Talk:Cervix/Archive 1

Comment
I love wikipedia! So funny, the varieties of styles! —Preceding unsigned comment added by 130.234.192.170 (talk) 21:59, 8 November 2009 (UTC)

Indicator of Fertility
Need to do some work on this section, the Cervix goes through a series of changes during the Menstrual cycle and during pregnancy and I think we should document them on this entry for the Cervix. I've found alot of information about it and I am still digesting it.. hoping to combine it all together and rewrite the section dealing with cervical mucus. and are very good resources for this.

Found some more:             

And more  

Here is the beginning of the section as I have written, culled from the sources for the part on the menstrual cycle:

A typical mature Cervix spends most of the Menstrual cycle blocked by a high viscosity, dense mucus called G mucus. G mucus is an impenetrable gestagenic mucus formed in the lower cervix. It prevents sperm entry to the uterus and protects the reproductive system from infection. [Discuss G-Mucus receding and being replaced by different mucus as hormones change as ovulation begins, discuss what happens after egg is present, dicuss what happens if no fertilization, discuss menstration]

Menstruation
Need to add some info about the cervix's function during menstruation. Will research and write more later. Celerityfm 19:12, 6 Jun 2005 (UTC)

Added a bit about menstruation...

Okay, seriously, IT IS NOT A CHANGE IN MUCUS. It is a change from mucus to serous fluid. Please make sure you understand the medical methodology of secretion. Serous and mucus are not interchangeable terms. —Preceding unsigned comment added by 71.64.131.102 (talk) 17:17, 10 March 2008 (UTC)

Mucus vs. Fluid
Most fertility awareness instructors now use the term "cervical fluid" instead of "cervical mucus," because so many found the latter term distasteful, and were more open to talking about fluid. I don't know if that's the common use in medical circles, or if there is a preference either way. Can anyone offer any insight into this? It would certainly make for more comfortable reading of the article if we changed "cervical mucus" to "cervical fluid," but if the most prevalent usage is still "mucus" then it shouldn't change. MamaGeek (Talk/Contrib) 11:39, 15 June 2006 (UTC)


 * Creighton Model teachers, Billings teachers , and Couple to Couple League teachers all use mucus.  Any one of those organizations is much larger than the secular FA groups I am aware of  .  Mucus is without a doubt the more widely-used term. Lyrl 23:38, 15 June 2006 (UTC)

Um, hello....it becomes a serous fluid during ovulation so the mucosa will not inadvertently kill sperm. Almost any current histology text will confirm the fluid change, and no, serous is not a form of mucus. —Preceding unsigned comment added by 71.64.131.102 (talk) 17:13, 10 March 2008 (UTC)


 * The term 'mucus' is widely used and its use in this article is referenced. Because so many large organization use 'mucus', if different sources (such as histology texts) use different terms, this article needs to cover both terms to avoid confusion among readers.  Also, please provide a new reference (a specific text) before changing reference information in a Wikipedia article. LyrlTalk C 01:19, 11 March 2008 (UTC)

Sperm in cervical crypts
Sperm actually all travel to the fallopian tubes starting 1 minute and believed to finish within 30 minutes of ejactulation. They bind to the tube walls, where they wait for ovulation. Any sperm left in the cervical crypts are not going to fertilize an egg. Explanations by Dr. Joanna Ellington, sperm physiologist:  Lyrl 23:50, 15 June 2006 (UTC)

Fornix
Hey, there's a redirect here from the Fornix page in the brain saying that fornix is also a term for part of the cervix. Any chance of a mention of that somewhere on this page?

Confuseddave 09:13, 29 September 2006 (UTC)


 * It looks like the fornix is actually not part of the cervix, but rather a portion of the vagina - that portion located behind the cervix . As such, it seems like a topic better covered in the vagina page. Lyrl  Talk Contribs 13:12, 29 September 2006 (UTC)

Naboth's gland and cervical crypts?
Are these two terms for the same thing? "Naboth's glands" and "cervical crypts" are both described as mucus-producing areas of the cervix (sounds like the same thing...), but a Google search for (cervical crypt naboth) turns up no information (mostly foreign language articles or ad pages listing every word they could think of to get search engine hits). If they are the same thing, it might be helpful to note that in the article. Lyrl Talk Contribs 00:55, 11 December 2006 (UTC)

