The structure of the cervix of a woman. What is the cervix? Norm and pathology. cervical canal. Cervical erosion. Anatomical structure of the cervix

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The cervix has its own clinical and morphofunctional features in different age periods of a woman's life, which determine the options for topographic and anatomical relationships in it.

The formation of the cervix occurs by the fusion of the Mullerian canals at the 12-16th week of embryogenesis. As you know, in the cervix, a vaginal part is distinguished, protruding into the lumen of the vagina, and a supravaginal part, located above the attachment of the walls of the vagina to the uterus, consisting mainly of connective and muscle tissue, in which vessels and nerves are located. The vaginal part of the cervix, covered with stratified squamous epithelium, is called the exocervix. Muscle tissue is mainly contained in the upper third of the cervix and is represented by circularly located muscle fibers with layers of elastic and collagen fibers, the functional activity of which is regulated by dual sympathetic and parasympathetic innervation.

Muscle tissue provides the obturator function of the cervix during pregnancy; during childbirth, it forms the lower segment of the birth canal. The cervical canal has a fusiform shape, its length from the external os to the isthmus is not more than 4 cm, the width is not more than 4 mm, the external os is round or in the form of a transverse slit. The cervical canal is covered with a single-row high columnar epithelium and is called endocervix.

The structure of the integumentary epithelium of the vaginal part of the cervix in women has been studied in detail at the light-optical and ultrastructural levels by domestic and foreign researchers (Bohman Ya.V., 1989; Vasilevskaya L.N., Vinokur M.L., 1971; and others).

The stratified squamous epithelium of the vaginal part of the cervix is ​​a highly differentiated tissue with a complex structure and certain functional features.

The epithelium covering the cervix consists of four layers:
1) basal- represents immature epithelial cells located on the basement membrane in one row. These cells have uneven contours and varying sizes. The basement membrane separates the squamous stratified epithelium from the underlying connective tissue;
2) is located above the basal cells parabasal cell layer arranged in several rows. The cells of the basal and parabasal layers have mitotic activity;
3) intermediate cell layer consists of 6-7 rows of moderately differentiated cells;
4) surface layer It is represented by 2-3 rows of superficial cells that tend to become keratinized and are easily desquamated depending on the phase of the menstrual cycle.

The blood supply of the stratified squamous epithelium is carried out by blood vessels, which are located under the basement membrane. The formation of terminal loops of capillaries is directly dependent on the level of sex hormones in the blood (estrogen and progestogen).

The main function of the stratified squamous epithelium, like any epithelium located on the border with the external environment, is protective. Lumps of keratin provide strength to the mucous membrane and thus create a mechanical barrier; the immunological barrier is created by lactic acid, which is formed due to the metabolism of glycogen with the participation of lactobacilli.

The mucous membrane of the cervical canal is covered with a single-row high cylindrical epithelium with a basally located nucleus.

As is known, in the cervix, the border of two genetically different types of epithelium is the transition area between the squamous stratified epithelium of the vaginal part and the high columnar epithelium of the mucous membrane of the cervical canal. The area of ​​transition of squamous multilayered and cylindrical epithelium has a complex histoarchitectonics.

The cylindrical epithelium of the mucous membrane of the cervical canal near the transition to the stratified squamous epithelium is supplemented by a layer of reserve cells, where they are located in several layers and form, in some cases, an immature metaplastic epithelium. At the junction itself, the metaplastic epithelium consists of a large number of cells and tends to form layers. Reserve cells are located under the columnar epithelium on the basement membrane, as well as under the stratified epithelium of the transition zone. Most researchers recognize the bipotent properties of reserve cells, i.e. the possibility of their differentiation into stratified squamous or columnar epithelium under the influence of various factors (Vasilevskaya LN et al., 1987; Kashimura M., 1980; and others).

The area of ​​transition between the high cylindrical and squamous stratified epithelium in women of reproductive age in most cases coincides with the area of ​​the external os. However, it can also be located on the vaginal part of the cervix, which is associated with age, as well as hormonal balance in the body (Vasilevskaya L.N. et al., 1987; Zharov E.V. et al., 2000; and others).

The displacement of the transition zone to the exocervix in the prenatal period is considered a normal stage in the development of the cervix and is due to hormonal effects, in particular, estrogens produced by the mother's body. At the same time, the so-called "congenital erosions" or ectopia that arose during fetal development can persist until prepubertal age.

