The
uterus is a muscular organ that lies within the pelvis between the
bladder and rectum. It is shaped like upside-down pear and is about the
size of a fist in a non-pregnant woman. The uterus is composed of the
fundus (dome shaped portion above the tubes), the body (largest tapering
central portion) and the cervix (opening into the vagina).
If a woman inserts a speculum into her
vagina and opens it, she will see her (beautiful!) cervix, which looks
like a little pink doughnut about 3-6 inches from the opening her
vagina. The cervix is the lowermost part of the uterus that extends
into the vagina and connects the uterus to the top of the vaginal wall
(that’s right – the vagina is a sealed cavity and doesn’t open into the
abdomen – you can’t lose a tampon or condom within it). The cervix
opens to the vagina via an internal os and an external os, though the
external os is the only one visible upon cervical self-exam – it is the
little hole in the center of the doughnut. The inner canal of the
cervix, which you also can’t see upon speculum exam, is lined with
glands that produce secretions that vary in consistency and quality
throughout the cycle. The quality (color, consistency, texture) of this
fluid gives us accurate information about our current fertility or
possibly an infection.
The uterus is made of three layers of tissue. The outer layer is
called the perimetrium (or serosa) which becomes the broad ligament on
either side (shown as the yellow sheet-like structure in the image
above). The bulky middle layer of the uterus, called the myometrium, is
composed of three muscle layers, which are thickest at the fundus and
thinnest at the cervix. Pound for pound, the uterus is the strongest
muscle in the female body. Amazingly, the thin muscle of cervix thins
and dilates with the rhythmic contractions of labor allowing the os to
open to 10 cm (much like a head being pushed through a tight turtleneck
shirt). The incredibly powerful muscles of the fundus push the baby
from within the uterus into the vagina during labor and as it is birthed
through the vulva. The innermost lining of the uterus is called the
endometrium and it creates a thick, specialized tissue each cycle that
is shed during menstruation. It is this velvety nourishing tissue that
becomes the site where the placenta grows during pregnancy to nourish
the fetus.
Branching from the top of the uterus, there are two oviducts (also
called uterine or Fallopian tubes) that open to body of the uterus. The
oviducts are muscular passageways that help sweep the egg from the
ovary to the uterus at ovulation. At the end of the oviducts are
finger-like structures called fimbriae, which move over the surface of
the ovary to engulf the egg released during ovulation- this looks like a
sea anemone moving in the ocean.
The fimbriae nestle two ovaries, which are organs about the size of
almonds. Each ovary holds many follicles, or tiny sacks that contain
immature eggs, which are not visible to the naked eye.
It is estimated that women are born with about 1-3 million immature
eggs, called oocytes or follicles, that live within the ovaries. Unlike a
man who produces his sex cells (sperm) every day, a woman is born with a
certain number of sex cells that gradually die over time beginning in
infancy and continuing through menopause. When a woman first gets her
period at puberty, only about 400,000 follicles remain in her ovaries.
With each menstrual cycle, a thousand follicles are lost and (usually)
only one follicle will actually mature into an ovum (egg), which is
released into the oviduct, marking ovulation. Depending on how many of
her reproductive years are spent pregnant or not ovulating due
breastfeeding, it is estimated that between only about 400 of the
original 1-3 million will ever mature into ova.
Hormones of the Menstrual Cycle
The menstrual cycle is a complex interaction of the six key hormones
(chemical messengers) that affect changes in the reproductive organs
(uterus, ovaries, breasts, and oviducts). It is divided into three
distinct phases: the follicular, ovulation, and the luteal phases.
The length of a menstrual cycle – counted from the beginning of one
menstrual period to the beginning of the next – can be different for
each woman or change from cycle to cycle for the same woman. You will
see that many menstrual cycle diagrams represent a 28 day cycle, which
is an average, but a healthy menstrual cycle can vary between 21-35
days.
Follicular Phase
The menstrual cycle begins when a woman begins bleeding, often called
getting her period. The menstrual fluid contains blood, cervical mucus,
vaginal secretions, and endometrial tissue, though most people just
refer to it as blood. At this point, estrogen and progesterone are the
lowest they will be throughout the cycle. Menstruation marks the
beginning of the follicular phase, which ends at ovulation. The length
of the follicular phase is variable and can be affected by diet, stress,
or illness.
Triggered by a complex series of chemical signals, the pituitary
gland in the brain begins to secrete two key hormones, Follicle
Stimulating Hormone (FSH) and Lutenizing Hormone (LH). The increase in
FSH and LH cause about 10-20 of the follicles within the ovaries to
begin to mature and they too release a hormone, called estrogen or
estradiol. Levels of estrogen in the body steadily increase as the
follicles continue to mature for about a week – this estrogen causes the
lining of the uterus to begin to thicken. Usually only one of the
maturing follicles becomes dominant, as it is most sensitive to
estrogen, LH, and FSH. When the estrogen level reaches a certain
threshold, it triggers the pituitary gland to release a large amount of
LH.
