mucus dries, the salts crystallize, resembling the leaves of a fern. The mucus has a stretchy character described as Spinnbarkeit most prominent around the time of ovulation. At other times in the cycle, the mucus is thick and more acidic due to the effects of progesterone. This "infertile" mucus acts as a barrier to keep sperm from entering the uterus. Women taking an oral contraceptive pill also have thick mucus from
12768-414: The outer parts of the two ducts fuse, forming a single urogenital canal that will become the vagina , cervix and uterus . The cervix grows in size at a smaller rate than the body of the uterus, so the relative size of the cervix over time decreases, decreasing from being much larger than the body of the uterus in fetal life , twice as large during childhood, and decreasing to its adult size, smaller than
12901-416: The passage of water and water-soluble substances through the tissue. Keratinization happens when the epithelium is exposed to the dry external atmosphere. In abnormal circumstances, such as in pelvic organ prolapse , the mucosa may be exposed to air, becoming dry and keratinized. Blood is supplied to the vagina mainly via the vaginal artery , which emerges from a branch of the internal iliac artery or
13034-407: The pelvic exam of a pregnant woman is a bluish tinge to the vaginal wall. Pelvic exams are most often performed when there are unexplained symptoms of discharge, pain, unexpected bleeding or urinary problems. During a pelvic exam, the vaginal opening is assessed for position, symmetry , presence of the hymen, and shape. The vagina is assessed internally by the examiner with gloved fingers, before
13167-543: The pelvic muscles, to wrap around the inserted penis (or other object), this creates friction for the penis and helps to cause a man to experience orgasm and ejaculation , which in turn enables fertilization . An area in the vagina that may be an erogenous zone is the G-spot . It is typically defined as being located at the anterior wall of the vagina, a couple or few inches in from the entrance, and some women experience intense pleasure, and sometimes an orgasm, if this area
13300-458: The perineal body and the pubovaginal part of the levator ani muscle. The vaginal opening (also known as the vaginal introitus and the Latin ostium vaginae ) is at the posterior end of the vulval vestibule , behind the urethral opening . The term introitus is more technically correct than "opening", since the vagina is usually collapsed, with the opening closed. The opening to the vagina
13433-421: The quality of her cervical mucus: the sensation it causes at the vulva , its elasticity ( Spinnbarkeit ), its transparency, and the presence of ferning . Several hundred glands in the endocervix produce 20–60 mg of cervical mucus a day, increasing to 600 mg around the time of ovulation. It is viscous because it contains large proteins known as mucins . The viscosity and water content varies during
13566-403: The release of plasma as transudate from the capillaries through the vaginal epithelium. Before and during ovulation , the mucous glands within the cervix secrete different variations of mucus, which provides an alkaline , fertile environment in the vaginal canal that is favorable to the survival of sperm . Following menopause, vaginal lubrication naturally decreases. Nerve endings in
13699-401: The right. These form a network of smaller veins, the vaginal venous plexus , on the sides of the vagina, connecting with similar venous plexuses of the uterus , bladder , and rectum . These ultimately drain into the internal iliac veins . The nerve supply of the upper vagina is provided by the sympathetic and parasympathetic areas of the pelvic plexus . The lower vagina is supplied by
13832-610: The same day. As a screening test, VIA is comparable to cervical cytology in accurately identifying precancerous lesions. A result of dysplasia is usually further investigated, such as by taking a cone biopsy , which may also remove the cancerous lesion. Cervical intraepithelial neoplasia is a possible result of the biopsy and represents dysplastic changes that may eventually progress to invasive cancer. Most cases of cervical cancer are detected in this way, without having caused any symptoms. When symptoms occur, they may include vaginal bleeding, discharge, or discomfort. Inflammation of
13965-464: The same. Cervical cancer may be prevented by pap smear screening and HPV vaccines , but HPV vaccines only cover HPV types 16 and 18, the cause of 70% of cervical cancers. Some symptoms of cervical and vaginal cancer are dyspareunia , and abnormal vaginal bleeding or vaginal discharge, especially after sexual intercourse or menopause. However, most cervical cancers are asymptomatic (present no symptoms). Vaginal intracavity brachytherapy (VBT)
14098-400: The sides of the cervix. To the rear, the supravaginal cervix is covered by peritoneum, which runs onto the back of the vaginal wall and then turns upwards and onto the rectum , forming the recto-uterine pouch . The cervix is more tightly connected to surrounding structures than the rest of the uterus. The cervical canal varies greatly in length and width between women or over the course of
14231-429: The speculum is inserted, to note the presence of any weakness, lumps or nodules . Inflammation and discharge are noted if present. During this time, the Skene's and Bartolin's glands are palpated to identify abnormalities in these structures. After the digital examination of the vagina is complete, the speculum, an instrument to visualize internal structures, is carefully inserted to make the cervix visible. Examination of