At the same time, in most girls, as the body grows and develops, the ectopia decreases, and by the time of puberty, the boundary between the squamous multilayered and high cylindrical epithelium is established at the level of the external pharynx. In some cases, this process is delayed and then the site of ectopia on the cervix remains. The maximum frequency of such ectopia is observed in young nulliparous women under 25 years of age.

As the woman's body grows and develops, the transition zone shifts to the area of ​​​​the external pharynx, and the ectopia disappears. In reproductive age, cyclic changes occur in the cervix during the normal menstrual cycle associated with the influence of ovarian hormones. The opening of the cervical canal from the 8-9th day of the cycle begins to expand, and transparent vitreous mucus appears in it.

By the 10-14th day of the cycle, the opening of the cervical canal expands from 0.25 to 0.3 cm in diameter, rounds, becomes shiny, and when the naked cervix is ​​illuminated with the help of vaginal mirrors, it resembles a pupil. In the following days of the cycle, the amount of mucus decreases again, it disappears, the neck becomes dry. The functional significance of cervical mucus lies in the fact that it is actually a barrier between the vagina and the uterine cavity, plays a protective role against the penetration of bacteria into the uterine cavity.

In the menopause, against the background of age-related changes in the whole organism, involutive processes primarily capture the reproductive system. They are characterized first by the cessation of the childbearing, and then the menstrual function. This is based on a sharp decrease in the synthesis of ovarian sex hormones, which have a multifaceted effect on metabolic processes and, accordingly, on the function of various organs and systems.

In the postmenopausal period, due to involutional processes in the reproductive system, there is a shift of the transition zone to the lower third of the endocervix. Against the background of age-related estrogen deficiency, morphological changes occur, manifested in the form of atrophic colpitis and nonspecific cervicitis. At the same time, degenerative changes develop in the underlying stroma, associated with a deterioration in trophism, a decrease in blood flow microcirculation and processes of extravasation of the stroma and all layers of the vaginal wall. The onset of postmenopause is not always accompanied by atrophic changes in the epithelium of the cervix and vagina, since for a long time it is possible to influence not only ovarian hormones, but also hormones produced compensatory by the adrenal glands.

The listed age-related features of the cervix predispose to a certain topographic and anatomical localization of pathological processes: for example, vulvovaginitis is more common in girls, endocervicitis in women of reproductive age, inflammatory and proliferative processes of the exocervix mucosa, localization of cancer on the exocervix is ​​typical. For postmenopausal women, degenerative-dystrophic processes of the exocervix are specific, localization of cancer in the endocervix is ​​typical, i.e. in the cervical canal.

The condition of the cervix is ​​determined not only by the age characteristics of the woman, but also by the nature of the biocenosis of the genital tract and the level of local immunity.

It is believed that the female genital tract contains three "ecological niches" (Rusakevich P.S., 2000): 1) flat epithelium of the vagina; 2) prismatic epithelium of the cervix (crypts); 3) the unique environment of the cervical glands (if any). Each "niche" has its own microbial ecosystem. The nature of microcenosis is influenced by a number of factors (acidic pH in the vagina and alkaline in the endocervix). Only a slightly greater variety of species is noted in the vagina. It was revealed that 1 ml of vaginal secretion of healthy non-pregnant women contains 108-1010 microbial cells (mc/ml). The share of aerobes is 105-108 microns/ml, anaerobes - 108-109 microns/ml. The microbial landscape of the vagina and cervix is ​​dominated by lactobacilli (Doderlein sticks). In 71 - 100% of women they are found 106-109 microns / ml.

Other microflora is represented by staphylococci (golden in 4 - 33% of women, epidermal - in 10-74% - up to 107 microns / ml), bifidobacteria (in 10% of women up to 107 microns / ml), lactic acid bacteria and streptococci (14%), bacteroids (6%), peptostreptococci (14% of cases). Enterobacteria, non-hemolytic and hemolytic streptococci, fusobacteria and other types of microbes can also be found in the cervix.

With a normal biocenosis of the female genital tract, the total number of microorganisms is less than 107 microns / ml of secretion; they are dominated by Doderlein sticks (lactobacilli), gardnerella make up 5-37%, mycoplasmas 15-30% (Rusakevich P.S., 2000).