Transition/transformation zone
A note on the transition zone. It is always present, it just migrates througout life and during pregnancy. It represents the junction of squamous epithelium and columnar epithlium - the transition of one cell type to the another. It is also the area where most cervical cancers originate.  --Name8318 15:33, 19 August 2007 (UTC)

Incorrect Information

 * Editors should be aware that the user Drsavard (and apparently 71.224.215.219) who proposed these changes does consulting work for QIAGEN pharmaceutical company, which is the owner of Digene, maker of the HPV test. Therefore they have a potential WP:COI regarding HPV testing. Zodon (talk) 06:05, 11 May 2008 (UTC)

''I am a medical doctor specializing in internal medicine with 25 years of experience. I found the following information in this article to be incorrect and I’d like to update it to include the correct information. If no one protests the updates below within 48 hours, I’d like to go ahead and make these edits to ensure that Wikipedians receive the correct information as soon as possible. All references are included below.'' Existing Text In humans the cervix may be affected by cervical cancer, a particular form of cancer which is detectable by cytological study of epithelial cells removed from the cervix in a process known as the pap smear. Evidence now shows that those with exposure to HPV, (human papilloma virus), are at increased risk for cervical cancer. These viruses are related to the viruses that causes warts. Updated Text In humans, cells on the cervix may become cancerous. Detection usually occurs following cytological study of epithelial cells removed from the cervix (a process known as the Pap smear), and – in an increasingly common practice – testing for HPV (human papillomavirus). If one or both of these tests are abnormal, a colposcopy exam and biopsy are used to confirm the diagnosis. Evidence now shows that women who have persistent infections with ‘high-risk’ types of HPV are at increased risk of developing cervical cancer. Of the approximately 40 types of HPV that affect the genital area, there are about 15 such ‘high-risk’ (oncogenic) strains. Approximately 12 other types are ‘low-risk’; they cannot cause cervical cancer, but can cause genital warts or minor cell changes on the cervix that disappear on their own. Drsavard (talk) 14:18, 10 March 2008 (UTC)


 * I like the types of changes you are proposing. I don't know that the level of detail on exactly how many strains of HPV exist is needed in this article (it could just say "Women with high-risk strains have an increased the risk of developing cervical cancer, although some strains of HPV can cause genital warts or minor cell changes but not cancer" or something along those lines).  But it's not something I feel strongly about. LyrlTalk C 01:25, 11 March 2008 (UTC)
 * Agree that don't need quite so much detail on types here (obscures the main points). (Especially since keep seeing different numbers of each type, the fewer places these numbers get to the better.)  Now putting some sources to some of the numbers of HR/etc. types in the HPV article - that would definitely help.  Lyrl's suggested wording for this seems fine, or other wording you prefer.
 * Suggest leave out the HPV testing portion. That is still evolving and the benefits are questionable.  It is being heavily marketed by the manufacturer, but evidence of clinical benefit except in special cases (triage, follow-up) is lacking.  Is its use as noted growing significantly everywhere, or is this a local perspective?  Zodon (talk) 08:42, 11 March 2008 (UTC)


 * Thank you for inspiring me to review the copy and my suggested edits once again. I now realize that the wording somewhat implies that the presence of HPV is not necessary to the development of cervical cancer.  However, the experts now agree that it is - although other factors such as smoking can then make it more likely that HPV infections become persistent and evolve into cancer.

