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Some Cervical Disorders and Their Prevention

For women worldwide, cervical cancer is the third leading cause of death from cancer. In addition, cervicitis and condylomata can be significant problems for many women during their lifetime. Because January 2007 is Cervical Health Awareness Month, I thought it appropriate to review some aspects of these cervical disorders, with a focus on their prevention.

While the uterus is almost entirely made of smooth muscle, its lowermost portion, the cervix, is primarily composed of dense, fibrous material. This structural difference allows the cervix to play a critical role in pregnancy: the cervix remains tightly closed throughout gestation, thinning and opening at just the right time to allow for birth of the baby. Unfortunately, it is this unique makeup of the cervix which also predisposes it to disease.

Cervicitis is a painful inflammation of the cervix, most often caused by infection. The condition is common, affecting more than half of all women at some point during their adult life. Most cases of cervicitis are due to an overgrowth of bacteria which are normally present in the vagina. Sometimes, cervicitis can be caused by sexually transmitted diseases such as Chlamydia, Gonnorhea, Trichomonas, Herpes Virus, or Human Papilloma Virus. Painful intercourse, persistent vaginal discharge, and aching pelvic pain are some common symptoms of cervicitis. Many cases can be resolved with a simple course of antibiotic therapy.

Human Papilloma Virus (HPV) is the most common sexually-transmitted infection in the United States, affecting approximately one third of the sexually active adult population. HPV is transmitted through sexual intercourse. Although it usually causes no symptoms, certain strains of HPV can cause changes in the cells of the cervix, which may, over time, lead to cervical cancer. Pap smear screening has had a dramatic impact on the incidence of cervical cancer, as pre-cancerous changes can be detected and treated before cancer has a chance to develop.

HPV is also the cause of condylomata, or venereal warts. When these warts develop on the cervix, they rarely cause symptoms. However, when cervical condylomata are discovered during a pelvic examination, they indicate that one may be at a higher risk for developing pre-cancerous changes. Warts that develop below the level of the cervix are more frequently symptomatic, causing itching, burning, and discomfort during intercourse. Venereal warts that cause such symptoms may be treated with medicines, or with surgery.

Risk factors for the development of cervical disease include: having intercourse at an early age, having multiple sexual partners, and smoking. Prevention of cervical disease is therefore aimed at modifying these risk factors. Although condoms may help to reduce the transmission of HPV, the risk of spreading infection to sexual partners is still significant, since the virus often infects skin cells at the genital bases, which may remain in contact between partners even when a condom is properly used.

For the prevention of cervical cancer, the importance of regular pap smears cannot be overemphasized: if no previous changes have been noted, pelvic examinations should be performed once a year, beginning at age 18, or at the age of onset of sexual activity; if cervical changes have been noted, your health care provider will likely recommend more frequent follow-up.

On June 8, 2006, the US Food and Drug Administration announced a very exciting development: the approval of the first vaccine intended to prevent HPV infection. The new HPV vaccine has been designed to prevent infection with the strains of the virus that have been most frequently associated with the development of cervical disease and venereal warts. The HPV vaccine is currently approved for use in females from 9 to 26 years of age. This vaccine shows great promise toward reducing the development of cervical disease, especially cervical cancer.

For more information on maintaining cervical health, and on Cervical Health Awareness Month, please visit the National Cervical Cancer Coalition at: http://www.nccc-online.org/awareness.php.
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