Normal vaginal biocenosis with factors of local immunity are the first line of anti-infective protection.

The factors of local immunity include cellular and humoral factors. Cellular factors resemble the lymphoid elements of the bronchi, Peyer's patches in the intestine. In the submucosal layer there are accumulations of lymphocytes, plasma cells, tissue macrophages, neutrophils. The latter are functionally complete, have high phagocytic activity, a powerful lysosomal apparatus (enzymes), and an apparatus of oxygen-dependent cytotoxicity.

The humoral system of the genital organs is quite independent. In this case, the cervix is ​​the site of the greatest immunological activity. There are several types of humoral protective factors. Immunoglobulins (Ig) are represented mainly by Ig A and Ig G, to a lesser extent by Ig M. They are found in the cervical mucosa and are secreted by plasma cells. The amount of immunoglobulins G and A in the cervical mucus changes cyclically in the phases of the menstrual cycle (increases at the beginning and at the end of the cycle). Progesterone (endo- and exogenous) is also able to enhance the secretion of immunoglobulins. An increase in the number of immunoglobulins indicates an increase in the activity of local anti-infective immunity.

Complement plays an important role in protecting the mucous membranes of the genital tract. It is produced by the mucous membrane of the cervix and vagina. The complement of mucous membranes, mainly cervical mucus, is able to attach to secretory Ig A. As a result, the phenomenon of opsonization of microorganisms and their subsequent phagocytosis by mucus neutrophils occurs. The cervical and vaginal contents contain lysozyme. It causes a direct bactericidal effect and enhances the phagocytic activity of neutrophils. Means of local anti-infective protection are represented by lactoferrin, B-lysines, interferons.

V.N. Prilepskaya, E.B. Rudakova, A.V. Kononov

The uterus is the reproductive unpaired internal organ of the female. It is made up of plexuses of smooth muscle fibers. The uterus is located in the middle part of the small pelvis. It is very mobile, therefore, relative to other organs, it can be in different positions. Together with the ovaries, it makes up the female body.

General structure of the uterus

This internal muscular organ of the reproductive system is pear-shaped, which is flattened in front and behind. In the upper part of the uterus on the sides there are branches - the fallopian tubes, which pass into the ovaries. Behind is the rectum, and in front is the bladder.

The anatomy of the uterus is as follows. The muscular organ consists of several parts:

1. The bottom is the upper part, which has a convex shape and is located above the line of discharge of the fallopian tubes.
2. The body into which the bottom smoothly passes. It has a conical shape. Tapers down and forms an isthmus. This is the cavity leading to the cervix.
3. Cervix - consists of the isthmus, and the vaginal part.

The size and weight of the uterus is individual. The average values ​​of her weight in girls and nulliparous women reach 40-50 g.

Anatomy of the cervix, which is a barrier between internal cavity and the external environment, is designed so that it protrudes into the anterior part of the vaginal fornix. At the same time, its posterior fornix remains deep, and the anterior - vice versa.

Where is the uterus?

The organ is located in the small pelvis between the rectum and the bladder. The uterus is a very mobile organ, which, in addition, has individual characteristics and shape pathologies. Its location is significantly affected by the condition and size of neighboring organs. The normal anatomy of the uterus in the characteristics of the place occupied in the small pelvis is such that its longitudinal axis should be oriented along the axis of the pelvis. Its bottom is tilted forward. When filling the bladder, it moves back a little, when emptying, it returns to its original position.

The peritoneum covers most of the uterus, except for the lower part of the cervix, forming a deep pocket. It extends from the bottom, goes to the front and reaches the neck. The back part reaches the wall of the vagina and then passes to the anterior wall of the rectum. This place is called Douglas space (recess).

Anatomy of the uterus: photo and wall structure

The organ is three-layered. It consists of: perimetrium, myometrium and endometrium. The surface of the uterine wall is covered by the serous membrane of the peritoneum - the initial layer. At the next - middle level - tissues thicken and have a more complex structure. Plexuses of smooth muscle fibers and elastic connective structures form bundles that divide the myometrium into three inner layers: inner and outer oblique, circular. The latter is also called the average circular. This name he received in connection with the structure. The most obvious is that it is the middle layer of the myometrium. The term "circular" is justified by the rich system of lymphatic and blood vessels, the number of which increases significantly as it approaches the cervix.