14364-431: The squamous epithelium lining the vagina. The junction between these two types of epithelia is called the squamocolumnar junction. Underlying both types of epithelium is a tough layer of collagen . The mucosa of the endocervix is not shed during menstruation. The cervix has more fibrous tissue, including collagen and elastin , than the rest of the uterus. In prepubertal girls, the functional squamocolumnar junction
14497-512: The squamous epithelium of the ectocervix becomes columnar; cancers such as clear cell adenocarcinomas ; cervical ridges and hoods; and development of a cockscomb cervix appearance, which is the condition wherein, as the name suggests, the cervix of the uterus is shaped like a cockscomb . About one third of women born to diethylstilbestrol -treated mothers (i.e. in-utero exposure) develop a cockscomb cervix. Enlarged folds or ridges of cervical stroma (fibrous tissues) and epithelium constitute
14630-432: The stimulation of the clitoris, the walls of the vagina lubricate. This begins after ten to thirty seconds of sexual arousal, and increases in amount the longer the woman is aroused. It reduces friction or injury that can be caused by insertion of the penis into the vagina or other penetration of the vagina during sexual activity. The vagina lengthens during the arousal, and can continue to lengthen in response to pressure; as
14763-410: The term to refer to both the cervix and the internal uterine orifice. The first attested use of the word to refer to the cervix of the uterus was in 1702. Vagina In mammals and other animals, the vagina ( pl. : vaginas or vaginae ) is the elastic, muscular reproductive organ of the female genital tract . In humans, it extends from the vulval vestibule to the cervix (neck of
14896-408: The time of Hippocrates , over 2,000 years ago. The cervix is approximately 4 cm long with a diameter of approximately 3 cm and tends to be described as a cylindrical shape, although the front and back walls of the cervix are contiguous. The size of the cervix changes throughout a woman's life cycle. For example, during the fertile years of a woman's reproductive cycle , females tend to have
15029-407: The transformation zone. The cervical canal is a pathway through which sperm enter the uterus after being induced by estradiol after penile-vaginal intercourse , and some forms of artificial insemination . Some sperm remains in cervical crypts, infoldings of the endocervix, which act as a reservoir, releasing sperm over several hours and maximising the chances of fertilisation. A theory states
15162-408: The twenty to twenty-fourth week of development. If the lumen does not form, or is incomplete, membranes known as vaginal septa can form across or around the tract, causing obstruction of the outflow tract later in life. There are conflicting views on the embryologic origin of the vagina. The majority view is Koff's 1933 description, which posits that the upper two-thirds of the vagina originate from
15295-413: The upper group accompanies the vaginal branches of the uterine artery; a middle group accompanies the vaginal arteries; and the lower group, draining lymph from the area outside the hymen, drain to the inguinal lymph nodes . Ninety-five percent of the lymphatic channels of the vagina are within 3 mm of the surface of the vagina. Two main veins drain blood from the vagina, one on the left and one on
15428-405: The urethral opening and associated parts of the external genitalia. The vaginal canal travels upwards and backwards, between the urethra at the front, and the rectum at the back. Near the upper vagina, the cervix protrudes into the vagina on its front surface at approximately a 90 degree angle. The vaginal and urethral openings are protected by the labia. When not sexually aroused , the vagina
15561-399: The use of condoms , and sometimes female condoms (which give women more control). Both types can help avert pregnancy by preventing semen from coming in contact with the vagina. There is, however, little research on whether female condoms are as effective as male condoms at preventing STIs, and they are slightly less effective than male condoms at preventing pregnancy, which may be because
15694-481: The uterine arteries, travelling along the cardinal ligaments at the base of the broad ligament to the external iliac lymph nodes and ultimately the paraaortic lymph nodes . The posterior and lateral cervix drains along the uterine arteries to the internal iliac lymph nodes and ultimately the paraaortic lymph nodes , and the posterior section of the cervix drains to the obturator and presacral lymph nodes . However, there are variations as lymphatic drainage from
15827-577: The uterine structures involute and the functional squamocolumnar junction moves into the cervical canal. Nabothian cysts (or Nabothian follicles) form in the transformation zone where the lining of metaplastic epithelium has replaced mucous epithelium and caused a strangulation of the outlet of some of the mucous glands. A buildup of mucus in the glands forms Nabothian cysts, usually less than about 5 mm (0.20 in) in diameter, which are considered physiological rather than pathological. Both gland openings and Nabothian cysts are helpful to identify
15960-427: The uterus, after puberty. Previously, it was thought that during fetal development, the original squamous epithelium of the cervix is derived from the urogenital sinus and the original columnar epithelium is derived from the paramesonephric duct. The point at which these two original epithelia meet is called the original squamocolumnar junction. New studies show, however, that all the cervical as well as large part of
16093-444: The vagina and provide continuous, low dose and consistent drug levels in the vagina and throughout the body. Before the baby emerges from the womb, an injection for pain control during childbirth may be administered through the vaginal wall and near the pudendal nerve . Because the pudendal nerve carries motor and sensory fibers that innervate the pelvic muscles, a pudendal nerve block relieves birth pain. The medicine does not harm
