BATES CHAPTER 21
• Vulva – collective term for external female genitalia
o Mons pubis – hair-covered fat pad overlying symphysis pubis
o Labia majora – rounded folded of adipose tissue forming outer lips of vagina
o Labia minora – thinner pinkish-red folds or inner lips that extend anteriorly to form prepuce
o Clitoris
o Vestibule – boat-shaped fossa between labia minora that surrounds opening of urethra
o Urethral meatus
o Introitus – vaginal opening
▪ May be partially occluded by hymen
o Peritoneum – tissue between introitus and anus
o Bartholin glands – located posteriorly on both sides of vaginal opening, not usually visible
▪ 4:00 and 8:00 position
o Paraurethral (Skene) glands – posterior and adjacent to urethral meatus bilaterally
• Vagina – Musculo membranous tube extending upward and posteriorly between urinary bladder and rectum
o Vaginal mucosa lies in transverse folds – rugae
o Cervix – firm, collagenous cylindrical organ with central slit or depression
o Cervix protrudes into vagina dividing upper vagina into 3 recesses (fornices) – anterior, posterior, lateral
fornix
• Uterus – thick-walled fibromuscular structure shaped like inverted pear
o Ectocervix – vaginal surface of cervix
▪ Columnar epithelium – plushy pink, surrounding os and lines endocervical canal
▪ Squamous epithelium – shiny pink, continuous with vaginal lining
▪ Squamocolumnar junction – boundary between the two
• Transformation zone – squamocolumnar junction migrated toward os
▪ Ectropion – broad band of columnar epithelium circling os, gradually replaced by squamous
epithelium during puberty
o External os of cervix – round, oval, of slit-like depression that marks the opening into endocervical canal
o Isthmus – lower portion of uterus connecting to cervix
o Corpus – body of uterus, superior to isthmus
o Fundus – upper portion of uterus
o Perimetrium – serosal outer coating of the uterus from the perineum
o Myometrium – distensible smooth muscle middle layer of uterus
o Endometrium – adherent inner coating of uterus, connects inferiorly to endocervical canal
• Adnexa - “appendages” – ovaries, fallopian tubes, supporting tissues
o Fallopian tubes – insert bilaterally into uterine fundus, collects oocyte from periovarian peritoneal cavity,
conducts it to uterine cavity
▪ Fimbria – fanlike tip that extends to ovary on each side,
o Ovaries – almond-shaped glands that vary in size (usually 3.5 x 2 x 1.5 cm)
▪ Production of oocytes
▪ Secretion of hormones – estrogen, progesterone, testosterone
• Increased hormone secretion during puberty stimulates growth of uterus and endometrial
lining, vaginal enlargement, thickening of vaginal epithelium, and development of secondary
sex characteristics (breasts and pubic hair)
▪ Within 3 to 5 years after menopause, ovaries atrophy and become nonpalpable
o Rectouterine pouch (pouch of Douglas) – behind uterus in the shape of a cul-de-sac
• Pelvic floor – sling of tissues composed of muscle ligaments, and endopelvic fascia that supports pelvic organs
o Muscles aid in sexual function (orgasm), urinary and fecal continence, stabilization of connecting joints
o Pelvic diaphragm – separates pelvic cavity from perineum, levator ani and coccygeal muscles, innervated by
sacral nerve roots S3 - S5
o Perineal membrane – triangular sheet of fibromuscular tissue contains bulbocavernosus and ischocavernosus
muscles, superficial transverse perineal body, external anal sphincter, innervated by pudendal nerve
, ▪ Spans anterior triangle anchoring urethra, vagina, perineal body to ischiopubic rami
o Urogenital (levator) hiatus – key-like opening of pelvic diaphragm allowing urethra, vagina, and anorectum to
pass through
o Deep urogenital diaphragm – 3rd supporting structure inferior to pelvic diaphragm, innervated by pudendal
nerve
▪ External urethral sphincter, urethra, and supporting deep transverse perineal muscle
▪ Posterior triangle – external anal sphincter muscle that encircles rectum and internal anal sphincter
• Lymphatics
o Lymph from vulva and lower vagina drains into inguinal nodes
o Lymph from internal genitalia drains into pelvic and abdominal nodes
• Menarche – onset of menses
• Dysmenorrhea – pain with menses, often with bearing down, aching or cramping sensation in lower abdomen or
pelvis
o Primary – increases prostaglandin production during luteal phase from menstrual cycle, when estrogen and