Bypassing the submucosa, the wall of the uterus after the myometrium passes into the endometrium - the mucous membrane. This is the inner layer, reaching a thickness of 3 mm. It has a longitudinal fold in the anterior and posterior region of the cervical canal, from which small palm-shaped branches extend at an acute angle to the right and left. The rest of the endometrium is smooth. The presence of folds protects the uterine cavity from the penetration of unfavorable contents of the vagina for the internal organ. The endometrium of the uterus is prismatic, on its surface are the uterine tubular glands with vitreous mucus. The alkaline reaction they give keeps the sperm viable. During the period of ovulation, secretion increases and substances enter the cervical canal.

Ligaments of the uterus: anatomy, purpose

In the normal state of the female body, the uterus, ovaries and other adjacent organs are supported by a ligamentous apparatus, which is formed by smooth muscle structures. The functioning of the internal reproductive organs largely depends on the condition of the muscles and fascia of the pelvic floor. The ligamentous apparatus consists of a suspension, fixation and support apparatus. The combination of the performed properties of each of them ensures the normal physiological position of the uterus among other organs and the necessary mobility.

The anatomy of the uterus and appendages, as well as other organs of the female reproductive system, consists of developed muscle tissue and fascia, which play a significant role in the normal functioning of the entire reproductive system.

Characteristics of the suspension device

The suspension apparatus is made up of paired ligaments of the uterus, thanks to which it is “attached” at a certain distance to the walls of the small pelvis. The wide uterine ligament is a fold of the peritoneum of the transverse type. It covers the body of the uterus and the fallopian tubes on both sides. For the latter, the ligament structure is an integral part of the serous cover and the mesentery. At the side walls of the pelvis, it passes into the parietal peritoneum. The supporting ligament departs from each ovary, has a wide shape. Characterized by durability. Inside it passes the uterine artery.

The proper ligaments of each of the ovaries originate at the uterine fundus from the back side below the branch of the fallopian tubes and reach the ovaries. The uterine arteries and veins pass inside them, so the structures are quite dense and strong.

One of the longest suspensory elements is the round ligament of the uterus. Its anatomy is as follows: the ligament has the form of a cord up to 12 cm long. It originates in one of the corners of the uterus and passes under the anterior sheet of the broad ligament to the internal opening of the groin. After that, the ligaments branch into numerous structures in the tissue of the pubis and labia majora, forming a spindle. It is thanks to the round ligaments of the uterus that it has a physiological inclination anteriorly.

The structure and location of the fixing ligaments

The anatomy of the uterus should have assumed its natural purpose - the bearing and birth of offspring. This process is inevitably accompanied by active contraction, growth and movement of the reproductive organ. In this connection, it is necessary not only to fix the correct position of the uterus in the abdominal cavity, but also to provide it with the necessary mobility. Just for such purposes, fixing structures arose.

The main ligament of the uterus consists of plexuses of smooth muscle fibers and connective tissue, located radially to each other. The plexus surrounds the cervix in the region of the internal os. The ligament gradually passes into the pelvic fascia, thereby fixing the organ to the position of the pelvic floor. The vesicouterine and pubic ligamentous structures originate at the bottom of the front of the uterus and attach to the bladder and pubis, respectively.

The sacro-uterine ligament is formed by fibrous fibers and smooth muscles. It departs from the back of the neck, envelops the rectum on the sides and connects to the fascia of the pelvis at the sacrum. In a standing position, they have a vertical direction and support the cervix.

Supporting apparatus: muscles and fascia

The anatomy of the uterus implies the concept of "pelvic floor". This is a set of muscles and fascia of the perineum, which make it up and perform a supporting function. The pelvic floor consists of an outer, middle and inner layer. The composition and characteristics of the elements included in each of them are given in the table:

The uterus is recognized as the main organ of the female reproductive system. The structure determines its functions, the main of which is the bearing and subsequent expulsion of the fetus. The uterus plays a direct role in the menstrual cycle, is able to change size, shape and position, depending on the processes occurring in the body.

Anatomy and size of the uterus: a photo with a description

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

In gynecology, the departments of the organ are distinguished:

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

The uterus (in Latin matricis) is covered on the outside with perimetry - a modified peritoneum, from the inside - with the 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 lies in mobility. The uterus is held in the body due to the muscular and ligamentous apparatus.