Thus, I would review my edit this way: ''In humans, cells on the cervix may become cancerous. Detection usually occurs following cytological study of epithelial cells removed from the cervix (a test known as the Pap smear), and - in an increasingly common practice- testing for HPV. If one or both of these tests are abnormal, a colposcopy exam and biopsy are used to confirm the diagnosis. Research now has documented that persistent infection with high risk types of HPV must be present for cervical cancer to develop. However, it's also true that most women with high-risk HPV do not develop serious disease. Contributing factors such as smoking can make it more likely that an HPV infection persists and evolves into cervical cancer -- that is, if the resultant abnormal cells are not treated early. Of the approximately 30-40 types of HPV that affect the genital area, there are about 15 such high-risk strains. Approximately 12 other types of "low-risk"; they do not cause cervical cancer, but can cause genital warts or minor cell changes on the cervix that disappear on their own.'' Regarding your opinion that the benefits of HPV testing for cervical cancer screening in older women are "questionable," consider that in its most recent practice bulletin, ACOG said: "Because HPV DNA testing is more sensitive than cervical cytology, women with negative concurrent test results (negative cytology and negative HPV DNA) can be reassured that their risk of unidentified CIN 2 and CIN 3 or cervical cancer is approximately 1 in 1,000." In addition, in a letter supporting a proposed bill to require insurance coverage of routine HPV testing, the CA chapter of ACOG said: "Pap tests are not as useful as HPV DNA diagnostic techniques in detecting the virus HPV. Early detection using the latest technology will lead to better outcomes." In fact, a study in the JNCI found that nearly one-third of cervical cancer cases can be attributed to Pap detection failure. Although many physicians believe that the use of liquid-based cytology reduces that failure rate, several recent studies - including on in The Lancet - found no significant difference compared to conventional Paps. This is the basis for combining cytology with HPV testing, which is much better able to identify women at risk. There is a wealth of clinical data supporting the use of routine HPV testing of women age 30+ in conjunction with cytology. Below is just a sampling of these studies, beginning with the most recent: - Study results suggest that, in women age 30+ years, co-testing with a Pap smear and HPV DNA test was more sensitive than reflex HPV testing for the detection of high-grade cervical lesions (91% vs. 54%), provided women with a positive hc2 test and negative Pap were referred to colposcopy and biopsy Janet G. Baseman, Ph.D., Department of Epidemiology, University of Washington (American Journal of Obstetrics & Gynecology, March 2008) -For both vaccinated and unvaccinated women, age-based screening by use of HPV DNA testing as a triage test for equivocal results in younger women and as a primary screening test in older women is expected to be more cost-effective than current screening recommendations. Sue J. Goldie, MHP, Department of Health Policy and Management, Harvard School of Public Health (Journal of the National Cancer Institute, Feb. 26, 2008) -'''Compared with cytology, HPV testing has greater sensitivity for the detection of cervical intraepithelial neoplasia. The sensitivity of HPV testing for CIN grade 2 or 3 was 94.6% whereas the sensitivity of cytology alone was 55.4%. The sensitivity of both tests used together was 100%, and the specificity was 92.5%''' ''Human Papillomavirus DNA versus Papanicolaou Screening Tests for Cervical Cancer. New England Journal of Medicine 2007; 357; 1579-1588.  -'Implementation of HPV DNA testing in cervical screening led to a substantial increase in the number of CIN 2/3+ lesions detected at the baseline screening round. At the subsequent round, combined HPV DNA and cytological testing was used in both study groups and significantly fewer CIN 2/3+ lesions were seen in the women who received both tests at the baseline round than in the control group. Therefore, the results show that implementation of HPV DNA testing in cervical screening leads to earlier detection of clinically relevant cervical lesions.''' ''Meijer, C. et al. Human papillomavirus DNA testing for the detection of cervical intraepithelial neoplasia grade 3 and cancer: 5-year follow-up of a randomized controlled implementation trial. The Lancet 2007; DOI:10.1016/SO140-6736(07)61450-0.'' -HPV testing in primary screening and HPV vaccination against the most common