Diagram of the cervix in parous (have given birth) and non-parous (have not given birth) individuals.
The cervix: An owner’s manual
Your ultimate guide to the cervix
TL/DR: January is Cervical Health Awareness Month, and to celebrate, we’re giving the cervix center stage. This guide includes a briefer on the cervix, a how-to guide on finding your very own cervix, and important info on cervical cancer prevention.
Along with popping bubbly and setting your intentions this New Year, take a moment to celebrate the one who’s been with you since the start of this wild ride… your cervix. Yeah, maybe not what you expected us to say, but a fascinating and incredible body part nonetheless.
January is National Cervical Health Awareness Month, a dedicated excuse to learn, discuss, and ask questions about the cervix. So, whether you’re a cervix expert or you’re a total newbie to cervical health and terminology, this article is a great place to start. Read on to learn more about the little C that could.
Cervix 101: What it is & how to locate your cervix
This guide will give you the down-low on your down low: We’ll tell you exactly what the cervix is and does, walk you through the steps to find and feel your own cervix, and explain how the cervix is related to your cycle. We’ll also answer some frequently asked questions about Pap smears, HPV, and cervical cancer. Pull up a chair and let’s get to celebrating.
What is the cervix?
The cervix is a structure that divides the upper part of the uterus, known as the uterine body or sometimes uterine cavity, from the vaginal canal.1 It is a roughly donut-shaped structure that can contract and expand depending on what stage of the menstrual cycle you’re in, as well as throughout pregnancy.
The cervix is basically the gateway to your reproductive system: It lets a newborn baby out into the world, it’s the door through which your period blood flows, and it’s where an IUD must pass through during placement. When an object (or sperm) needs to get into your uterus from the outside, it must first pass through the ectocervix (by way of the external cervical os) and into the endocervical canal before it reaches the uterus or any other parts of the reproductive system.
In practical terms, this means that the cervix prevents bacteria and other pathogens from entering your uterus and potentially causing infection to you and/or a fetus, if present. It also can selectively allow sperm to enter and fertilize one of the eggs released from your ovary, leading to a pregnancy.
The average cervix structure is approximately 30 mm long. 2 During labor, the cervix will dilate up to 10 cm. That’s more than 30 times its original size!3 For some context, 1 cm is about the size of a Cheerio, whereas 10 cm is the size of a bagel. Name any other part of your body that can expand and contract that much in a matter of hours. We’ll wait.
How to find & feel your cervix
Self-exploration serves as an important educational tool when it comes to reproductive health. Have you ever felt your cervix? If your answer is “no” or, “um… I don’t know?” then fear not – this next part is for you.
First, a quick reminder (and this applies to menstrual product insertion, educational exploration, and/or recreational activities down there…): Wash your hands!
It might sound obvious (especially this year, of all years), but hand-washing with hot water and soap, including under your fingernails, for more than 30 seconds is the most effective way to make sure you’re hygienic and not bringing anything into that space. Think of it as an excuse to hum the chorus of the latest Ariana Grande song.
One more thing: it’s often recommended that your nails are short or neatly trimmed to prevent any micro-abrasions, as your cervix and surrounding tissue is somewhat sensitive.
Step 1: Position
You will have to position yourself in such a way that you can access the opening of the vagina and have some leverage to move around. Some folks choose to stand with one leg up, balancing on something like the edge of the bathtub or a closed toilet cover. Make sure you aren’t trying this on any slippery surface!
Other positions that might work: Squatting, lying on your back with knees open, or whatever space-creating yoga position is your fancy this week. If there’s a position that works well for you when inserting a menstrual cup or disc, try that.
If you happen to have a speculum lying around (this is a long shot, but, hey, you never know!), you can also try inserting it with a little bit of body-safe lubricant while lying down, and then proceed with the next few steps. Make sure you talk to your provider about how to properly use a speculum if you’re using one at home for the first time.
Step 2: Timing
Some people find that locating their cervix right after a warm shower or bath is helpful, as the area is generally more relaxed, your hands are warm, and things may be easier to navigate. It also may be helpful to practice this for the first time when you’re not on your period, although this is, of course, personal preference (period blood is slippery!).
Step 3: Exploration
Moving slowly, insert your longest finger (usually the middle finger) into the vagina and keep inserting until about your first or second knuckle. Take a pause here and see if you can feel anything that may be your cervix. If not, you can continue to insert until you do feel something: Depending on the time of the month and your individual anatomy, the cervix may be sitting higher (or lower) than you might’ve expected.
In addition, keep in mind that your cervix may not be centered at the end of the vaginal canal; its “symmetry” relative to your vagina also has to do with your cycle.
Pro tip: To make things a little easier, you can lube up your finger with a tiny bit of water-based, body-safe lubricant, first.