A detailed and detailed image of the female reproductive organ in the section is shown in the picture.

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

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

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

In a newborn girl, the length of the organ is 4 cm, from the age of 7 it gradually increases. During menopause, the intact uterus decreases, the walls become thinner, 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 walls of the uterus varies from 2 to 4 cm, depending on the day of the cycle. The mass of an 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 pharynx. The department ends with the vaginal part, where the external pharynx 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. Covers this section of the cylindrical epithelium.

In the vaginal part of the neck (exocervix) there is a stratified squamous epithelium, characteristic of this area. The area where one type of mucosal cells changes to another is called the transition zone (transformation).

Types of epithelium are depicted 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 tool - a colposcope - conducts a detailed examination of the organ on the gynecological chair. The photo shows a close-up of a healthy cervix and with pathological changes.

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

The structure of the neck is given special attention during pregnancy. Narrow or small (short) breasts increase 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 neck. These 2 parts are connected by an isthmus. The highest region of the body of the reproductive organ is convex in shape, called the bottom. This area protrudes beyond the entry line of the fallopian tubes.

An important indicator is the height of the fundus of the uterus (VDM) - the distance from the pubic bone to the upper point of the organ. It is taken into account when assessing the development of the fetus during pregnancy. The size of the bottom of the uterus shows the growth of the organ, and normally the value ranges from 10 centimeters for a period of 10 weeks to 35 centimeters at the end of the gestation period. The indicator is determined by the doctor during palpation.

Body

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

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

The fallopian tubes adjoin the lateral areas, 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, the posterior one borders on 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;
• supportive- creation of support for internal organs.

Suspension apparatus

The function of attaching an organ is performed by ligaments:

• round- 100-120 mm long, located from the corners of the uterus to the inguinal canal and tilt the bottom anteriorly;
• wide- resemble a "sail" stretched from the pelvic walls to the sides of the uterus;
• suspensory ligaments of the ovaries- proceed 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

Links include:

• cardinal(transverse)- consist of smooth muscle and connective tissues, are reinforced wide ligaments;
• uterovesical (cervical)- directed from the cervix and go around the bladder, prevent the uterus from tilting back;
• sacro-uterine ligaments- do not allow the organ to move towards the pubis, go from the posterior uterine wall, go around the rectum and attach to the sacrum.

Muscles and fascia

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

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

• sciatic-cavernous;
• bulbous-spongy;
• external;
• superficial transverse;
• deep transverse;
• pubic-coccygeal;
• iliococcygeal;
• ischiococcygeal.

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 layer structure is shown in the figure.

The mucous epithelium is rich in glands, is 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 coat is represented by intertwined smooth muscle cells. Contractions of the myometrium on different days of the cycle are regulated by the autonomic nervous system.

Perimetry

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

At the border with the neck, the layer bends and is transferred to the bladder, forming the vesicouterine space. In addition to the surface of the body behind, the peritoneum covers a small area of ​​​​the posterior fornix of the vagina, the rectum, forming a recto-uterine pocket.

These recesses, 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 is parallel to the axis of the pelvic bones. At what distance it is from the entrance in the depths of the vagina depends on the structural features, usually it is 8-12 centimeters. The diagram shows the position of the uterus, ovary, tubes in the female body.

Since the organ is mobile, it is easily displaced in relation to others and when they are affected. The uterus is located between the bladder in front and the loop of the small intestine, the rectum in the posterior region, and its location can be determined using ultrasound.

The reproductive organ is to some extent deviated forward and has a curved shape. In this case, the angle between the neck and the body is 70-100 degrees. The adjacent 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, an acute angle is formed between the body and the neck, open anteriorly. This position is called anteversio.

When the bladder is filled with urine, the uterus deviates backwards. In this case, the angle between the neck and the body becomes deployed. This state is determined by retroversion.

There are also types of bends of the body:

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

Appendages of the uterus

The complement of the female reproductive organ is 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 a suspensory ligament and a mesentery. The organ consists of the outer cortical layer, where the follicles mature, and the inner granular (medulla) containing the egg, blood vessels and nerves.

How much it weighs and the size of the ovary 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 body is the production of estrogens, progestogens, testosterone.

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

If pregnancy occurs, the corpus luteum performs intrasecretory functions, in the absence of fertilization, it gradually disappears. How the ovary is arranged, its structure is visible in the picture.

