MRI image of the fm reproductive tract

Debunking the Cervix: Fact or Fiction?

Debunking the Cervix: Fact or Fiction?

By Allison Danish, MPH

Sometimes it feels like the cervix is a mythical creature. The Loch Ness Monster of the reproductive tract. The Bigfoot of the pelvis. The Mothman of the pelvic viscera. 

Unlike cryptids, however, the cervix definitely exists. 

But what they do have in common is that they’re poorly understood, shrouded in myth, and are sometimes blamed for things they’re not actually responsible for. That’s why we employed the help of the Pelvic Pain Doc herself, Dr. Sonia Bahlani, board-certified OB/GYN, to help us bust some cervix myths. Let’s do this thing.

What is the cervix?

Let’s start from the beginning, shall we? What even is the cervix? 

“It’s the opening of the uterus into the vagina,” Dr. Bahlani explains. “So ultimately, when we get periods or get pregnant, this is the opening that’s our pathway from the inside of the vagina up into the uterus. Whenever I explain it to patients, I say I like to think of it feeling like the tip of a nose.” 

An illustration of the cervix

To recap: the cervix is the part of the uterus that peeks out into the vagina, it’s the passageway between the vagina and the rest of the uterus, and it’s one of the few internal organs you can touch with your finger. Now, what about those myths…?

Fact… or fiction?

1. The cervix is what causes painful sex.

Fiction! Usually. The cervix absolutely has nerve endings that are important for sexual function and have the ability to feel pain. Buuuuut as we explored in this piece, the cervix usually isn’t super sensitive to pain during sex unless there’s something else going on—like endometriosis or pelvic floor muscle dysfunction. Plus, if you’re feeling like something’s getting hit in the back of your vagina during penetration…“depending on the position, you can be hitting the posterior vaginal wall and not hitting the actual cervix itself,” Dr. Bahlani says. 

“The cervix is a point that exists within the vaginal canal that leads to the uterus… there’s vaginal tissue on top of it and vaginal tissue below it. The ratio of that really depends on the angle of the uterus and the cervix, which is completely individual based on the person and can be altered by our bladders and our rectums.” 

Image of the female reproductive system with the cervix highlighted

I like to think of the vagina like it’s a hallway. Near the end of the hallway, there’s a door—that’s the cervix. But at the very end of the hallway? Nothing. Maybe there’s a nice photo or a wall sconce or something, but there’s no door back there. That means you’re not always hitting the cervix during deep penetration—so it can be hard to tell what’s hurting. The cervix is just a commonly known bodily landmark that frequently gets blamed for the pain, whether it’s responsible or not. 

TLDR; if you’re feeling pain deeper inside the body during sex, please see a doc and try out Ohnut—but don’t be so quick to blame the cervix. 

2. You can have a low cervix.

Fact! This can generally happen one of three ways:

  1. You’re born with it
  2. After childbirth
  3. You have pelvic floor dysfunction

Dr. Bahlani says that while you can be born with a longer cervical canal that hangs a bit lower, it “is probably not going to activate any type of pressure, pain, or discomfort. But when it happens after things like childbirth, it can cause a sense of pressure in the vagina or even discomfort while sitting.” The main takeaway is: if you’re born with it, it’s probably not gonna cause you problems; if it develops over time, it might cause some pain or discomfort.

Being born with a longer cervix and developing a low cervix from uterine prolapse feel pretty self-explanatory—but how can pelvic floor dysfunction affect your cervix? 

The pelvic floor

The pelvic floor is a muscular hammock that supports your pelvic organs and helps you do life’s important functions like peeing, pooping, having sex, and walking. When someone has hypertonic (or tight and short) pelvic floor muscles, “it can cause pressure within the lower abdomen that pushes the cervix down further,” Dr. Bahlani explains. 

When those muscles are tight and short, they don’t relax like they should. And when those muscles aren’t relaxing, everyday activities put pressure on your pelvic organs, which can push the cervix out a little further into the vagina. Think of it like a push pop! But less tasty. 

3. You can bruise your cervix. 

Fiction! A lot of folks out there report having a bruised cervix after sex, and while pain and discomfort during deep penetration is absolutely real, you can’t technically bruise a cervix. Dr. Bahlani says, “You can’t bruise a cervix with a penis or with a sex toy or something like that. Embryologically, the cervix is made from the mesoderm [an early cell layer that goes on to form the skeletal, reproductive, and circulatory system]. While you have blood flow to the cervix, it's different from blood flow to our skin. You wouldn’t even be able to form a hematoma [a bruise].”