progesterone level decline
o Secondary – endometriosis, adenomyosis (endometriosis in muscular layers of uterus), pelvic inflammatory
disease, endometrial polyps
• Premenstrual syndrome (PMS) – cluster of emotional, behavioral, and physical symptoms occurring 5 days before
menses for 3 consecutive cycles, symptoms stop within 4 days after onset and interference with daily activities
o Depression, angry bursts, irritability, anxiety, confusion, crying spells, sleep disturbance, poor concentration,
social withdrawal
• Amenorrhea – absence of menses
o Primary – absence of ever initiating periods
o Secondary – cessation of periods after they have been established
• Abnormal uterine bleeding – bleeding between menses including infrequent, excessive, prolonged, or
postmenopausal bleeding
o Menorrhagia – bleeding heavier or longer duration than usual, tends to be bright red with clots
o Metrorrhagia – spotting or bleeding between menstruation
o Menometrorrhagia – combination of two above
• Menopause – absence of menses for 12 consecutive months, usually occurring between 48 and 55 yr
o Perimenopause – stages of variable cycle length and erratic cyclical bleeding with hot flashes, flushing, and
sweating
o Ovaries stop producing estradiol and progesterone, estrogen levels drop significantly
o Mood shifts, changes in self-image, hot flashes, accelerated bone loss, increased total and low-density
lipoprotein cholesterol, vulvovaginal atrophy with vaginal drying, dysuria, dyspareunia
o Early menopause – premature ovarian failure – symptoms similar menopause prior to 40, average early onset
27 years
o Postmenopausal bleeding – bleeding occurring 6 + months after cessation of menses
• Average age at menarche in US – 9 to 16
o Often takes at least 1 year for menstrual cycles to settle into regular pattern
• Interval between periods ranges from 24 to 32 days, menstrual flow lasts 3 to 7 days
• Menstrual history – age at menarche, last menstrual period (LMP), prior menstrual period (PMP)
• Flow can be assessed by number of pads or tampons used daily – make sure to verify size used
o Soaks tampon/pad or spots it lightly
• Acute pelvic pain in menstruating adolescent girls and women warrants immediate attention
o Differential diagnoses are broad but include life-threatening conditions
▪ Ectopic pregnancy
▪ Ovarian torsion
▪ Appendicitis
▪ Mittelschmerz – mild unilateral pain lasting for a few hours to a few days arising at midcycle from
ovulation, ruptured ovarian cyst, or tubo-ovarian abscess
• Chronic pelvic pain – pain that lasts more than 6 months and does not respond to treatment
o Pelvic Pain Assessment Form of the International Pelvic Pain Society
, o Endometriosis – retrograde menstrual flow and extension of uterine lining outside the uterus
o Pelvic inflammatory disease
o Fibroids – tumors in uterine wall or submucosal or subserosa surfaces arising from smooth muscle cells of
myometrium
• For patients younger than 21 years old, pelvic examinations should only be performed when indicated by medical
history
• Lithotomy position – slide all the way down examining table until buttocks extend slightly beyond edge
• Introduce speculum at 30° downward toward cervix
o Pedersen speculum – most comfortable for sexually active, narrow-bladed, best for small introitus
o Graves speculum – best for parous women with vaginal prolapse
• Tanner stages pg 1048
• Pediculosis pubis – lice or “crabs,” excoriations or small itchy red maculopapules, often at bases of pubic hairs
• Cervical cancer
o 4th most frequently diagnoses cancer among women and 4th leading cause of cancer death in women
▪ Much lower in developed countries
o Human papillovirus (HPV), usually types 16 and 18
▪ sexually transmitted
▪ 9-valent vaccine – targets HPV infections that cause cervical, vulvar, vaginal, anal, and oropharyngeal
cancers as well as most anogenital warts
▪ ACIP – routine vaccine for females and males beginning at 11 to 12 years
• If vaccinated before 15, recommend 2 doses of HPV vaccine within 6 to 12 months
• If vaccinated 15 to 20 and immunocompromised 9 to 26, recommend 3 doses of HPV vaccine
(0, 1 to 2, and 6 months)
• Recommended for all persons through 26 who were not previously adequately vaccinated
• Recommend clinicians consider discussing HPV vaccination for adults 27 to 45 who were note
