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Cervical Self Exam

This information is a brief overview to get you started with cervical self-exams. It is still necessary to have routine gynecology examinations and Pap smears. Not all disease conditions, even cancer, are visually detectable.

Why Examine your Cervix?
Each of us is ultimately responsible for our own health. Doing cervical self-exam with a speculum allows us to see our cervix and vaginal walls. The purpose of regular exams is to learn what is normal and healthy for us so we can recognize early changes or infections.

How to do Cervical Self-Exam
You will need a flashlight or desk lamp, a mirror, a plastic speculum and, if you are dry, some lubricant such as water or K-Y jelly to help with insertion. Become familiar with the speculum and how it works before inserting it into your vagina. Practice opening, locking and releasing it.

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Then prop yourself up on pillows in a half-sitting position, with knees bent and feet apart. It's important to be in a comfortable position. Take a few deep breaths to help relax the pelvic and abdominal muscles. This will make insertion of the speculum easier.

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If there is not enough vaginal mucus present you may want to lubricate the bills of the speculum with a small amount of water, K-Y jelly, spermicidal jelly or a similar water-soluble lubricant. Vaseline or other petroleum products are not recommended. They can plug the urethra which may increase the chances of getting a urinary tract infection.

Hold the bills of the speculum closed with one hand and separate your labia with your other hand. With the handles up insert the speculum gently into your vagina at the same angle as you insert tampons.

When the speculum is all the way in, press the two handles together to open the speculum inside you. Look into the mirror which has a light shining into it and you will see your vaginal walls-and hopefully your cervix. The cervix is round, 1 to 3 inches in diameter with a hole in the center and is pink or reddish-orange in color. If you do not see the cervix, move the speculum up, down, sideways, or even pull it out a little, to bring it into view. You may lock the speculum open by pushing down on the shorter handle until you hear a click.

To remove the speculum, pull it outward, slightly away from your cervix. If you have locked it open, unlock it by pulling up on the short handle until it clicks. Then release the pressure on the handles and remove the speculum from your vagina.

Care of the Speculum
To care for your speculum, wash it with mild soap and warm water. If you suspect a vaginal infection, disinfect the speculum by submerging it completely in rubbing alcohol for 20 minutes to avoid reinfection.

What to look for
Normal Changes-the transformation zone

Changes take place in women's cervices at different times in their lives and menstrual cycles. Most of the time the cervix looks pink smooth and shiny, like the inside of the mouth. Sometimes it may appear reddish-orange and slightly rough around the cervical os, the opening in the cervix. The reddish-orange tissue is always present inside the cervix, in the endocervical canal. Sometimes, due at least in part to hormonal changes, the tissue moves outside onto the face of the cervix. Both the pink and the reddish-orange tissues are normal. The area of reddish-orange tissue is called the transformation zone.

The transformation zone is more delicate and more easily injured than the pink tissue because it is only one-cell layer thick. It may bleed slightly when a speculum is inserted, when a Pap smear is taken, or sometimes there may be spotting after intercourse. These cells produce the mucus that is seen throughout the menstrual cycle. When this type of tissue is present on the face of the cervix, some women notice that they produce more cervical mucus.

What causes the transformation zone to appear on the face of the cervix?
Hormonal levels associated with pregnancy and birth control pills may cause the transformation zone to increase in size. The zone is more prominent in some women who have intrauterine devices (IUDs) also. The reason for this is not known. Use of a diaphragm with spermicide frequently causes the reddish-orange area to return to the pink color. The effects of a cervical cap and spermicide on the transformation zone are not well known.

Is this "erosion"?
Cervical erosion is loss of the surface layer of pink tissue exposing a layer of delicate subcutaneous cells. The transformation zone is all too frequently mistaken for true erosion by physicians. In face, many older gynecology textbooks do not even mention a transformation zone, only erosion.

Eversion
Sometimes the transformation zone is visible in women simply because the speculum forces the cervical to open out. In this case, the reddish-orange tissue will recede as the speculum is removed; watch and see.

