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Cervix
Schematic frontal view of female anatomy
1: fallopian tube, 2: bladder, 3: pubic bone, 4: g-spot, 5: clitoris, 6: urethra, 7: vagina, 8: ovary, 9: sigmoid colon, 10: uterus, 11: fornix, 12: cervix, 13: rectum, 14: anus
Latin	cervix uteri
Artery	vaginal artery, uterine artery
Precursor	Müllerian duct
MeSH	Cervix+uteri
Dorlands/Elsevier	cervix uteri

The cervix (from the Latin cervix uteri, meaning "neck of the womb") is the lower, narrow portion of the uterus where it joins with the top end of the vagina. It is cylindrical or conical in shape and protrudes through the upper anterior vaginal wall. Approximately half its length is visible with appropriate medical equipment; the remainder lies above the vagina beyond view. The cervix has an opening to allow sperm and menstrual fluid to move through.^[1]

Anatomy[link]

The cervix with cervical mucous‎

The cervical os

Ectocervix[link]

The portion projecting into the vagina is referred to as the portio vaginalis or ectocervix. On average, the ectocervix is 3 cm long and 2.5 cm wide. It has a convex, elliptical surface and is divided into anterior and posterior lips.

External os[link]

The ectocervix's opening is called the external os. The size and shape of the external os and the ectocervix varies widely with age, hormonal state, and whether the woman has had a vaginal birth. In women who have not had a vaginal birth the external os appears as a small, circular opening. In women who have had a vaginal birth, the ectocervix appears bulkier and the external os appears wider, more slit-like and gaping.

Endocervical canal[link]

The passageway between the external os and the uterine cavity is referred to as the endocervical canal. It varies greatly in length and width, along with the cervix overall. Flattened anterior to posterior, the endocervical canal measures 7 to 8 mm at its widest in reproductive-aged women.

Internal os[link]

The endocervical canal terminates at the internal os which is the opening of the cervix inside the uterine cavity.

Histology[link]

The epithelium of the cervix is varied. The ectocervix (more distal, by the vagina) is composed of nonkeratinized stratified squamous epithelium. The endocervix (more proximal, within the uterus) is composed of simple columnar epithelium.^[2]

The area adjacent to the border of the endocervix and ectocervix is known as the transformation zone. The Transformation zone undergoes metaplasia numerous times during normal life. When the endocervix is exposed to the harsh acidic environment of the vagina it undergoes metaplasia to squamous epithelium which is better suited to the vaginal environment. Similarly when the ectocervix enters the less harsh uterine area it undergoes metaplasia to become columnar epithelium.

Times in life when this metaplasia of the transformation zone occurs:

• puberty; when the endocervix everts (moves out) of the uterus
• with the changes of the cervix associated with the normal menstrual cycle
• post-menopause; the uterus shrinks moving the transformation zone upwards

All these changes are normal and the occurrence is said to be physiological.

However, all this metaplasia does increase the risk of cancer in this area - the transformation zone is the most common area for cervical cancer to occur.

At certain times of life, the columnar epithelium is replaced by metaplastic squamous epithelium, and is then known as the transformation zone.

Nabothian cysts are often found in the cervix.^[3]

Cervical mucus[link]

Mucus plug

Cervical Mucus is 90% water. Depending on the water content which varies during the menstrual cycle the mucus functions as a barrier or a transport medium to spermatozoa. Cervical mucus also contains electrolytes (calcium, sodium and potassium), organic components such as glucose, amino acids and soluble proteins.^[4]

Cervical mucus contains trace elements including zinc, copper, iron, mangenese and selenium, the levels of which vary dependant on cyclical hormone variation during different phases of the menstrual cycle ^[5] Various enzymes have been identified in human cervical mucus. Glycerol is a natural ingredient of human cervical fluid.^[6][7][8][9] Studies have shown that the amount of glycerol in cervical fluid increases during sexual excitement.^[7] This increase in glycerol has been postulated to be responsible for the lubricating quality of this fertile cervical fluid and may be biologically relevant during the early phase of reproductive events.