The fallopian tubes

A paired muscular organ connects the uterus to the ovaries. Its length is 100-120 millimeters, diameter is 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 is contractile. This is due to its function - transporting the egg to the uterine cavity.

Sometimes there is a life-threatening complication for a woman - an ectopic (ectopic) pregnancy. In this case, the fertilized egg remains inside the tube and causes a rupture of its wall and bleeding. In this case, it is urgent to operate the patient.

Features of the structure and function

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

The condition of the cervix determines the onset of ovulation. During this period, its surface becomes loose, the mucus becomes viscous, it falls 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 for the release of blood and part of the mucous membrane.

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

The functions for which the uterus is needed are defined:

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

uterus during pregnancy

The most significant changes undergo the female organ during the period of bearing a child.

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

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

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

Another important indicator is the length of the cervix. It is evaluated to avoid the development of complications of gestation and premature birth. The norms of the length of the neck by weeks of pregnancy are indicated 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 to the birth canal, the organ gradually begins to descend.

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

Strong contractions occur during childbirth to expel the fetus from the uterine cavity. The gradual opening of the cervix releases the baby out. The placenta comes out next. The neck of a woman giving birth after stretching does not return to its original shape.

Circulation

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

The main arteries are:

• mother- is a branch of the internal iliac artery.
• Ovarian- departs 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 sections of the uterus, tubes, ovaries on the right occurs into the inferior vena cava, on the left - into the left renal vein. Blood from the lower uterus, cervix, vagina enters the internal iliac vein.

The main lymph nodes of the genital organs are the lumbar. Iliac and sacral provide lymph outflow from the neck and lower body. A slight outflow 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 due to the influence of the nerves of the superior hypogastric plexus.

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

The action of the nervous system is due to 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 body 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 an impressive size (over 20 centimeters).

With a small volume, such formations are subject to observation, large ones are removed with the help of an operation. The symptom of a "dense uterus", in which its walls thicken, 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, fibromas, pathologies of the cervix. The latter include erosion, dysplasia, cancer. Regular inspection significantly reduces the risk of their development. With dysplasia of 2-3 degrees, 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, features of the body can cause infertility. For example, with a "hostile uterus" (immunoactive), immunity prevents the fertilization of the egg, destroying the spermatozoa.

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 uterus, there is a doubling of the vagina. In this case, the development of the fetus is possible in two organs.

bicorn

Outwardly, it resembles a heart; in the bottom area, the horned uterus is divided in two and connected in the neck area. One of the horns is underdeveloped.

Saddle (arc-shaped)

A variant of a bicornuate uterus, the bifurcation of the bottom is minimally expressed in the form of a depression. 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 one they are connected in the neck area.

Omission

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

elevation

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

Turn

In this case, the rotation of the uterus is distinguished, when the entire organ with the neck is rotated or torsion (twisting), in which the vagina remains in place.

eversion

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

A completely inverted organ is characterized by the output of the neck, the body of the vagina. Partially inside-out is manifested by incomplete descent of the uterine fundus beyond the boundaries of the internal opening.

Bias

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

Dropping out

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

In reproductive age, the position of the organ is restored by surgical intervention. If it fell out completely, deletion is shown.

Uterus removal

Extirpation of an organ (hysterectomy) is performed according to serious indications: with large fibroids, oncology of the uterus, 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 surrogate motherhood.

Options for removing the uterus are briefly shown in the photo, after the operation, the bladder moves back, the intestines down.

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

The formation of the cervix along with the uterus occurs at 12-16 weeks of pregnancy.

The cervix has many functions:

• Protective- This is a biological barrier to the penetration of infection into the female genital tract. It is described in detail here.
• reproductive- The mucus that forms in the cervical canal promotes the penetration of spermatozoa into the uterine cavity.
• childbearing- during pregnancy, due to the closed state of the cervix, the fetus is carried.
  During childbirth, the cervix shortens, flattens, opens, and becomes part of the birth canal through which the baby moves.
• Sexy - It is believed that there are points on the cervix that contribute to the onset of orgasm.

The shape of the cervix in girls - conical, in adults who gave birth to women - cylindrical.

1 - external pharynx of the cervical canal, 2 - internal pharynx of the cervical canal, 3 - vaginal part of the cervix, covered with MPE, 4 - cervical canal, covered with cylindrical epithelium.