How will you know when you’ve found your cervix? At the end of your vaginal canal, you should feel a roughly circular-shaped protrusion – this is your cervix! Again, depending on the time of the month (more on that later), it may feel soft and squishy or firm and uniform. You may even be able to feel the cervical os, which is the tiny hole-like opening of the cervix, but don’t sweat it if you can’t.
Remember: everyone’s cervix is unique! If these descriptors don’t match your cervix-finding experience, don’t worry – you’re not an alien and you’re not missing a body part. It might just take a little time to get familiar with your own internal anatomy.
To enhance the learning experience, practice feeling for your cervix at different stages of your menstrual cycle, like during ovulation (roughly halfway through your cycle) or menstruation, to see how the texture, rigidity, shape, or height of your cervix changes over time.
Want to take a photograph of your own, beautiful cervix? Pick up a self-exam kit from The Beautiful Cervix Project, a collective that encourages people with cervices to learn cervical self-exam and fertility awareness in order to promote respect, confidence, and health.
Check out more photographs of cervices submitted to the Project here. Note: External genitalia is not visible in any of the photos, but they are all taken by using a speculum to open the vagina to view the cervix. Please view at your discretion.
How deep is the cervix?
The “average” cervix is located somewhere between 2.5 and 5 inches deep within the vaginal canal. However, the look, feel, and placement (or depth) of your cervix will change throughout your cycle depending on what else is going on in your reproductive system.4 5
Also, keep in mind that these measurements can change dramatically during sexual arousal: Sexual excitement actually causes the upper two-thirds of the vagina to lengthen by forcing both the cervix and uterus to ascend (i.e. move higher up within your body).
How the cervix changes position throughout your cycle
During ovulation, the cervix is wholly focused on allowing sperm to enter the uterus so they can swim upwards and join with the released eggs for fertilization. Here’s a helpful acronym to remember what the cervix is like during ovulation: SHOW. Soft, high, open, and wet.
The cervix will be softer, almost comparable to the softness of your lips; it will be high, i.e. located deeper in the vaginal canal; it will be open, so that the cervical os can allow sperm to enter; and it will be wet, meaning that it is releasing protective secretions to protect the local environment from the relatively acidic sperm.
As you approach menstruation, the cervix will feel harder to the touch, something like the cartilage of your ear or the tip of your nose, and will also drop lower. The cervical os will become smaller, and the cervix generally produces less discharge during this time (in your luteal phase) when compared to ovulation.
Another really interesting fact about the cervix? Not only does it change its position or “height,” but it may also change its angle in relation to the vaginal canal. This means that, if you imagine the cervix as a donut, the hole of the donut may rotate to point upwards, downwards, or even out to the side.
Like most cervical changes, this is subject to individual variation and may also depend on the shape of your uterus. For example, if you’ve been told by a healthcare provider that you have a retroverted uterus, then your cervix may be angled upwards at its “baseline.” FYI, an estimated 20% of the population has a retroverted uterus.6
To summarize, the cervix moves and changes texture throughout your cycle. During ovulation the cervix will SHOW (soft, high, open, wet) us it’s ready for fertilization, whereas during menstruation the cervix will be harder to the touch and lower, with less discharge (no acronym for this one – but let us know if you think of one!).
Tips for using menstrual cups & discs with a high or low cervix
Remember that menstrual blood exits through the cervical os, so, when choosing a menstrual product, it may be helpful to think about where your unique cervix lies. Like we just discussed, there are general trends of how the cervix changes throughout your cycle. But there are person-to-person variations in the cervix’s “baseline” position, ranging from how high it sits in the vaginal canal to the angle of the os.
These individual variations may impact the comfort and effectiveness of certain menstrual products, including menstrual cups and discs – both of which are placed near the cervix. If you have a “low” cervix, for example, you may find it a bit more difficult to correctly place and position a menstrual cup since there may be less internal “square footage” (i.e. length of vaginal canal) to work with.
Think back to that magical moment when you felt your cervix for the first time. It may have taken a couple tries, and some very experimental stretching, but you felt *something* that maybe, possibly is your cervix.
Do you remember how many knuckles of your finger were inserted at that time? How about this: did you have to angle deeper, or did you feel it fairly soon upon insertion? These are clues that can let you know whether you might have a low, high, or average cervix at baseline.
If you think you may have a low or high cervix and you’ve been having a hard time with certain period products (i.e. leaks, discomfort), here are a few tips from the Flexperts:
LOW CERVIX & PERIOD PRODUCTS:
A low cervix will sit closer to the vaginal opening within the canal. It may require only one to two knuckles to feel, as opposed to the entire finger.
If your cervix sits low, it may be a bit easier to insert and remove products like Flex Disc™ since you won’t have to reach as far into the canal. However, make sure that you continue to push the rim of the disc down (towards your tailbone) such that it completely surrounds the cervix – and then tuck the front rim behind your pubic bone.