After a menstrual period ends, the external os is blocked by mucus that is thick and acidic. This "infertile" mucus blocks spermatozoa from entering the uterus.^[10] For several days around the time of ovulation, "fertile" types of mucus are produced; they have a higher water content, and are less acidic and higher in electrolytes. These electrolytes cause the 'ferning' pattern that can be observed in drying mucus under low magnification; as the mucus dries, the salts crystallize, resembling the leaves of a fern.^[11]

Some methods of fertility awareness involve estimating a woman's periods of fertility and infertility by observing changes in her body. Among these changes are several involving the quality of her cervical mucus: the sensation it causes at the vulva, its elasticity (Spinnbarkeit), its transparency, and the presence of ferning.^[11]

Cervical mucus

Most methods of hormonal contraception work primarily by preventing ovulation, but their effectiveness is increased because they prevent the fertile types of cervical mucus from being produced. Conversely, methods of thinning the mucus may help to achieve pregnancy. One suggested method is to take guaifenesin in the few days before ovulation.^[12]

During pregnancy, the cervix is blocked by a special antibacterial mucosal plug, which prevents infection, somewhat similar to its state during the infertile portion of the menstrual cycle. The mucus plug comes out as the cervix dilates in labor or shortly before.

Cervical position[link]

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, like the tip of the nose, and is positioned low and closed. However, as a woman approaches ovulation, the cervix becomes softer, more similar to the lips, and rises and opens in response to the high levels of estrogen present at ovulation.^[13] These changes, accompanied by the production of fertile types of cervical mucus, support the survival and movement of sperm.

Function[link]

During menstruation the cervix stretches open slightly to allow the endometrium to be shed. This stretching is believed to be part of the cramping pain that many women experience. Evidence for this is given by the fact that some women's cramps subside or disappear after their first vaginal birth because the cervical opening has widened. During childbirth, contractions of the uterus will dilate the cervix up to 10 cm in diameter to allow the child to pass through.

During orgasm, the cervix convulses and the external os dilates. Robin Baker and Mark A. Bellis, both at the University of Manchester, first proposed that this behavior would tend to draw semen in the vagina into the uterus, increasing the likelihood of conception.^[14] This explanation has been called the "upsuck theory of female orgasm." Komisaruk, Whipple, and Beyer-Flores, in their book, The Science of Orgasm, claimed there is evidence in support of the upsuck theory.^[15] Science historian Elisabeth Lloyd, author of The Case of the Female Orgasm, questioned the logic of this theory and the quality of the experimental data used to back it,^[16] commenting in 2005: "[The upsuck theory] has been widely accepted in the community of scientists for the past 12 years... But unfortunately the evidence for it is really badly flawed. In one of their tables 73% of the data came from one woman. It's really quite shocking that for 12 years this research has been taught as "fact" all across the US, Canada and the UK."^[17]

Short cervix^[18] is the strongest predictor of preterm birth.^[19][20][21] Some treatments to prevent cervical cancer, such as LEEP, cold-knife conization, or cryotherapy may shorten the cervix.

Cervical cancer[link]

Human papillomavirus (HPV) infection is a necessary factor in the development of nearly all cases of cervical cancer. HPV vaccines can reduce the chance of developing cervical cancer, if administered before initiation of sexual activity. Potentially pre-cancerous changes in the cervix can be detected by a Pap smear, in which epithelial cells are scraped from the surface of the cervix and examined under a microscope. With appropriate treatment of detected abnormalities, cervical cancer can be prevented. Most women who develop cervical cancer have never had a Pap smear, or have not had one within the last ten years.

Worldwide, cervical cancer is the fifth most deadly cancer in women.^[22] It affects about 16 per 100,000 women per year and kills about 9 per 100,000 per year.^[23] Pap smear screening has greatly reduced cervical cancer incidence and mortality in nations with regular screening programs.