adequately vaccinated and who are at risk for acquiring new HPV vaccinations
• Vaccinated women should still get cervical cancer screening, using condoms does not
eliminate risk of cervical HPV infections Box 21-5
o Pap smears can identify high-risk precancerous changes
▪ Average risk – having no history of high-grade precancerous cervical lesion or cervical cancer, not
being immunocompromised, and having no in utero exposure to DES
o USPSTF grade A – screening women ages 21 to 65
▪ 21 to 29 – every 3 years with cytology alone
▪ 30 to 65 – every 3 years with cytology alone, every 5 years with HPV testing for high-risk types alone,
every 5 years with both tests together
o Grade D – screening younger than 21, average-risk 65+ with adequate previous screening, s/p hysterectomy
with removal of cervix
o Primary high-risk testing alone can be used starting at age 25
• Postmenopausal hormone replacement therapy (HRT) – receiving hormones increased risks for cardiovascular disease
events and breast cancer
o USPSTF grade D – use of either estrogen alone (s/p hysterectomy) or combined use of estrogen and progestin
for preventing chronic conditions in postmenopausal women
• Ovarian cancer
o 5th leading cause of cancer death in US women
o BRCA 1 or BRCA 2 association
o USPSTF grade D – any ovarian cancer screening among asymptomatic, average risk women
Lesions of vulva
• Epidermoid cyst – small firm round yellowish nodule in labia
o Look for dark punctum marking blocked gland opening
• Venereal wart (Condyloma Acuminatum) – warty lesion of labia and within vestibule, from HPV infection
• Syphilitic chancre – firm painless ulcer from primary syphilis forms ~ 21 days after exposure
, o May remain hidden and undetected in vagina
o Heals regardless of treatment in 3 to 6 weeks
• Secondary syphilis (Condyloma Latum) – large raised, round or oval, flat-topped gray or white lesions
o Contagious
o Rash and mucous membrane sores in mouth, vagina, anus
• Genital herpes (HSV 1 or HSV 2) – shallow small painful ulcers on red bases
o May take 2 to 4 weeks to heal
o Recurrent outbreaks of localized vesicles, then ulcers
• Carcinoma of vulva – ulcerated or raised red vulvar lesion in elderly woman
o Usually squamous cell carcinoma arising on labia
Bulges and swelling of vulva, vagina, and urethra
• Cystocele – bulge of upper two-thirds of anterior vaginal wall together with bladder
o Weakened anterior supporting tissues
• Cystourethrocele – entire anterior vaginal wall, bladder and urethra produce bulge
• Urethral caruncle – small red benign tumor visible at posterior urethral meatus
• Prolapse of urethral mucosa – swollen red ring around urethral meatus
• Bartholin gland infection
o Acute – gland appears tense, hot, very tender abscess
▪ Look for pus from duct or erythema around duct
o Chronic – nontender cyst
• Rectocele – herniation of rectum into posterior wall of vagina
Vaginal discharge
• Physiologic discharge – clear or white, possible white clumps, not malodorous
• Trichomonal vaginitis – yellowish green or gray, frothy, profuse, and pooled at vaginal fornix, malodorous
o Trichomonas vaginalis, not always sexually acquired
o Mild pruritis, pain on urination, dyspareunia
o Scan saline wet mount for trichomonads
• Candidal vaginalis – white and curdy, typically thick, nor profuse, not malodorous
o Candida albicans
o Pruritis, vaginal soreness, pain on urination, dyspareunia
o Scan KOH for branching hyphae of Candida
• Bacterial vaginosis – gray or white, thin, homogenous, malodorous, coats vaginal walls, not profuse
o Bacterial overgrowth, often sexually transmitted
o Unpleasant fishy or musty genital odor
o Scan saline wet prep for clue cells, sniff for fishy odor after applying KOH, test vaginal secretions for pH > 4.5
Variations of cervical surface
• Squamous epithelium – shiny pink
• Columnar epithelium – deep red, plushy
• Metaplasia – columnar epithelium transformed into squamous epithelium as estrogen increases during adolescence
• Retention cyst (Nabothian cyst) – blockage of secretions of columnar epithelium, translucent nodule on cervix
• Cervical polyp – bright red, soft, fragile
Shape of cervical os
• Normal – oval, slit-like
• Types of lacerations from delivery – bilateral transverse, stellate, unilateral transverse
Abnormalities of cervix
• Mucopurulent cervicitis – purulent yellow drainage from os r/t C. trachomatis, N. gonorrheae, herpes infection
