Presentation Authors: Madeline Monaghan, Olivia Giovannetti, Kingston, Canada, Johanna Hannan*, Greenville, NC, Barry Komisaruk, Newark, NJ, Sue Goldstein, Irwin Goldstein, San Diego, CA, Michael Adams, Kingston, Canada
Introduction: The cervix's role in reproduction and pregnancy is well-recognized, but its function in female sexual response is unknown. Using functional MRI, Komisaruk et al (2011) showed that pressure to the cervix activated the paracentral lobule in the genital sensory cortex, providing evidence that cervical sensory activity is perceptible. The triple afferent innervation of the cervix via the pelvic, hypogastric, and vagus nerves supports its multifaceted physiologic role. Inna et al (2010) reported negative deficits in overall sexual and orgasmic satisfaction after Loop Electrosurgical Excision Procedures (LEEP) for cervical dysplasia. The present study characterized the innervation of cervical tissue from hysterectomy specimens.
Methods: Seven tissue samples from Kingston General Hospital, selected from an archive tissue bank from total hysterectomy procedures, were examined histologically. Tissue blocks from both the anterior and posterior walls of the cervix were used for analysis. The tissue included the cervical external os, which is removed during the LEEP procedure.
Results: A general nerve stain, protein gene product 9.5 (PGP9.5), showed overall innervation of the tissue. Further immunohistochemical analyses stained for subpopulations of nerves. The tissue stained positive for: cholinergic innervation [anti-choline acetyltransferase (ChAT) antibody]; adrenergic innervation [anti-tyrosine hydroxylase (TH) antibody]; and sensory innervation [anti-Nav1.8 (Nav1.8) antibody, Fig.1]. Comparison with PGP9.5 showed additional innervation nonspecific to ChAT, TH, or Nav1.8. Qualitative analysis of serial sections demonstrated many highly innervated vascular and glandular structures, as well as nerve fibers that appear to be travelling through the tissue.
Conclusions: The cervix is a richly vascularized and innervated organ. Evidence of sensory innervation through Nav1.8 positive staining in and near the epithelium suggests the LEEP procedure transects through these neural structures. Future studies will collect and morphologically reconstruct excised cervical tissue obtained from LEEP to understand the tissueâ€™s structure and physiology. A greater knowledge of the tissue removed during LEEP will allow for surgical modifications to reduce the risk of post-LEEP sexual dysfunction.