Clinical Anatomy of the Cervix: Characterization Within the Context of Iatrogenic Outcomes Following LEEP
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Authors
Giovannetti, Olivia
Date
2023-04-21
Type
thesis
Language
eng
Keyword
cervix , anatomy , sexual response , cervical dysplasia , knowledge translation , loop electrosurgical excision procedure
Alternative Title
Abstract
The cervix has a well-established role in reproduction, though emerging evidence suggests that the cervix may also play a role in sexual responses (SR), such as the mediation of sexual pleasure. A contribution to SR is further supported by reports of sexual dysfunction (SD) symptoms following cervical dysplasia (CD) treatments, including loop electrosurgical excision procedure (LEEP). This thesis describes a series of investigations that address the overlooked role of the cervix in SR, and establishes connections between cervical procedures, symptomatic outcomes, and knowledge translation (KT) of resources. The overall objective of the research was to characterize cervix microanatomy and importance in SR, elucidating both patient and provider perspectives. This work introduces a survey which aimed to comprehensively define cervical sensations and anatomical locations of SR. SR were characterized by self-report survey tools and semi-structured interviews. The potential for cervix involvement was characterized via surgical simulation, immunohistochemistry (IHC), and microbiome profiling pre/post-surgery. KT was then evaluated using qualitative measures of health literacy. The major findings are: (i) there is an association between cervical procedures and self-reported sexual issues, (ii) innervation is present in the cervical transformation zone and within excised cervical tissues from LEEP, (iii) LEEP mostly restores microbiome dysbiosis, though individual participant profiles may indicate an uneven healing process, (iv) there is a characteristic symptom profile of women who undergo LEEP and report negative outcomes, and discordance between patient and provider perspectives, and (v) online LEEP resources do not meet thresholds for adequate health literacy which limits KT of risk information. These findings demonstrate that the cervix is a contributor to SR for some women, and emphasizes the significance of evaluating cervix microanatomy to inform and improve iatrogenic outcomes. Our survey tool has the potential to clinically stratify women who may be more susceptible to SD after cervical procedures, and tailoring treatment/resources for these patients could help mitigate unwanted outcomes. This body of work establishes foundational concepts for future studies, including innovative tissue analysis and imaging techniques, and the expansion of the investigation to other tissues involved in SR.
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Queen's University's Thesis/Dissertation Non-Exclusive License for Deposit to QSpace and Library and Archives Canada
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Copying and Preserving Your Thesis
This publication is made available by the authority of the copyright owner solely for the purpose of private study and research and may not be copied or reproduced except as permitted by the copyright laws without written authority from the copyright owner.
ProQuest PhD and Master's Theses International Dissemination Agreement
Intellectual Property Guidelines at Queen's University
Copying and Preserving Your Thesis
This publication is made available by the authority of the copyright owner solely for the purpose of private study and research and may not be copied or reproduced except as permitted by the copyright laws without written authority from the copyright owner.