Cervical fluid in the follicular phase is typically scant or
tacky. For many women who are tracking cervical position, the cervix
feels hard, closed, and low. As ovulation approaches, the cervical
fluid becomes more watery and lubricative/slippery and stretchy like raw
eggwhites and the cervix begins to soften.
Ovulation
The spike in LH (seen as the peak in the green line on the graph
below) cause the fully mature dominant follicle to burst through the
wall of the ovary. The release of the mature ovum is called ovulation.
Some women literally
feel ovulation and experience ‘mittlesmertz,’ or a slight pain in one of their ovaries during ovulation.
The cervical mucous near ovulation is typically very stretchy,
slippery, and clear (looks and feels like eggwhites). This fertile
fluid helps the sperm move toward the egg and protects sperm from the
acidity of the vagina, which would normally kill them. The cervix feels
higher, softer, and more open.
Luteal Phase
The mature ovum released from the ovary at ovulation is swept by the
fimbriae into the oviduct by rhythmic muscular movement of the oviduct,
where it will live for about 24 hours if not fertilized by sperm. The
remains of the dominant follicle in the ovary is called the corpus
luteum and produces large amounts of progesterone during the luteal
phase. The length of the luteal phase is not variable and typically
lasts 14 days for most women, though a range of between 12-16 days is
considered normal.
If conception or implantation does not occur, the corpus luteum in
the ovary will shrivel about 14 days after ovulation and will cause a
sharp decrease in both estrogen and progesterone, triggering the onset
of menstruation and the beginning of a new menstrual cycle. The
unfertilized ovum is about the size of a grain of sand; it is shed as
part of the menstrual fluid.
Progesterone is high during the luteal phase; it is a heat
inducing hormone and thus raises the basal body temperature (BBT) by
several tenths of a degree for the duration of the cycle. The jump in
basal body temperature that remains steady indicates a woman has
ovulated.
The cervix feels low, firm, and closed during the luteal phase.
Conception
In order for conception to occur, semen must first survive the
acidity of the vagina (fertile cervical fluid changes the vaginal pH to
be more alkaline and sperm friendly) and then swim through the cervical
canal into the body of the uterus and then into the oviduct to greet a
woman’s egg. If an ovum is fertilized by sperm in the oviduct (called
conception), the fertilized egg (blastocyst) migrates into the uterine
lining, where it will implant approximately 7 to 14 days after
ovulation. The corpus luteum will continue to provide high levels of
progesterone to support pregnancy until the placenta takes over that job
in approximately 12 weeks.
How does the cervix change throughout the cycle?
If you’re already
charting your menstrual cycle, checking the position and texture of your
cervix each day can help you confirm where you are in your cycle. If
you’re not already charting, have a feel anyway – its a great skill to
have in your empowered woman toolbox!
Here’s how to feel your cervix:
- Wash your hands
- Squat or stand with one foot raised on a stool.
- Insert your longest finger into your vagina until you feel your
cervix. It will feel like a protruding nub/cylinder toward the back of
the soft walls of your vagina. If your finger is long enough, you should
be able to circle your finger all the way around the cervix and feel a
little dent in the middle of it (called the os, the opening to the
uterus).
- Note the following:
- How deep in your vagina is your cervix resting? (How much of your finger is inside of you?)
- Does your cervix feel soft, like pursed lips, or more firm, like the tip of your nose?
- Is your cervix angled to one side or aligned more centrally?
- Does your os feel slightly open and squishy or squeezed shut?
While menstruating, the cervix may feel firm and low and the os open
as it releases blood. It may be angled to one side slightly. Once all
the blood has been shed, the os again feels closed.
As ovulation nears, the rising levels of estrogen cause the ligaments
that attach the uterus to the pelvis to tighten and pull the uterus up
further into the body. Hence, the cervix gradually draws deeper in the
vagina and if often harder to reach near ovulation. The cervix may feel
softer (like pursed lips) be more centrally aligned, and the os slightly
open.
After ovulation, estrogen levels drop and the cervix usually resumes
feeling low, firm, and closed until she gets her period a few weeks
later. It is not uncommon for the cervix to be tilted to one side.