• Vulva – collective term for external female genitalia
o Mons pubis – hair-covered fat pad overlying symphysis pubis
o Labia majora – rounded folded of adipose tissue forming outer lips of vagina
o Labia minora – thinner pinkish-red folds or inner lips that extend anteriorly to form prepuce
o Clitoris
o Vestibule – boat-shaped fossa between labia minora that surrounds opening of urethra
o Urethral meatus
o Introitus – vaginal opening
▪ May be partially occluded by hymen
o Peritoneum – tissue between introitus and anus
o Bartholin glands – located posteriorly on both sides of vaginal opening, not usually visible
▪ 4:00 and 8:00 position
o Paraurethral (Skene) glands – posterior and adjacent to urethral meatus bilaterally
• Vagina – Musculo membranous tube extending upward and posteriorly between urinary bladder and rectum
o Vaginal mucosa lies in transverse folds – rugae
o Cervix – firm, collagenous cylindrical organ with central slit or depression
o Cervix protrudes into vagina dividing upper vagina into 3 recesses (fornices) – anterior, posterior, lateral
fornix
• Uterus – thick-walled fibromuscular structure shaped like inverted pear
o Ectocervix – vaginal surface of cervix
▪ Columnar epithelium – plushy pink, surrounding os and lines endocervical canal
▪ Squamous epithelium – shiny pink, continuous with vaginal lining
▪ Squamocolumnar junction – boundary between the two
• Transformation zone – squamocolumnar junction migrated toward os
▪ Ectropion – broad band of columnar epithelium circling os, gradually replaced by squamous
epithelium during puberty
o External os of cervix – round, oval, of slit-like depression that marks the opening into endocervical canal
o Isthmus – lower portion of uterus connecting to cervix
o Corpus – body of uterus, superior to isthmus
o Fundus – upper portion of uterus
o Perimetrium – serosal outer coating of the uterus from the perineum
o Myometrium – distensible smooth muscle middle layer of uterus
o Endometrium – adherent inner coating of uterus, connects inferiorly to endocervical canal
• Adnexa - “appendages” – ovaries, fallopian tubes, supporting tissues
o Fallopian tubes – insert bilaterally into uterine fundus, collects oocyte from periovarian peritoneal cavity,
conducts it to uterine cavity
▪ Fimbria – fanlike tip that extends to ovary on each side,
o Ovaries – almond-shaped glands that vary in size (usually 3.5 x 2 x 1.5 cm)
▪ Production of oocytes
▪ Secretion of hormones – estrogen, progesterone, testosterone
• Increased hormone secretion during puberty stimulates growth of uterus and endometrial
lining, vaginal enlargement, thickening of vaginal epithelium, and development of secondary
sex characteristics (breasts and pubic hair)
▪ Within 3 to 5 years after menopause, ovaries atrophy and become nonpalpable
o Rectouterine pouch (pouch of Douglas) – behind uterus in the shape of a cul-de-sac
• Pelvic floor – sling of tissues composed of muscle ligaments, and endopelvic fascia that supports pelvic organs
o Muscles aid in sexual function (orgasm), urinary and fecal continence, stabilization of connecting joints
o Pelvic diaphragm – separates pelvic cavity from perineum, levator ani and coccygeal muscles, innervated by
sacral nerve roots S3 - S5
o Perineal membrane – triangular sheet of fibromuscular tissue contains bulbocavernosus and ischocavernosus
muscles, superficial transverse perineal body, external anal sphincter, innervated by pudendal nerve
, ▪ Spans anterior triangle anchoring urethra, vagina, perineal body to ischiopubic rami
o Urogenital (levator) hiatus – key-like opening of pelvic diaphragm allowing urethra, vagina, and anorectum to
pass through
o Deep urogenital diaphragm – 3rd supporting structure inferior to pelvic diaphragm, innervated by pudendal
nerve
▪ External urethral sphincter, urethra, and supporting deep transverse perineal muscle
▪ Posterior triangle – external anal sphincter muscle that encircles rectum and internal anal sphincter
• Lymphatics
o Lymph from vulva and lower vagina drains into inguinal nodes
o Lymph from internal genitalia drains into pelvic and abdominal nodes
• Menarche – onset of menses
• Dysmenorrhea – pain with menses, often with bearing down, aching or cramping sensation in lower abdomen or
pelvis
o Primary – increases prostaglandin production during luteal phase from menstrual cycle, when estrogen and