Inside the cervix there is a cervical canal, it has a spindle shape, 4 cm long, the internal pharynx opens into the uterine cavity, and the external one into the vagina.

Muscle tissue is mainly contained in the upper third of the cervix and is represented by circularly located muscle fibers with layers of elastic and collagen fibers. Muscle tissue provides the obturator function of the cervix. During childbirth, it forms the lower segment of the birth canal.

Vaginal part of the cervix covered with stratified squamous epithelium (SSE). MPE of the cervix, like the vaginal mucosa, undergoes cyclical changes during the menstrual cycle. Under the influence of estrogens, the processes of cell maturation occur with the accumulation of glycogen and keratin in them.

In the MPE of the cervix, 4 layers of cells are distinguished:

• basal,
• parabasal,
• intermediate,
• surface.

Basal cells are located on the basement membrane. These are small cells with a large nucleus. Basal cells provide growth and regeneration of stratified squamous epithelium under physiological conditions, under pathological conditions it is a source of pathological proliferation.

In smears in a healthy woman, basal cells appear only in the postmenopausal period. The presence of these cells in smears in young women is a consequence of endocrine diseases or inflammatory processes.

The parabasal layer is represented by 2-3 rows of larger cells with large nuclei and glycogen-free cytoplasm. They also provide growth and regeneration of the epithelium.

Parabasal cells are found in cervical smears in postmenopausal women and in small numbers in women of reproductive age during menstruation.

The intermediate layer consists of 6-12 rows of large polygonal cells with a small nucleus. The cytoplasm contains glycogen. This layer is well defined in the proliferative phase of the menstrual cycle.

Surface cells predominate in smears from the cervix in the first phase of the menstrual cycle. Their maximum number is observed during ovulation. In the 2nd phase, the upper rows peel off on their own.

Under the MPE is the stroma — a network of collagen and elastic fibers, among which are blood, lymphatic vessels, and nerve structures.

The basement membrane is located between the stroma and the MPE.

The main function of the MPE is protective. This is determined by the presence in the cells keratin, which causes strength mucous membrane and glycogen, which provides an acidic environment of the vagina with the participation of lactobacilli.

Endocervix - mucous membrane of the cervical canal covered with high columnar epithelium.

Cyclic changes in the epithelium of the endocervix are weakly expressed. The main function of the columnar epithelium is secretory. The amount and physico-chemical properties of the mucous secretion depend on the phase of the menstrual cycle. The secret is essential for fertilization and is a barrier to infection.

On the basement membrane under the cylindrical epithelium, undifferentiated cubic cells, the so-called reserve cells, can be located. Under the physiological conditions of the menstrual cycle, reserve cells provide the process of regeneration of the cylindrical epithelium.

Under the influence of hormonal disorders or inflammation, reserve cells turn into squamous epithelial cells. These changes underlie the formation of pseudo-erosions.

External pharynx- area of ​​​​junction of stratified squamous and cylindrical epithelium.

Otherwise known as the transition zone. This place is the most common localization of cancer. The border between the MPE and the columnar epithelium is located in premature newborns outside the external os, in full-term newborns and girls up to 8-11 years old inside the cervical canal.

In the reproductive period, the border is located at the level of the external pharynx. During menopause, it shifts to the outer third of the cervical canal. Pathological processes of the cervix also have age-related features.

In girls, these are the most common inflammatory processes (vulvovaginitis).

In women of the reproductive period, limited inflammatory processes (endocervicitis, inflammatory and proliferative processes) often occur. Cervical cancer in women of the reproductive period is localized in transition zone.

Women in menopause often develop atrophic processes. Cervical cancer in menopausal women is localized in the cervical canal.

Between the cervix and the body of the uterus there is a formation - the isthmic part of the cervix, in which the anatomical internal os is located. This is the narrowest part of the cervical canal. The area between the cervical mucosa and the endometrium is called the histological internal os. In the cervical canal there is a mucous plug, which has bactericidal, proteolytic activity due to the presence of lysozyme, lactoferrin, the presence of Ig of all classes that play an important role in local protection against infection.

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

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

Studies have shown that papillomavirus causes malignant processes in the cervix. 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 even in her youth, and after 10 years, papilloma will lead to cell mutation. The peak incidence of cancer falls on 40-55 years.