Lymphatic drainage[link]

The lymphatic drainage of the cervix is along the uterine arteries and cardinal ligaments to the parametrial, external iliac vein, internal iliac vein, and obturator and presacral lymph nodes. From these pelvic lymph nodes, drainage then proceeds to the paraaortic lymph nodes. In some women, the lymphatics drain directly to the paraaortic nodes.

Additional images[link]

• 

  Organs of the female reproductive system.

• 

  Ovary

• 

  Uterus and uterine tubes.

• 

  Posterior half of uterus and upper part of vagina.

• 

  Cervix dilation sequence in labour

References[link]

External links[link]

• My Beautiful Cervix—site with a series of photographs illustrating the cervix over a menstrual cycle

Hunter Doherty "Patch" Adams
Adams in Anaheim, California, May 15, 2008
Born	(1945-05-28) May 28, 1945 (age 67) Washington, D.C., U.S.
Nationality	United States
Education	M.D., Virginia Commonwealth University
Alma mater	George Washington University
Home town	Arlington, Virginia
Spouse	Linda Edquist (1975–98; divorced)
Children	Atomic Zagnut Adams Lars Zig Edquist Adams

Hunter Doherty "Patch" Adams (born May 28, 1945, in Washington, D.C.) is an American physician, social activist, citizen diplomat and author. He founded the Gesundheit! Institute in 1971. Each year he organizes a group of volunteers from around the world to travel to various countries where they dress as clowns in an effort to bring humor to orphans, patients, and other people.^[1]

Adams is currently based in Urbana, Illinois. In collaboration with the institute, he promotes an alternative health care model, not funded by insurance policies.^[1]

Early life[link]

Adams had a difficult childhood. His father, an officer in the United States Army, had fought in Korea, and died while stationed in Germany when Adams was still a teenager.^[1] After his father's death, Adams returned to the United States with his mother and brother. Upon his return, Adams has stated that he encountered institutional injustice which made him a target for bullies at school. As a result, Adams was unhappy and became actively suicidal. After being hospitalized three times in one year for wanting to end his life, he decided "you don't kill yourself; you make revolution."^{[citation needed]}

Early career[link]

After graduating (1963) from Wakefield High School,^[2] Adams completed pre-med coursework at the George Washington University. He began medical school without an undergraduate degree, and earned his Doctor of Medicine degree at Virginia Commonwealth University (Medical College of Virginia) in 1971. In the late 1960s one of his closest friends (a man, not a woman as depicted in the Patch Adams film) was murdered. Convinced of the powerful connection between environment and wellness, he believes the health of an individual cannot be separated from the health of the family, community, and the world. While working in an adolescent clinic at MCV, in his final year of med school, he met Linda Edquist, a fellow VCU student who volunteered in the clinic. Soon after graduation, Patch, Linda, and friends founded the Gesundheit! Institute (originally known to many as the Zanies), which ran as a free community hospital for 12 years.

Adams and Edquist married in 1975 and had two sons, Atomic Zagnut "Zag" Adams and Lars Zig Edquist Adams. The couple divorced in 1998.^[3]

Gesundheit! Institute[link]

A revamped Gesundheit! Institute, envisioned as a free, full-scale hospital and health care eco-community, is planned on 316 acres (128 ha) in Pocahontas County, West Virginia. Its goal is to integrate a traditional hospital with alternative medicine, with the organization developing educational programs in sustainable systems design targeted to medical students and the general public.

Since the 1990s Adams has supported the Ithaca Health Alliance (IHA),^[4] founded as the Ithaca Health Fund (IHF) by Paul Glover. In January 2006 IHA launched the Ithaca Free Clinic, bringing to life key aspects of Adams' vision. Adams has also given strong praise to Health Democracy, Glover's book written and published the same year.

