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Women's Health


Understanding Cervical Health


Knowing the Facts Can Be Life Changing at Any Age



77005130
January 01, 2011
At only a few square centimeters, the cervix is a small and often overlooked body part, but cervical Health is an important concern that, if ignored, can lead to serious repercussions.

Over the past 40 years, cervical cancer deaths have dropped dramatically in the United States, but thousands of women still die every year and thousands more are diagnosed and treated.

Of the 120 types of the human papilloma virus, 15 have been found to be oncogenic, or cancer-causing. Of those, 70 percent of cervical cancer cases are caused by types 16 and 18, says Dr. Elizabeth Ferries-Rowe, assistant professor of obstetrics and gynecology with the IU med school, and the chief of obstetrics and gynecology with Wishard Health Services.

The primary difference between the two HPV vaccines on the market is that Cervarix prevents only types 16 and 18, while Gardasil also prevents types 6 and 11, which cause (often precancerous) genital warts.

The vaccines are recommended for ages 9 to 26. Dr. Hubert Fornalik, a gynecologic oncologist with St. Vincent, says the best time to get any vaccine is before potential infection, and therefore, before sexual contact if possible.

"I have three daughters. I'll get them vaccinated when they're old enough," Dr. Ferries-Rowe says of her 2-, 6- and 8-year-olds.

Dr. Fornalik's daughters are still a bit young to be vaccinated, as well – the oldest is 5.

"I've seen enough patients with cancer," he says; the youngest patient he's ever had die was 18. "That's the key – to catch those people early."

The vaccines are the surest way to prevent HPV transmission, Dr. Fornalik says, as it can pass from close genital contact, even without intercourse and even if the man is wearing a condom.

Some people may be reluctant to have their child vaccinated because HPV is a sexually-transmitted infection, but Dr. Ferries-Rowe doubts that the vaccine increases sexual activity.

Males can also get the vaccine to help prevent the spread of the virus.

"I think it's really beneficial to provide it to men, too," Dr. Fornalik says. "Most women get their HPV from men."

A slight association has been found between HPV and penile cancer, though this link is not nearly as strong as its connection to cervical cancer.

An estimated 23 million women, and plenty of men, in the United States have HPV, but only 15 of the more than 120 HPV types are not carcinogenic.

"The vast majority of women will test positive," Dr. Ferries-Rowe says. "Many people who have HPV don't have abnormal Pap smears."

After the vaccine, a Pap smear is the most effective recourse in fighting cervical cancer. A single Pap smear actually contains samples of three different segments – the outer ectocervix, the inner endocervix, and the transformation zone between them, as cancers can originate in either end. Unless a woman has certain risk factors, like a previous abnormal Pap result, she only needs to get a Pap smear every two years in her 20s and every three years in her 30s and beyond.

"It takes a long time, from the initial infections of HPV to cancer," Dr. Fornalik says. "We can diagnose it early, and we can treat it early."

Other potential risk factors include immunosuppression – such as HIV/AIDS or chronic steroid use for another condition – and smoking. In advanced cases, there may be abnormal non-menstrual bleeding, lower-back pain, bleeding during or after intercourse and blood in the stool or urine.

Many women are less inclined to come in for an exam on the years they don't need a Pap smear, but the exam should also include a clinical breast exam, listening to the heart and lungs, checking the thyroid and abdomen, updating the patient's chart and checking on any prescriptions.

"Most people assume that any time a speculum goes in, they're getting a Pap smear, and that's not the case," Dr. Ferries-Rowe says.

The pelvic exam includes a look-and-feel approach – using the speculum to visually examine, and a bi-manual (two-fingered) tactile examination. Dr. Fornalik says some precancerous lesions can be seen with the speculum exam.

Though uncommon as a cause of infertility in women, problems in the cervix can make conception and pregnancy more difficult. Treatment for conditions like cervical cancer can have the same effect.

"The usual dose of radiation is high enough to sterilize ovaries," Dr. Fornalik says.

Cervical dysplasia is an abnormal and often precancerous growth of cells on the cervical wall; excising, or cutting away, these growths can damage the cervix's mucus glands. Because the mucus in the cervix creates a sort of reservoir for sperm between the vagina and uterus, too little mucus or too-thick mucus can make it difficult for the sperm to pass through. This is one way birth control pills help prevent pregnancy – in addition to affecting ovulation, the progesterone in the pills thickens the cervical mucus, making it difficult for sperm to make it through to the uterus.

During pregnancy, there is a risk of cervical insufficiency (or "incompetency"), in which the cervix is not strong enough to hold the fetus inside the uterus.

"It's usually identified in one pregnancy and treated in the next," Dr. Ferries-Rowe says.

The most common solution is a procedure known as a cerclage, which acts as sort of drawstring to hold the cervix open, but tight enough to support the fetus.

Whatever the problem, knowledge is an important tool in keeping yourself healthy – your whole self.

Allison Tyra is a graduate of Indiana University's School of Journalism. An Indianapolis native, she spends most of her time freelancing for various Midwest-based publications, watching too much Glee/Grey's Anatomy and giving into her cats' demands for attention.

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