In addition to the commonly charted cervical mucus changes and Basal Body Temperature (BBT) changes of the menstrual cycle, cervical position, texture and openness can be a useful guide in identifying the fertile time. Below is a guide to using cervical observations to chart your fertility.
Where is the Cervix Located?
While the the cervix is often referred to as if it is a discreet thing, it is actually the name given to the lower portion of the uterus. It is the part of the womb that extends into the vagina and can be palpated with your finger. It is also the passageway which a baby must pass through when being birthed vaginally. When unaroused, a vagina is typically 3-4 inches long, with the cervix located at the end. The cervix can be easily palpated with an index finger. It should feel like a "snout" at the end of your vagina.
How Does the Cervix Change During your Cycle?
The cervix, as part of the uterus, is affected by the dozen ligaments that suspend it in the pelvic cavity. Levels of relaxin, a hormone, fluctuate throughout the cycle and influence how the ligaments hold the uterus within the pelvis. This can cause the uterus (and cervix respectively) to raise and lower within the vagina. In turn, this changes the angle of the cervix within the vagina.
The opening to the cervical canal, the "tunnel" between the vagina and the uterine cavity, is called the "os." The os must open in order to allow cervical mucus out, and to allow sperm in. For this to happen, the entire cervix softens. When the cervix is soft it feels like the texture of your lips. When it is hard it feels like the cartilage in your nose.
Why Does Cervical Position Fluctuate?
Cervical changes serve several functions:
- An open os allows the release of cervical mucus, which is pivotal to supporting sperm survival in the vagina.
- An open os also allows passage of sperm into the cervix, so they can make their way through the uterus and into the fallopian tubes.
- A high cervix facilitates deeper penetration during intercourse, increasing pleasure for both partners and increasing the chance of orgasm and pregnancy.
- A cervix that is directly in line with the vagina increases the chances of sperm getting into the cervix (bull's-eye!).
- After ovulation has passed, the os closes, the cervix hardens, and the uterus shifts down. The closed os prevents bacteria from entering the uterus, thus decreasing chances of the uterus being infected with a virus.
Indication of Fertile Time - During Ovulation Cervix is Open, Soft, and High
At ovulation, the cervix should optimize the chances of conception. This means:
- Open - The os should be open, to allow sperm transport into the uterus and to allow cervical mucus out of the crypts and into the vagina
- Soft - The texture of the cervix should be soft, like your lips
- High - Ideally, the cervix will be high, however there may be many reasons why it is not (see below)
- Straight - The cervix should be directly in line with the vagina
Indication of Infertile Time - Cervix is Closed, Hard, and Low
At times of infertility, the cervix should protect the uterus from infection. This means:
- Closed - Considered to be the least open position
- Hard - A hard cervix is typically a sign that you are in the infertile time of your cycle. A hard cervix is normal between menstruation and the onset of cervical mucus, which marks the shift into the fertile phase of the cycle. The cervix is also hard after ovulation and up until menstruation when it softens and opens again to allow menses to flow out of the uterus
- Low - Typically a low cervix indicates a time of infertility. It results in vaginal sex being less comfortable and therefore decreases chances of sexual activity during this time. This in turn reduces the risk of introducing foreign bacteria that could result in an infection
- Tilted towards the rectum - The uterus should be resting fairly horizontally, just above the bladder, meaning the cervix should be tilted towards the rectum. However, this can vary by individual based on the unique alignment of the pelvic organs within the pelvic cavity
What Does a Low Cervix Mean?
Typically a low cervix signals a time of infertility. However, if your cervix is always low you may have what is called a prolapsed uterus. Good pelvic floor health is critical to the correct placement of organs in the pelvis. If you suspect you may have a prolapsed uterus (a uterus that is falling into your vagina) then it is a good idea to seek out the help of a specialist. Pelvic floor physiotherapists, Arvigo practitioners and Mercier therapists all specialize in addressing this type of issue. You can also strengthen pelvic floor muscles using pelvic floor exercisers such as the Epi-No or Yoni eggs. Pilates and yoga are other helpful activities for maintaining pelvic floor muscles.
How to Perform A Cervical Check
- Be sure your nail is short and not freshly cut to avoid scratching yourself.
- For hygiene purposes, be sure to perform your cervical check using clean hands, and be certain you do not leave soap residue that could cause irritation or a yeast infection.
- Get into a comfortable position (squatting or having one foot up on a toilet are ideal).
- Insert an index finger gently into your vagina. Feel for a "snout-like" protrusion at the end of your vagina.
- Press lightly on it to ascertain whether it is hard or soft.
- Feel for the small hole in the center. Does it feel open or closed?
- Lastly, notice whether your cervix feels directly in line with your vagina (e.g., right at the tip of your inserted finger) or whether it feels angled to the front or back (e.g., the front pad of your finger).
Many of these distinctions will be difficult to make until you have experienced the full range of changes. These delineations - hard/soft, open/closed are easiest to make when you have experienced the full spectrum of changes, so observing and charting through one entire cycle is usually necessary before being able to differentiate with any level of confidence. Be sure to sit or stand in the same position whenever doing your cervical examinations as your cervix will feel different depending on how gravity is acting upon your organs.
How Do You Chart Cervical Changes?
In the Justisse Method of Fertility Management, a circle is drawn at the top of the chart or in the "miscellaneous" box of the chart.
- A colored in circle denotes a closed os.
- A high circle (in the box used for marking this notation) shows the cervix is high.
- Other notations may include Hd/Sf for hard/soft, O/C for open/closed.
Cervical notations are frequently charted in phone or computer apps as a circle. A flat or small circle usually is used to denote a closed os. A low circle is usually used to show that the cervix is low in the vagina. Sometimes a colour code is used to differentiate between soft and hard. If you are using a particular system for charting, follow the directions indicated for that system. If you are charting on your own, come up with a notation system that makes sense for you.
Individual Variation in Cervical Position
The most important aspect of charting cervical changes is determining what is fertile for you.This requires charting for a full cycle and comparing observations against other primary fertility signs. Variations in pelvic floor health, amount of relaxin production, previous pregnancies, individual anatomy and obesity can all impact the positioning of the reproductive organs within the pelvis. For this reason, identifying the change that marks the shift into fertility is what is important, more so than the individual position.