progesterone level decline
o Secondary – endometriosis, adenomyosis (endometriosis in muscular layers of uterus), pelvic inflammatory
disease, endometrial polyps
• Premenstrual syndrome (PMS) – cluster of emotional, behavioral, and physical symptoms occurring 5 days before
menses for 3 consecutive cycles, symptoms stop within 4 days after onset and interference with daily activities
o Depression, angry bursts, irritability, anxiety, confusion, crying spells, sleep disturbance, poor concentration,
social withdrawal
• Amenorrhea – absence of menses
o Primary – absence of ever initiating periods
o Secondary – cessation of periods after they have been established
• Abnormal uterine bleeding – bleeding between menses including infrequent, excessive, prolonged, or
postmenopausal bleeding
o Menorrhagia – bleeding heavier or longer duration than usual, tends to be bright red with clots
o Metrorrhagia – spotting or bleeding between menstruation
o Menometrorrhagia – combination of two above
• Menopause – absence of menses for 12 consecutive months, usually occurring between 48 and 55 yr
o Perimenopause – stages of variable cycle length and erratic cyclical bleeding with hot flashes, flushing, and
sweating
o Ovaries stop producing estradiol and progesterone, estrogen levels drop significantly
o Mood shifts, changes in self-image, hot flashes, accelerated bone loss, increased total and low-density
lipoprotein cholesterol, vulvovaginal atrophy with vaginal drying, dysuria, dyspareunia
o Early menopause – premature ovarian failure – symptoms similar menopause prior to 40, average early onset
27 years
o Postmenopausal bleeding – bleeding occurring 6 + months after cessation of menses
• Average age at menarche in US – 9 to 16
o Often takes at least 1 year for menstrual cycles to settle into regular pattern
• Interval between periods ranges from 24 to 32 days, menstrual flow lasts 3 to 7 days
• Menstrual history – age at menarche, last menstrual period (LMP), prior menstrual period (PMP)
• Flow can be assessed by number of pads or tampons used daily – make sure to verify size used
o Soaks tampon/pad or spots it lightly
• Acute pelvic pain in menstruating adolescent girls and women warrants immediate attention
o Differential diagnoses are broad but include life-threatening conditions
▪ Ectopic pregnancy
▪ Ovarian torsion
▪ Appendicitis
▪ Mittelschmerz – mild unilateral pain lasting for a few hours to a few days arising at midcycle from
ovulation, ruptured ovarian cyst, or tubo-ovarian abscess
• Chronic pelvic pain – pain that lasts more than 6 months and does not respond to treatment
o Pelvic Pain Assessment Form of the International Pelvic Pain Society
, o Endometriosis – retrograde menstrual flow and extension of uterine lining outside the uterus
o Pelvic inflammatory disease
o Fibroids – tumors in uterine wall or submucosal or subserosa surfaces arising from smooth muscle cells of
myometrium
• For patients younger than 21 years old, pelvic examinations should only be performed when indicated by medical
history
• Lithotomy position – slide all the way down examining table until buttocks extend slightly beyond edge
• Introduce speculum at 30° downward toward cervix
o Pedersen speculum – most comfortable for sexually active, narrow-bladed, best for small introitus
o Graves speculum – best for parous women with vaginal prolapse
• Tanner stages pg 1048
• Pediculosis pubis – lice or “crabs,” excoriations or small itchy red maculopapules, often at bases of pubic hairs
• Cervical cancer
o 4th most frequently diagnoses cancer among women and 4th leading cause of cancer death in women
▪ Much lower in developed countries
o Human papillovirus (HPV), usually types 16 and 18
▪ sexually transmitted
▪ 9-valent vaccine – targets HPV infections that cause cervical, vulvar, vaginal, anal, and oropharyngeal
cancers as well as most anogenital warts
▪ ACIP – routine vaccine for females and males beginning at 11 to 12 years
• If vaccinated before 15, recommend 2 doses of HPV vaccine within 6 to 12 months
• If vaccinated 15 to 20 and immunocompromised 9 to 26, recommend 3 doses of HPV vaccine
(0, 1 to 2, and 6 months)
• Recommended for all persons through 26 who were not previously adequately vaccinated
• Recommend clinicians consider discussing HPV vaccination for adults 27 to 45 who were note
adequately vaccinated and who are at risk for acquiring new HPV vaccinations
