Issues with a low cervix
Dear Dr Mitchell,
I have always heard the term “having a low cervix”, but I have seen many different responses to this diagnosis. I would love for some clarification on the matter of a low cervix as it relates to pregnancy, sex, pain during sex, lower back pain and menstruation.
A low cervix is a term used to describe a cervix that is felt low in the vagina, sometimes at the opening of the vagina, or even outside of the vagina in severe cases of uterine prolapse. This occurs when the pelvic floor muscles are overstretched and damaged, more commonly during childbirth. The risk for this increases with the delivery of big babies, forceps delivery, vacuum delivery, prolonged second stage of labour with excessive pushing to deliver the head of the baby, and precipitous labour with an extremely short period of pushing and rapid delivery of the foetus. Damage to the pelvic floor may also occur if there are extensive lacerations in the vagina.
As women get older, the significant decline in the level of oestrogen causes the pelvic floor muscles to become weaker, lose their nerve supply, and prolapse of the uterus, cervix, bladder and rectum occurs. Chronic constipation, chronic coughing, severe asthma and chronic obstructive airway disease (emphysema), smoking, diabetes mellitus, and heavy lifting also contribute to damage to the pelvic floor muscles over a prolonged period of time.
This can cause back pain, pain during sexual activity, and an increased risk for infections. The cervix protrudes outside the vaginal opening in severe cases and ulceration can occur resulting in infection and chronic vaginal discharge. Leaking urine during coughing, sneezing, exercise and sexual activity may also occur in some women with prolapse of the anterior vaginal wall and bladder.
Pelvic floor prolapse also increases the risk for a pregnancy loss in the early stage of pregnancy.
A low cervix is sometimes used to describe a weak cervix as occurs in cervical incompetence where the muscles of the internal cervical opening have become weak and damaged. This may occur if a part of the cervix is removed because of precancerous changes in the cervix, repeated termination of pregnancy, and dilatation of the cervix for other medical reasons. This may also be an inherent condition and is familial in some cases. Women who take diethylstilbestrol in pregnancy are at risk of their female offspring having an abnormal T-shaped uterus and cervical incompetence. This then puts them at risk for recurrent pregnancy losses. The placement of a cervical suture (cervical cerclage) helps to correct the problem during pregnancy, and allows the woman to carry the pregnancy to term.
In cases of prolapse of the cervix, pelvic floor exercises, change in lifestyle with elimination of the identified risk factors, weight loss in obese women, and the use of a ring pessary or surgical correction can be undertaken. Surgery may involve removing the uterus and cervix or shortening the ligaments and restoring the cervix to its normal position.
Lifestyle changes with elimination of the identified risk factors are vital in preventing recurrence of the low cervix or prolapse.
Best regards.
Dr Sharmaine Mitchell is an obstetrician and gynaecologist. Send questions via e-mail to allwoman@jamaicaobserver.com; write to All Woman, 40-42 1/2 Beechwood Ave, Kingston 5; or fax to 968-2025. All responses are published. Dr Mitchell cannot provide personal responses.
DISCLAIMER:
The contents of this article are for informational purposes only and must not be relied upon as an alternative to medical advice or treatment from your own doctor.