types have the potential to reduce the incidence of invasive adenocarcinoma. ''Castellsague, X. et al. Worldwide Human Papillomavirus Etiology of Cervical Adenocarcinoma and Its Cofactors: Implications for Screening and Prevention. Journal of the National Cancer Institute 2006; 98:303-315.'' -'''HPV testing is substantially more sensitive in detecting CIN 2+ than cytology (96.1% vs. 53%) but is less specific (90.7% vs. 96.3%). In this analysis, the sensitivity of HPV testing was similar in all studies carried out in different areas of Europe and North America, whereas the sensitivity of cytology was highly variable. These results support the use of HPV testing as the sole primary screening test, with cytology reserved for women who test HPV-positive''' ''Cuzick, J. et al. Overview of the European and North American SZtudies on HPV testing in Primary Cervical Cancer Screening. International Journal of Cancer 2006; 98:765-74.'' - Because HPV DNA testing is more sensitive than cervical cytology in detecting CIN 2 and CIN 3, women with negative concurrent test results can be reassured that their risk of unidentified CIN 2 and CIN 3 or or cervical cancer is approximately 1 in 1,000. ''G Practice Bulletin No. 61, "Human Papillomavirus. Clinical Management Guidelines for Obstetrician-Gynecologists." April 2005'' -The negative predictive value of combined HPV/Pap testing is 99.21% for CIN 3. ''Sherman M.E., et al. Human Papillomavirus Testing, and Risk for Cervical Neoplasia: A 10-Year Cohort Analysis. Journla of the National Cancer Institute, 2003; 95:46-52.'' -'''In another study of more than 11,000 women, the digene HPV Test was shown to be 97% sensitive for CIN2+, compared to 77% for conventional Paps resulting in ASC-US or abnormal results. The study also documented that women infected with high-risk HPV and who have normal or borderline cytology can be managed as effectively with repeat testing after 12 months with immediate colposcopy.''' ''Cuzick, J. et al. Management of women who test positive for high-risk types of human papillomavirus: the HART study. The Lancet 2003; 362:1871-76.'' -'''Still another study demonstrated that HPV testing is a more sensitive indicator of high-grade CIN than either conventional or liquid cytology alone. Screening with both an HPV and Pap test offered a sensitivity and negative predictive value of almost 100%. Twenty one percent of women who were persistently positive for high-risk HPV DNA types when tested with hc2 were diagnosed with CIN 2/3 within 36 months, compared to only 0.08% of women who were initially HPV-negative.''' ''Lorincz, A., Richart, R. Human Papillomavirus DNA Testing As An Adjunct To Cytology In Cervical Screening Programs. APLM 2003; 127:959-968>.'' -A study of 8,466 women undergoing routine cervical cancer screening showed that when used in conjunction with a Pap, the sensitivity of the digene HPV Test was 100% for detection of CIN2+, while that of the Pap alone was 43.5%. Petry K., et al. Inclusion of HPV testing in routine cervical cancer screening for women above 29 years in Germany: results for 8,466 patients, British Journal of Cancer, 2003, 88:1570-1577. -Women with persistent HPV infection are more than 300 times more likely than HPV-negative women to develop high-grade cervical disease. ''Bory J., et al. Recurrent Human Papillomavirus Infection Detected with the Hybrid Capture 2 Assay Selects Women with Normal Cervical Smears at Risk for Developing High Grade Cervical Lesions:A Longitudinal Study of 3,091 Women. Int. J. Cancer, 2002; 102:519-525.'' -In an ASC-US population, the senstivity of the digene HPV Test for detecting high-grade precursors and cervical cancer is 96%, compared to 85% for a repeat liquid-based Pap test. ''Solomon, D. et al. Comparison of Three Management Strategies for Patients with Aytpical Squamous Cells of Undetermined Significance: Baseline Results from a Randomized Trial, J. Nat Cancer Inst, 2001; 93:293-299.'' -A cohort analysis of 5,671 women older than 30 (conducted within a larger study of 7,932 women) showed that conventional cytology was 57% sensitive for HSIL; liquid cytology was 84% sensitive, and the digene HPV Test was 100% sensitive. ''Clavel C. et al. Human Papillomavirus Testing in Primary Screening for the Detection of High-Grade Cervical Lesions: A Study of 7,932 Women. Brit J Cancer, 2001; 89 (12): 1616-1623.'' - High-risk HPV types have been detected in 99.7% of cases of cervical cancer, confirming that the virus must be present for cervical cancer to develop. ''Walboomers J.M.M. et al. Human Papillomavirus is a Necessary Cause of Invasive Cervical Cancer Worldwide. Journal of Pathology 1999; 189:12-19''