If you have a low cervix and you’re having trouble using a menstrual cup, it might be due to the fact that the cup is too long for the depth of your vaginal canal, making it very easy to push the rim of the cup over to one side rather than creating a complete seal beneath the cervix.
Alternatively, a low cervix may end up sitting inside your menstrual cup. If you suspect this to be the problem, run your finger around the cup’s rim to see if you’ve missed the cervix, in which case you can try to pinch the base of the cup and pull down until it’s below the cervix. Then, angle the cup towards your cervix and do another finger check to ensure that everything is sitting properly.
Another tip for cup users? A low cervix also means you may need to empty your menstrual cup more frequently or consider a larger size, as your cervix could be dipping into the cup and taking away some of the space for blood to collect. If you’re experiencing menstrual cup leakage, this could be why.
HIGH CERVIX & PERIOD PRODUCTS:
A high cervix will sit deeper within the canal. It may require the entire length of the finger to feel, and probably some finagling. Not to fear: all period products can be used with a high cervix. You may just need to spend a bit more time experimenting with insertion and removal until you master your technique.
Menstrual disc removal may be a challenge for folks with a high cervix – and cup removal, too, especially if the cup you use doesn’t have a pull-tab to grasp.
Here’s a disc removal pro tip: If you have a high cervix (or if your cervix has migrated higher up than usual, as it sometimes does after penetrative sex) and you’re struggling to hook your finger under your Flex Disc to remove it, bear down on your pelvic floor muscles like you’re trying to poop. Do this while you have a finger inserted: You should feel the rim of the disc move downwards, making it easier to remove.
When inserting a menstrual disc, those with a high cervix may not, at first, push the disc in far enough – which can lead to leakage or discomfort. During insertion, remember to angle your disc down (towards your tailbone) and keep pushing it back as far as it will go, all the way into the posterior fornix. Then tuck the front rim of the disc securely behind your tailbone.
Are you a menstrual cup user with a high cervix? You may prefer a longer cup or one with a pull-tab (like Flex Cup™) so that it’s easier to grasp for removal. Remember, you want your menstrual cup to sit close enough to the cervix to create a complete seal, collecting your period blood leak-free. If you feel like you have to shove your cup so far up that it’s almost out of reach – and super annoying to remove – take a longer or larger capacity cup for a spin.
“AVERAGE” CERVIX & PERIOD PRODUCTS:
An average cervix is… trick question, there’s no such thing! The position of the cervix is relative to the person it’s in. What is high for you may be average for another, and vice versa. This goes to show why self-exploration is an important tool for understanding your body.
Not all period products are a perfect match for all body types. If you’ve been struggling for months to get a certain product to work for you and are still leaking or experiencing discomfort, it may be time to switch products. Even switching brands can help: Some users that haven’t been able to get Flex Disc to work, for instance, have found success with our other menstrual disc brand, Softdisc. Softdisc looks and feels similar to Flex Disc, but its rim is made of a different polymer that works better for some folks.
Cervix 201: Pap smears, cervical cancer research, & HPV
On a more serious note, an important part of your cervical health awareness is cervical cancer awareness. Cervical cancer used to be one of the leading causes of death for women in the United States; however, in recent years, this number has gone down – largely as a result of increased Pap smears as well as the HPV vaccine (see: HPV Testing, below, for more information on this).7
Even though the numbers are improving, we can’t let up: In 2017, the CDC reported over 12,000 new cases of diagnosed cervical cancer in the United States and more than 4,000 deaths.8 The number one cause of cervical cancer is HPV, which is a virus that is spread through sexual contact.7 Cervical cancer awareness is a crucial part of maintaining your cervical – and overall – health.
Pap smears: How often & what to expect
The most common screening tool for cervical cancer is the Pap smear. If you have not had one, here’s what to expect:
The healthcare provider will use a speculum to assist them in visualizing the cervix. A speculum is a device that is inserted into your vagina (don’t worry – it’s lubricated!) and used to open up the vaginal walls to make it easier for your provider to take a look inside.
Your provider will then perform a visual examination of the area, as well as procure a tiny sample of the tissue to send for testing using a little tool called a spatula or, in some cases, a spatula and a brush, or a cytobrush, which is a combination of the two.
They’ll use the tool to lightly scrape a little bit of tissue from the cervix in order to test those cells for any abnormalities. The results should come back relatively quickly as this is a fairly routine procedure.
Does a Pap smear hurt?
We won’t lie, it’s not 100% comfortable – but, for most, it’s just like a quick scratch, by no means unbearable, and it’s over super fast (quicker than a flu shot!). If you’re anxious about it, just talk to your provider. They’ll be happy to walk you through the steps out loud and ease your nerves.