Not all women follow this pattern exactly so don’t worry if you
don’t. For example, women with retroverted (tipped) uteruses may find
thier cervix easier to reach near ovulation and women who have given
birth vaginally usually have softer cervices throughout the cycle. Its
empowering just to know what is normal for you. You may notice your
cervical changes vary from cycle to cycle or that you have a consistent
pattern that aligns with your other symptoms of fertility (cervical
fluid and basal body temperature).
The key is to check every day so you can feel the relative differences from day to day; cervical changes can be very subtle.
Check your cervix in
the same position and at the same time each day (i.e. in a squat before
showering in the morning), so you’re comparing apples to apples – or
cervices to cervices, as the case may be.
View Into the Vagina During Cervical Self-Exam
What Are Fertility Awareness Methods?
Men produce about 1000 sperm per second and are thus considered
fertile everyday. A man’s ejaculate contains between 50-500 million
sperm. Conception can only occur when one of these live sperm meets a
woman’s live egg.
Women ovulate (release an egg) once per menstrual cycle and the egg
lives a maximum of 24 hours. For a few days prior to ovulation, tiny
glands in the cervix called cervical crypts produce fertile cervical
fluid (a wet, often slippery, raw eggwhite consistency). This fertile
cervical fluid can help sperm survive for up to five days in the vagina
as they patiently wait for the egg to be released. So, even though her
egg itself only lives for about a day or less, women are considered to
have a ‘fertile window’ when they are producing fertile cervical fluid –
meaning that intercourse/insemination in that window of time could lead
to conception if the sperm stay alive (for a few hours or even days) in
the fertile fluid and then make their way into the Fallopian tube to
fertilize the egg after ovulation.
There
are a variety of methodologies for calculating a woman’s natural
fertility windows, both religious and secular – collectively they are
called Fertility Awareness Methods (FAM) or Natural Family Planning
(NFP). Some are less accurate and based on guessing a women’s fertility
based on averages of past cycles (Calendar methods/the Rhythm
Method/many period tracker Apps). Some are based in checking cervical
fluid only (the Ovulation Method). A very effective practice is called
the Symptothermal Method (STM) of FAM and is based on the scientific
facts that hormonal fluxes during a woman’s menstrual cycle cause
observable changes in the quality of her cervical fluid and a rise in
her basal body temperature (BBT, or temperature upon waking) after
ovulation.
In practice, STM is relatively simple: throughout the day, a woman
notices and records the sensation and quality of her cervical fluid as
it appears at her vulva or on her toilet paper after wiping. On this
chart, she also records her basal body temperature, taken orally,
vaginally or under her armpit when she first wakes up in the morning.
Optionally, some women also check the firmness and depth of their cervix
within their vagina to confirm the other two fertility signs on their
charts.
STM takes about 4-8 hours to learn, either through reading a book,
taking a workshop or during one-on-one lessons with a teacher/mentor.
Once initial guidelines are understood, STM takes a commitment of about 2
minutes a day to maintain and interpret data on her chart.
STM can become an empowering path of enhancing a woman’s overall body
literacy, increasing communication with her partner, and gauging her
overall health. STM can be used as a natural form of birth control, to
help achieve pregnancy, and to find underlying health issues that may be
affecting the regularity of her cycles or her fertility overall.
For instance, I’ve come to think that “fuck” was a reaction to “love making” which expresses shame of the generation that relied on it as a forced “nice” moralistic way of putting it (you can only have sex with “love” thereby making every other reason “not nice”). Both attitudes are opposite sides of the same coin – one moralistic and the other violently anti-moralistic, and neither really gets to the heart of the matter and does it justice. A term, like “mating” is much closer, and I kind of find this perspective here, in the Beautiful Cervix site.
To call a matter-of-fact term like “cervix” “beautiful” recognizes the truth of it, and frees it and everything it alludes to to be regarded more genuinely as part of a woman’s beauty and fascination, and even a source of true, personal eroticism – it can be deeply exciting to feel that you are part of that ancient, fundamental cycle.
Thanks you everyone for an incredibily refreshing site!
October 6th, 2013 at 8:03 pm
Also I do have the implanon birth control implant that doesn’t need to be removed until July. So I highly doubt I’m pregnant!
November 25th, 2013 at 4:06 pm
http://www.beautifulcervix.com/cervix-photo-galleries/
All galleries with a * are of women who have had children
Now I feel more comfortable thinking that the next time that I try to put it I will know where I need to do it.
Thanks a lot, all of you!!
now my cervix has changed thanks to childbirth hence my doula friend directed me to you,
we need to get back in touch with our bodies this website is great example of that.
March 16th, 2014 at 11:15 pm
Cloudy or opaque cervical mucous is common. “Creamy” or “tacky” cervical mucous is often cloudy if not outright opaque, and “egg white” cervical mucous can be a little cloudy as well.