What’s likely happening if you feel like your cervix is bruised is “pelvic floor dysfunction,” Dr. Bahlani explains. “Even knowing the anatomy and being a physician, if I was to have pain with pelvic floor dysfunction, I wouldn’t be able to delineate that pain between my cervix, my bladder, my uterus. So I definitely think that’s probably more a sign of pelvic floor dysfunction than anything else.” 

And this makes a lot of sense! It’s hard to tell what hurts during sex because the nerves in this part of the body feel pain diffusely—meaning it’s hard to pin down where the discomfort is coming from. And on top of that, most of us don’t know we even have a pelvic floor. So, if there’s pain in the back during sex and it feels like a bruise you’d get on your arm—it makes sense that someone would call it a bruised cervix. But alas, this is not possible. The cervix is once more pelvic floor dysfunction’s scapegoat. 

A cervix playing a tiny violin

4. You can penetrate the cervix during sex.

Aaaaaabsolutely fiction. As Dr. Bahlani says, “that’s a good thing. In doing procedures where I am penetrating the cervical canal, it is not pleasurable for patients. It’s not something that I think they would want to happen.”

Unless you’re pregnant or in active labor, the cervical opening is less than 4.5mm in diameter (that’s smaller than a pencil eraser)—which is waaaaaay too small to accidentally penetrate. 

5. Your cervix moves during your menstrual cycle.

The jury is still out on this one. Some fertility researchers and consultants say yes, calling this phenomenon the cephalad shift (cephalad is just a fancy way to say “towards the head”). The basis behind this theory is that estrogen and progesterone affect the ligaments that support the uterus, causing the uterus (and therefore the cervix) to lift up or down. The primary evidence for this theory, to my knowledge, is from studies in which patients using fertility-awareness techniques used their fingers to measure whether their cervix was “low,” “high,” or “very high.” 

On the other hand, OB/GYNs and pelvic floor physical therapists I’ve talked to haven’t heard of this. Dr. Bahlani says, “You can have changes in the cervix that you can see during your cycle, but I’ve medically not heard of the cervix moving.”

I’m going to be perfectly honest here, this cervical quandary haunts my dreams. Like, Edgar Allen Poe, The Tell-Tale Heart level. I used to think this was fact without a second thought until I started looking into it. It’s one of those phenomena that was studied with “enh” methodology back in the 1980s, has some anecdotal evidence supporting it, and is more-or-less accepted in fertility spaces. Because the bodies of AFAB people have historically been ignored in medical research, there’s a lot we don’t know about these sexual and reproductive organs. Heck—we literally just found out in 2022 that the human clitoris has 10,000 nerve endings.

I’m personally pretty skeptical of this “cervix fact” because it’s not clear what purpose the cephalad shift has. The lengthening of the vagina that occurs during arousal already lifts the cervix out of the way in preparation for penetrative sex. The softening and opening of the cervix allows sperm through for fertilization. But what purpose would a high cervix serve during ovulation? And can the cervix being higher sometimes be better explained by a full bladder and rectum, or just feeling a little saucier that day so there’s more blood flow to the vagina? 

TLDR; this hasn’t been researched enough to say whether it’s true or not. 

6. The cervix is important for sexual functioning. 

Fact! “Back in the day, doctors used to screen people for cervical cancer and do LEEPs [when abnormal cells are removed from the cervix either to diagnose or treat something] very easily without context. And now we know that there are tons of nerve endings at the end of the cervix, and it impacts our sexual function. And so our guidelines have changed.”

Over time, researchers found that people who underwent “total” hysterectomies (when the uterus and cervix are removed) and LEEPs experienced sexual side effects such as less feeling in their genitals and loss of orgasm. The nerves that supply the cervix absolutely have a profound role in sexual function and pleasure. 

With misinformation abound, it can be hard to know what to believe—especially when it comes to body parts that have been neglected in the research beyond their utility for havin’ babies. But armed with good information, we’re able to feel more at home in our bodies and make informed decisions about our health.

So with that, I leave you with one question… What cervix myths have you heard?

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