71.224.215.219 (talk) 17:30, 25 April 2008 (UTC)


 * I think much of this information is simply outside the scope of an anatomy article. You might try cervical cancer, human papillomavirus, vulvovaginal health, etc. LyrlTalk C 12:23, 26 April 2008 (UTC)

Question
Would it be a good idea to, if we can't get actual free images, link to a site like (obviously nsfw, but not porn)? —Preceding unsigned comment added by 128.205.35.24 (talk) 00:49, 21 August 2008 (UTC)


 * It would be nice to link to pictures like that. That particular site, though, violates the terms of the GFDL: the header image was taken from Wikipedia, but no credit is given to Wikipedia editors as authors of the image.  Also, the image is outdated: the current image on menstrual cycle related articles has been modified to correct several errors.  I have not been able to find a way to contact the page owner to correct this oversight.  Lacking such a correction, I'm hesitant to add a link from Wikipedia to that page. LyrlTalk C 02:18, 24 August 2008 (UTC)


 * I suppose you could try the gmail address for that same google account. It appears that the author of that site is attempting to do it as a public service; as such, she might even be willing to license one of the images for inclusion in Wikipedia.  There's certainly other sites with cervix images out there.  -- 128.205.35.24 (talk) 14:36, 29 August 2008 (UTC)


 * I am the creator of the site My Beautiful Cervix and I think having an external link to it on the cervix page would be beneficial. I would also be willing to post just one of the photos to the image gallery on that page, but I think my entire site best represents the many changes in the cervix during the menstrual cycle - which are referenced on the cervix page.  FYI, I have since updated the menstruation chart/image and credited lyrl from wikipedia on my site (and i apologize for not doing that in the first place-- thanks for the friendly reminder) Beautifulcervix (talk) 18:57, 29 November 2008 (UTC)
 * Wikipedia is not a web directory to various places with interesting information. Wikipedia needs content, not links. People can use google and find plenty of info themselves on the web. If you want to contribute to wikipedia, please consider releasing the photos under the license compatible with wikipedia, see copyrights. `'Míkka>t 08:35, 30 November 2008 (UTC)


 * To my knowledge, this website is unique because of the photographs it provides and not something that readers could just "find themselves on the web". Therefore, WP:NOTDIR does not apply.
 * This website meets criteria #3 of what should be linked (the material is neutral and accurate, but the level of detail on a specific aspect of the cervix is not appropriate for a Wikipedia anatomy article), and also meets criteria #4 of "what should be linked" (the material is meaningful and relevant to the article topic but not included in the article). Because it meets the Wikipedia guidelines for external links (WP:EL), the website should be linked. LyrlTalk C 13:32, 30 November 2008 (UTC)


 * However it also comes under links normally to be avoided: #11 (personal web page not by a recognized expert). If it were just the pictures with some explanation, that would be one thing, but the links have a more commercial bent than seems appropriate.  (Specifically the link for doula and for fertaware.com).  It would be better if the advertisements were clearly marked as such, rather than mixed in with the content (i.e. to my taste it may come under #5 (objectionable ammounts of advertising - because of the stealth nature of the advertising).  So while the content is nice, I am not sure if it is appropriate as an EL.
 * As far as neutrality, the site is promoting fertility awareness, without covering the disadvantages (what good for and what not so good for), so neutrality seems a little questionable. Would it be more appropriate as an EL on the fertility awareness page, if it is to be kept as an external link?  Zodon (talk) 21:35, 30 November 2008 (UTC)
 * To me, the links to the owner's doula and midwife sites are self-disclosure and give the author some experitise (i.e. this is a person with medical training, not some random woman off the street). The FA information is rather brief, and where she recommends for further information are comprehensive and reputable sources - the Fertility Awareness Center (the oldest secular fertility awareness organization, and where Toni Weschler received her training) and to Weschler's book.  I agree it is a judgment call about the advertising.
 * I think there may be other pages that would benefit from this link (fertility awareness, menstrual cycle). But since the link's inclusion at all seems controversial, it would be nice to wait for consensus on this article (I hope to include the link) before linking elsewhere. LyrlTalk C 23:23, 30 November 2008 (UTC)
 * This discussion is interesting. I'm not sure if it helps to clarify my intention.  I have not found any other sites on the internet that document the cervix through a full menstrual cycle--there are some sites that have a few pictures of cervices taken on different days (usually directly linked to advertising a book on fertility awareness), abnormal cervices OR from cadavers.