Photo and description of all types

Cancer of the cervix is ​​of different types. This affects the appearance of the visible part of the organ. During a gynecological examination, the doctor can observe various patterns of pathological processes.

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

Squamous cell carcinoma

The external os is located in the area of ​​the vagina. It is covered with non-keratinized stratified epithelium. Often, squamous cell carcinoma develops at the site of the transition of the epithelium from flat to cylindrical.

The appearance of squamous cell pathology depends on its subtype:

Infiltrative-ulcerative

The organ has a reddened, inflamed appearance. Numerous small ulcers bleed, their edges have clear limits, they are slightly raised above the mucosa. There are areas with yellowish crusts. Pathology is located in the central part of the external pharynx, spreading in all directions.

The central entrance is poorly visible because of the tumor, it is filled with liquid. The part of the cervix not affected by oncology and the visible zone of the vaginal walls has 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 wide base. Slightly protrudes 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 a normal color and structure, the walls of the vagina are also not changed. 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 a cylindrical epithelium, tubular glands. A neoplasm is formed from glandular particles. Therefore, the disease is often called glandular cancer.

Varieties of adenocarcinoma:

Endometrioid foma

The tumor grows into the tissues superficially. Pathology is located in the central part of the vaginal region of the cervix. The central opening is strongly clamped by a tumor. It has a red color, papillary growths, small bruises are visible. The pathogenic area is slightly recessed into the body of the neck.

On the surface of the external pharynx, small growths are visible and blood vessels are enlarged. The walls of the vagina 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 papillary growths from which it was formed. A large number of papillomas remotely resembles 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. It shows bruising, yellowish areas. The edges of the neoplasm are not even, 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 over the mucosa is noticeable. The surface of the neoplasm is bumpy, juicy, with bruises. Pathology is colored red, blood vessels are visible through it. In some parts of the external pharynx, white-yellow formations and sores are visible.

The entrance to the cervical canal is almost invisible. It is closed by an overgrown tumor. In its center, a dark red spot is noticeable.

Malignant formation has spread throughout the mucosa. The surface has a non-uniform color. Multiple blood vessels show through the pink mucosa.

A whitish coating is smeared all over the mucosa, the contours of which slightly protrude beyond the neck.

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 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 strongly deformed, there is a recess filled with a gray-bloody mass.

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

Color from pale pink to red, there are yellow patches. On the surface there may be sores and small growths resembling papillomas.

The central entrance is strongly open, has loose torn edges.

The visible part of the vagina is not affected, has a normal color and texture.

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

The color of the mucosa is pink. The entrance to the cervical canal is displaced due to deformation of the external os, it is filled with bloody secretions.

Photo and description of degrees

Oncology of the cervix is ​​usually divided into 4 stages, each of which has its own characteristics. The staging is based on the spread of the disease. Depending on this, the appearance of the vaginal region of the organ changes.

Stages of pathology:

• 1 stage- 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.
• 2 stage- significant changes in the structure are visible, the tumor has affected most of the mucosa. Pathology has reached the vagina, uterus.
• 3 stage- the oncological process spreads to the pelvic region, kidneys.
• 4 stage- metastasis throughout the body.

What does a normal neck look like?

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

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

The central hole can be of several types:

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

1 degree

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

The tumor does not rise above the mucosal surface. There are several small sores in the affected area. They don't bleed. The central foramen is clearly visible but slightly deformed due to neoplasm exposure. Mucous secretion is transparent, sometimes yellowish areas are visible.

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

2 degree

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

The neoplasm has blurred contours, they differ markedly 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 viewed, it is closed by a tumor. In the place where there should be a hole, a small depression is noticeable.

The visible part of the vagina has a normal color and texture.

3 degree

At stage 3, the outer part of the cervix is ​​severely deformed. It has a loose structure, multiple tubercles are visible throughout its mucosa. Ulcers cover most of the cervix. The central part bleeds heavily, while it is impossible to see the opening into the cervical canal.

The mucosa is pale in color, covered with a white coating. The tumor affected the entire area of ​​the organ. Cancer has affected the walls of the vagina.

4 degree

At stage 4, the oncological process has completely modified the outer part of the cervix. Cancer has gone beyond the mucosa, 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, white-yellow discharge can be seen. Bloody depressions 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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