Can you get a Pap smear during your period?
According to the American Society of Clinical Oncology, “the best time to schedule your Pap test is at least five days after the end of your menstrual period. A Pap test can be done during your menstrual period, but it is better to schedule the test at another time.”
So, yes, you technically can get your Pap done during your period, but talk to your provider if it looks like your appointment will fall during your period: They may prefer to reschedule.
How often should you get a Pap smear?
The guidelines for cervical cancer screening change year to year but, in general, most professional societies (ACOG, USPSTF) currently recommend that everyone with a cervix have a Pap smear once every 3 years starting at age 21.9 After age 30 and at menopause, this frequency may be reevaluated by your healthcare provider depending on your health history and previous screening results.
HPV Testing: When is it necessary?
Hold up: what’s HPV? Short for human papillomavirus, HPV refers to a group of viruses spread through sexual contact. There are more than 100 human papillomaviruses and they range in classification from low- to high-risk in terms of prognosis and complications. Thankfully, the majority are low-risk.
Some HPV strains cause no symptoms, while others can cause genital warts or warts around the anus, mouth, or throat. Certain types of HPV are considered very high-risk: these are the ones that lead to cervical and other cancers.
Most healthcare providers offer HPV testing at the same time as your regularly scheduled Pap smear; this is because it can be performed on the same sample of cells taken during your Pap smear. When a Pap smear and HPV test are done simultaneously, it’s called “co-testing.”
Many professional societies state that the co-test is a good way to minimize the frequency of screening. For example, instead of coming in to do a Pap smear every 3 years, you might be able to come in once every 5 years and have both a Pap smear and HPV testing done at the same time.
Another note on HPV: There is currently a vaccine available for HPV prevention, called Gardasil 9, and it is more than 99% effective.10 The target group for this vaccination is all genders at 11-12 years of age — but it can also be given safely to older teens and adults. It’s a two-part vaccine, with a second dose that must be administered within 6 to 12 months of the first.
If you have any other questions about Pap smears, co-testing with HPV tests, and/or the HPV vaccine itself, have a conversation with your healthcare provider or OB-GYN.
Cervix and pregnancy
There’s no doubt that the cervix plays a crucial role during pregnancy. This is why, as soon as a pregnancy is confirmed your healthcare provider will begin regular checks on your Cervix. Here’s a couple things they will be monitoring when it comes to your cervix.
Not to be confused with cervical depth, the cervical length is the length of the lower end of your uterus. During pregnancy, your healthcare professional will closely monitor your cervical length to check for any signs of premature labor. If you experience a short cervix too early in pregnancy or if it is slightly open, your baby may be at higher risk for premature birth and your provider might recommend a treatment like vaginal progesterone. Deliveries between 20 weeks and 36 weeks + 6 days are considered preterm.
Sometimes, the cervix can become thin and open too soon during pregnancy, typically without any pain or contractions. This is known as cervical insufficiency, or incompetent cervix. It can contribute to premature births or pregnancy loss.
There is no way to diagnose cervical insufficiency before actually being pregnant. This is why it is always important to let your health provider know of any symptoms you are experiencing. Some treatments to help manage cervical insufficiency can include progesterone supplementation, periodic exams and cervical cerclages.
Fun facts about your cervix
To wrap up our ultimate guide to the cervix, here are a couple of fun facts. Now you’re totally armed and ready for your next trivia night (you’re welcome).
1. The cervix is flexible. It expands up to 10 cm during pregnancy and childbirth, only to return to its original size after delivery. Talk about resilience.
2. The cervix is bruisable. This strong yet delicate structure can actually be bruised during sex if there is too much pressure, too quickly. It usually goes away after a couple of days of rest, but if the pain persists longer than that, get in touch with your healthcare provider.
3. There is such a thing as a cervical orgasm. No, it’s not when you penetrate the cervix, as the urban myth goes (your cervix CANNOT be penetrated during sex!). It is, however, a powerful orgasm that some individuals experience during deep penetrative sex, when just the right amount of pressure is applied to the cervix and surrounding tissue. This is because the cervix contains nerve pathways that are involved in sexual response.11
4. The cervix produces mucus. Also known as vaginal discharge, your cervix has glands that produce a clear, viscous, alkaline mucus. The consistency and texture of your cervical mucus changes throughout your menstrual cycle, as well as during pregnancy.
5. The cervix is unique. Although the cervix plays a similar role in structure and function among all of us, each individual cervix is beautiful in its own way, and as unique as the person it lives in. Let’s send some love down there to our friend, the cervix, this Cervical Health Awareness Month.
This article is informational only and is not offered as medical advice, nor does it substitute for a consultation with your physician. If you have any gynecological/medical concerns or conditions, please consult your physician.
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