I do not feel my site advertises fertility awareness--it just happens that much of the accessible information out there about cervical changes comes from fertility awareness sources- the same sources that are linked to on the wiki cervix page as resources. If I had a site with just photos, I think people would be a bit lost if they didn't have an idea about what they're looking at and why its changing. Also, changes in the cervix are not necessarily about fertility awareness--they are fascinating in and of themselves. I am not getting any money from the links that are in the body of my site- as Lyrl stated, I linked to my doula site to give me some 'expertise' on the subject of women's bodies/issues -I know wikipedia has a worldwide audience, and its not a great business strategy to advertise local services to people across the globe--marketing was not my intention. Is there any policy against external linking to "commercial" sites anyway? Because I'm just noticing that many of the external links are to businesses (e.g. NCAR, Shakespeare Festival, CU Boulder in 'Boulder, CO''s wiki page) I don't feel the wiki cervix article is complete without a photo of what it looks like- consider the liver, ear, or tongue pages. I think having one photo on the page would be useful, but as illustrated in my site, it doesn't always look the same. I'm sure this discussion will continue and I hope we can come to some consensus on it. Beautifulcervix (talk) 23:37, 2 December 2008 (UTC)
 * Yes, the article with photos is better than without. Wikipedia is a place for free dissemination of information. the main function of external links is to provide reputable references to information in wikipedia. Your website does not have much encyclopedic information besides photos.People may readily find tens of thousands of cervix images using google themselves and I don't see why yours are better than others to be linked from a wikipedia article. Once again, please consider releasing your photos under one of licenses acceptable by Wikipedia Commons and upload them there, with all your credits and links. Being free is a definite advantage for their use in wikipedia, since this is a core philosophy of wikipedia . `'Míkka>t 04:00, 3 December 2008 (UTC)


 * It is very important that the references in Wikipedia article be reliable (WP:RS). What we are discussing here is an external link, which has a different set of guidelines: WP:EL.
 * This website is unique because it has images of one woman's cervix over the course of an entire menstrual cycle. The images available from a Google search do not provide the information available from this website.  I believe this website meets the criteria "what should be linked" in WP:EL. LyrlTalk C 23:17, 3 December 2008 (UTC)
 * I can say the same about thousands of other images of cervix in the web: they have something unique not shown in others. BTW, if one wants to go really legal here, notice that while WP:EL is a guideline, WP:RS is part of a policy, i.e., has a clear priority. This is not the first and unfortunately not the last case when someone wants a piece of their body shown in wikipedia. A couple years ago wikipedia was flooded with penises of all sizes and erection states (you can still find hundreds of them in wikimedia commons). There was also a case of a particularly insistent and eloquent lady/girl who uploaded a huge number of her nude photos insisting that they are important for each and every anatomy article. The verbal wrangle with her dragged for, like, a month, and only direct intervention of Jimbo Wales got all these images deleted.  `'Míkka>t 00:03, 4 December 2008 (UTC)


 * I've run the argument about the RS policy around in my head for quite a while and still do not understand how a policy on article sourcing could apply to external links. The trend in comments and edits to the article seems to be in support of including the link; it's not strong enough to call a consensus, currently, but I've re-added the link as part of a potential WP:BRD cycle. LyrlTalk C 20:38, 10 January 2009 (UTC)

Image of Cervix
I don't believe the current images really show the cervix in any recognizable way, maybe physicians are used to looking at these diagrams but IMO preferably a photo or at least a realistic color graphic of the cervix should be included.

There are more pictures of Vulvas at Wikimedia Commons than you can shave a stick at but no cervix's. 121.98.130.163 (talk) 09:05, 6 January 2009 (UTC)

upsuck
You should cover some of the varying scientific opinions on this, but my edits are being deleted

Cindy M. Meston states:

"Most of the evolutionary theories for women having an orgasm have been disproved. Initially, it was thought it triggered ovulation, which of course it doesn't. Then it was thought that orgasm helped pull more sperm in and increased the chances of getting pregnant. There is still some evidence that through the process of orgasm and the contractions of the uterus some of the crappier sperm die off so that the healthier sperm are more likely to make it to the egg."

Mary Roach:

"We don't know. We're not even sure about cervical upsuck in humans. It seems as though, when a woman is fertile, there is peristaltic action that helps the sperm along, but at other times it seems as though the wind, as it were, is blowing in the opposite direction."

Another experiment described here http://www.theaustralian.com.au/higher-education/appointments/probing-questions/story-e6frgckf-1111116528006

"They brought six women into their lab, outfitted them with cervical caps filled with ersatz semen and had them make their way to orgasm under an X-ray machine. The substance in the cap was radiopaque, meaning it would show up on the film. The team saw no evidence of even the slightest sucking effect."

Eutheria
I was looking at the evolutionary picture but did not find anything in this article… what a speciecist article ;-) 201.246.73.31 (talk) 01:53, 3 February 2013 (UTC)