In October 2007, Adams and the Gesundheit Board unveiled its campaign to raise $1 million towards building a Teaching Center and Clinic on its land in West Virginia. The Center and Clinic will enable Gesundheit to see patients and teach health care design.

Adams urges medical students to develop compassionate connections with their patients. His prescription for this kind of care relies on humor and play, which he sees as essential to physical and emotional health. Ultimately, Adams wants the Gesundheit! Institute to open a 40-bed hospital in rural West Virginia that offers free, holistic care to anyone who wants it.^[5]

Adams was awarded the Peace Abbey Courage of Conscience Award on January 29, 1997.^[6]

In 2008, Adams agreed to become honorary chair of the "International Association for the Advancement of Creative Maladjustment" or IAACM. In a number of his speeches and essays, Martin Luther King, Jr. had called for such an IAACM, but none was ever created. MindFreedom International, a nonprofit coalition that Gesundheit! belongs to as a sponsor group, launched the IAACM to support "creative maladjustment" and social change.^[7]

In media[link]

The 1998 film Patch Adams was based on Adams' life and views on medicine. Adams has criticized the film, saying it eschewed an accurate representation of his beliefs in favor of commercial viability. He said that out of all aspects of his life and activism, the film portrayed him merely as a funny doctor.^[8] Patch Adams also said of Robin Williams in an interview, "He made $21 million for four months of pretending to be me, in a very simplistic version, and did not give $10 to my free hospital. Patch Adams, the person, would have, if I had Robin's money, given all $21 million to a free hospital in a country where 80 million cannot get care."^[9]

However, in another interview, Adams did clarify that he did not hate Williams^[10], and Williams has actively supported St. Jude Children's Research Hospital for several years.^[11]

As a speaker, Dr. Adams travels around the globe lecturing about his medicine methods. ^[12].

Bibliography[link]

• Adams, Patch; Maureen Mylander (1998). Gesundheit! : bringing good health to you, the medical system, and society through physician service, complementary therapies, humor, and joy. Rochester, Vermont: Healing Arts Press. ISBN 978-0-89281-781-8. http://lccn.loc.gov/99187488. Retrieved 2008-12-16. 
• Adams, Patch; Maureen Mylander (1993). Gesundheit! : bringing good health to you, the medical system, and society through physician service, complementary therapies, humor, and joy. Rochester, Vermont: Healing Arts Press. ISBN 978-0-89281-442-8. http://lccn.loc.gov/92007008. Retrieved 2008-12-16. 
• Adams, Patch; Maureen Mylander (1998). Gesundheit! [sound recording]. Los Angeles, California: NewStar Media. ISBN 978-0-7871-1828-0. http://lccn.loc.gov/00717433. Retrieved 2008-12-16.  4 sound cassettes (ca. 6 hr.) : digitally mastered, Dolby processed.
• Adams, Patch (1998). House calls. cartoons by Jerry Van Amerongen. San Francisco, California: Robert D. Reed Publishers. ISBN 978-1-885003-18-8. http://lccn.loc.gov/98034266. Retrieved 2008-12-16. 
• Bourque, Judith (1999). The real Patch Adams (videorecording) / a film by Judith Bourque. Oley, PA: Bullfrog Films. ISBN 978-1-56029-811-3. http://lccn.loc.gov/2003389123. Retrieved 2008-12-16.  1 videocassette (53 min.) : sd., col. ; 1/2 in.
• Graham, John (1999). It’s up to us. foreword by Patch Adams. Langley, Washington: Giraffe Project. ISBN 978-1-893805-00-2. http://lccn.loc.gov/99097193. Retrieved 2008-12-16. 

References[link]

External links[link]

	Biography portal
	United States portal
	Medicine portal

Wikiquote has a collection of quotations related to: Patch Adams

Wikimedia Commons has media related to: Patch Adams

• Official website
• Patch Adams at the Internet Movie Database