• Vaccinated women should still get cervical cancer screening, using condoms does not
eliminate risk of cervical HPV infections Box 21-5
o Pap smears can identify high-risk precancerous changes
▪ Average risk – having no history of high-grade precancerous cervical lesion or cervical cancer, not
being immunocompromised, and having no in utero exposure to DES
o USPSTF grade A – screening women ages 21 to 65
▪ 21 to 29 – every 3 years with cytology alone
▪ 30 to 65 – every 3 years with cytology alone, every 5 years with HPV testing for high-risk types alone,
every 5 years with both tests together
o Grade D – screening younger than 21, average-risk 65+ with adequate previous screening, s/p hysterectomy
with removal of cervix
o Primary high-risk testing alone can be used starting at age 25
• Postmenopausal hormone replacement therapy (HRT) – receiving hormones increased risks for cardiovascular disease
events and breast cancer
o USPSTF grade D – use of either estrogen alone (s/p hysterectomy) or combined use of estrogen and progestin
for preventing chronic conditions in postmenopausal women
• Ovarian cancer
o 5th leading cause of cancer death in US women
o BRCA 1 or BRCA 2 association
o USPSTF grade D – any ovarian cancer screening among asymptomatic, average risk women
Lesions of vulva
• Epidermoid cyst – small firm round yellowish nodule in labia
o Look for dark punctum marking blocked gland opening
• Venereal wart (Condyloma Acuminatum) – warty lesion of labia and within vestibule, from HPV infection
• Syphilitic chancre – firm painless ulcer from primary syphilis forms ~ 21 days after exposure
, o May remain hidden and undetected in vagina
o Heals regardless of treatment in 3 to 6 weeks
• Secondary syphilis (Condyloma Latum) – large raised, round or oval, flat-topped gray or white lesions
o Contagious
o Rash and mucous membrane sores in mouth, vagina, anus
• Genital herpes (HSV 1 or HSV 2) – shallow small painful ulcers on red bases
o May take 2 to 4 weeks to heal
o Recurrent outbreaks of localized vesicles, then ulcers
• Carcinoma of vulva – ulcerated or raised red vulvar lesion in elderly woman
o Usually squamous cell carcinoma arising on labia
Bulges and swelling of vulva, vagina, and urethra
• Cystocele – bulge of upper two-thirds of anterior vaginal wall together with bladder
o Weakened anterior supporting tissues
• Cystourethrocele – entire anterior vaginal wall, bladder and urethra produce bulge
• Urethral caruncle – small red benign tumor visible at posterior urethral meatus
• Prolapse of urethral mucosa – swollen red ring around urethral meatus
• Bartholin gland infection
o Acute – gland appears tense, hot, very tender abscess
▪ Look for pus from duct or erythema around duct
o Chronic – nontender cyst
• Rectocele – herniation of rectum into posterior wall of vagina
Vaginal discharge
• Physiologic discharge – clear or white, possible white clumps, not malodorous
• Trichomonal vaginitis – yellowish green or gray, frothy, profuse, and pooled at vaginal fornix, malodorous
o Trichomonas vaginalis, not always sexually acquired
o Mild pruritis, pain on urination, dyspareunia
o Scan saline wet mount for trichomonads
• Candidal vaginalis – white and curdy, typically thick, nor profuse, not malodorous
o Candida albicans
o Pruritis, vaginal soreness, pain on urination, dyspareunia
o Scan KOH for branching hyphae of Candida
• Bacterial vaginosis – gray or white, thin, homogenous, malodorous, coats vaginal walls, not profuse
o Bacterial overgrowth, often sexually transmitted
o Unpleasant fishy or musty genital odor
o Scan saline wet prep for clue cells, sniff for fishy odor after applying KOH, test vaginal secretions for pH > 4.5
Variations of cervical surface
• Squamous epithelium – shiny pink
• Columnar epithelium – deep red, plushy
• Metaplasia – columnar epithelium transformed into squamous epithelium as estrogen increases during adolescence
• Retention cyst (Nabothian cyst) – blockage of secretions of columnar epithelium, translucent nodule on cervix
• Cervical polyp – bright red, soft, fragile
Shape of cervical os
• Normal – oval, slit-like
• Types of lacerations from delivery – bilateral transverse, stellate, unilateral transverse
Abnormalities of cervix
• Mucopurulent cervicitis – purulent yellow drainage from os r/t C. trachomatis, N. gonorrheae, herpes infection