Cryotherapy
If you see a reddish-orange area for the first time after previous exams showed a pink cervix, do not be alarmed. Have it checked by a health or medical practitioner to be sure it is a normal change. Physicians sometimes encourage women to have cryotherapy on the reddish tissue to cause it to scar over and appear pink. Cryotherapy is freezing the tissue with liquid nitrogen. Since this procedure is sometimes performed unnecessarily, we advise women to have a Pap smear first. If the Pap smear reports slightly abnormal changes in the cells (mild dysplasia), or if the delicate tissue bleeds and cause discomfort when touched, you might want to consider cryotherapy.

Normal changes-nabothian cysts
Another normal change that may be seen on the cervix is nabothian cycsts. The cysts may vary in appearance from smaller than a pinhead and yellow in color to as large as the tip of a little finger and clear like a blister. The cysts form when mucus-producing glands on the cervix are plugged. This happens more frequently when there has been transformation zone on the cervix and it is changing to pink tissue. Sometimes cysts will be reabsorbed or will break up spontaneously; sometimes they remain unchanged for years. There is no need to treat them medically or surgically.

Normal Changes-rugae
The normal appearance of the vagina is pink with wrinkles which gives it a washboard appearance. These wrinkles are called rugae. After menopause, the rugae usually disappear. The walls of the vagina then appear smooth and pink, sometimes very pale pink.

Normal Cervical Mucus
Most women notice changes in their cervical mucus throughout the month but are unaware of the significance and causes. There are two types of normal mucus; clear, stretchy, fertile mucus and white or yellow, non-stretchy, non-fertile mucus. Sperm can survive in stretchy, fertile mucus for five and one half days and in the non-fertile, non-stretchy mucus for only a couple of hours. The ovarian hormone estrogen causes the production of clear stretchy mucus and the hormone progesterone causes the production of the non-stretchy mucus for only a couple of hours. The ovarian hormone estrogen causes the production of clear stretchy mucus and the hormone progesterone causes the production of the non-stretchy mucus. Both types of mucus come from the reddish-orange tissue of the endocervix. The fertile time in a woman's cycle is from the beginning of the wet, slippery, clear stretchy mucus until three and one half days after the last day of stretchy mucus. Even though you may have no need to know about your fertility, you might want to know if you are ovulating and when as part of knowing more about the normal functioning of your body.

If you see a health or medical practitioner for menstrual problems it might be helpful if you can tell her/him about the mucus changes in you cycle. It could help in the detection of some disease processes, such as ovarian cysts.

If you wish to use mucus changes to plan or prevent pregnancy you need to know more than this brief information. There are booklets on the topic such as Fertility Awareness: Natural Birth Control for Women, available at the Emma Goldman Clinic.

Abnormal vaginal secretions
Organisms that cause vaginal or cervical infection usually change the appearance and increase the amount of vaginal secretions. There may be itching of the genitals and burning on urination with vaginal infections. Since burning on urination can also be a symptom of urinary tract infections, it is important to determine whether the cause is a vaginal infection or a urinary tract infection. Urinary tract infections may ascend to the kidneys and cause kidney damage if untreated.

There are four organisms that more commonly cause vaginal imbalances and infections: yeast bacteria, trichomonas and chlamydia. Yeast imbalances usually cause a thick, white discharge that looks somewhat like cottage cheese and often smells like yeast. Bacteria tend to cause a yellow, more liquid and often unpleasant smelling discharge. Trichomonas usually cause a greenish, sometimes frothy, liquid discharge with an unpleasant odor and usually more intense itching. Chlamydia cause recurrent vaginal infections.

Yeast and some types of bacteria are present all the time in women's vaginas. It is only when the body gets out of balance due to stress, poor nutrition, taking drugs, etc., that vaginal infections begin. Many women are learning to recognize vaginal infections and are choosing to use home remedies rather than pharmaceutical drugs if they suspect and infection is just beginning.

If you have questions about what you are experiencing, see a health care worker, a physician or a resource book (available at EGC). By examining yourself at regular intervals you will be more likely to recognize unusual changes at a very early stage, which is a benefit whether you want to try a home remedy or see a health professional.

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