16226-422: The vagina can provide pleasurable sensations when the vagina is stimulated during sexual activity. Women may derive pleasure from one part of the vagina, or from a feeling of closeness and fullness during vaginal penetration. Because the vagina is not rich in nerve endings, women often do not receive sufficient sexual stimulation, or orgasm , solely from vaginal penetration. Although the literature commonly cites
16359-599: The vagina is self-cleansing, it usually does not need special hygiene. Clinicians generally discourage the practice of douching for maintaining vulvovaginal health. Since the vaginal flora gives protection against disease, a disturbance of this balance may lead to infection and abnormal discharge. Vaginal discharge may indicate a vaginal infection by color and odor, or the resulting symptoms of discharge, such as irritation or burning. Abnormal vaginal discharge may be caused by STIs, diabetes, douches, fragranced soaps, bubble baths, birth control pills, yeast infection (commonly as
16492-568: The vagina may also be done during a cavity search . Lacerations or other injuries to the vagina can occur during sexual assault or other sexual abuse . These can be tears, bruises, inflammation and abrasions. Sexual assault with objects can damage the vagina and X-ray examination may reveal the presence of foreign objects. If consent is given, a pelvic examination is part of the assessment of sexual assault. Pelvic exams are also performed during pregnancy, and women with high risk pregnancies have exams more often. Intravaginal administration
16625-440: The vagina, childbirth pain is significantly more tolerable. Pleasure can be derived from the vagina in a variety of ways. In addition to penile penetration, pleasure can come from masturbation , fingering , or specific sex positions (such as the missionary position or the spoons sex position ). Heterosexual couples may engage in fingering as a form of foreplay to incite sexual arousal or as an accompanying act, or as
16758-488: The vagina. The lamina propria is rich in blood vessels and lymphatic channels. The muscular layer is composed of smooth muscle fibers, with an outer layer of longitudinal muscle, an inner layer of circular muscle, and oblique muscle fibers between. The outer layer, the adventitia, is a thin dense layer of connective tissue and it blends with loose connective tissue containing blood vessels, lymphatic vessels and nerve fibers that are between pelvic organs. The vaginal mucosa
16891-473: The vagina. When associated with the ectocervix, inflammation may be caused by the herpes simplex virus. Inflammation is often investigated through directly visualising the cervix using a speculum , which may appear whiteish due to exudate, and by taking a Pap smear and examining for causal bacteria. Special tests may be used to identify particular bacteria. If the inflammation is due to a bacterium, then antibiotics may be given as treatment. Cervical stenosis
17024-463: The vaginal lumen surrounds the cervix of the uterus, it is divided into four continuous regions ( vaginal fornices ); these are the anterior, posterior, right lateral, and left lateral fornices. The posterior fornix is deeper than the anterior fornix. Supporting the vagina are its upper, middle, and lower third muscles and ligaments. The upper third are the levator ani muscles, and the transcervical, pubocervical , and sacrocervical ligaments. It
17157-469: The vaginal fluid can be caused by an overgrowth of bacteria as in bacterial vaginosis , or in the parasitic infection trichomoniasis , both of which have vaginitis as a symptom. Vaginal flora populated by a number of different bacteria characteristic of bacterial vaginosis increases the risk of adverse pregnancy outcomes. During a pelvic exam, samples of vaginal fluids may be taken to screen for sexually transmitted infections or other infections. Because
17290-421: The vaginal opening, were originally considered the primary source for vaginal lubrication, but further examination showed that they provide only a few drops of mucus . Vaginal lubrication is mostly provided by plasma seepage known as transudate from the vaginal walls. This initially forms as sweat-like droplets, and is caused by increased fluid pressure in the tissue of the vagina ( vasocongestion ), resulting in
17423-441: The woman becomes fully aroused, the vagina expands in length and width, while the cervix retracts. With the upper two-thirds of the vagina expanding and lengthening, the uterus rises into the greater pelvis , and the cervix is elevated above the vaginal floor, resulting in tenting of the mid-vaginal plane. This is known as the tenting or ballooning effect. As the elastic walls of the vagina stretch or contract , with support from
17556-422: The word vagina is often used incorrectly to refer to the vulva or to the female genitals in general. The term vagina is from Latin vāgīna , meaning "sheath" or " scabbard ". The vagina may also be referred to as the birth canal in the context of pregnancy and childbirth . Although by its dictionary and anatomical definitions, the term vagina refers exclusively to the specific internal structure, it
17689-616: Was developed by Aurel Babes in 1927. In some parts of the developed world including the UK, the Pap test has been superseded with liquid-based cytology . An inexpensive, cost-effective and practical alternative in poorer countries is visual inspection with acetic acid (VIA). Instituting and sustaining cytology-based programs in these regions can be difficult, due to the need for trained personnel, equipment and facilities and difficulties in follow-up. With VIA, results and treatment can be available on
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