It is understandable to be surprised by an anatomical observation like seeing the cervix when squatting, but this experience is frequently a normal variation in pelvic positioning. The cervix is a small, cylindrical organ that functions as the barrier between the vaginal canal and the uterus. Its main role is to protect the uterus from the outside environment while also allowing the passage of menstrual blood and sperm. The cervix is not fixed in a single position, and its location inside the vaginal vault can change temporarily based on physiological cycles and physical movement.
Understanding Normal Cervical Anatomy and Appearance
The cervix is typically located high up in the vaginal canal, positioned toward the back wall. It is generally about four centimeters long and three centimeters in diameter, though its size can vary between individuals. When felt or seen, the end of the cervix that bulges into the vagina, known as the ectocervix, usually feels firm and smooth, often compared to the texture of the tip of a nose.
The center of the cervix contains a small opening called the external os, which is the gateway to the uterus. In individuals who have not given birth vaginally, this opening is often small and circular, while it may appear more slit-like after vaginal delivery.
The appearance and position of the cervix are dynamic, changing significantly throughout the menstrual cycle due to fluctuating hormone levels. Around ovulation, rising estrogen levels cause the cervix to soften, rise higher, and open slightly to facilitate sperm entry. Conversely, during menstruation, the cervix typically descends lower into the canal and feels firmer to allow menstrual blood to exit.
The Mechanism: Why Squatting Changes Pelvic Position
The visibility of the cervix during a squat is a direct result of biomechanical changes that occur in the pelvis and abdomen during this deep movement. Squatting causes a profound change in the alignment of the pelvic bones and the soft tissues they support. When the hips are flexed deeply, the surrounding muscles shorten, which effectively decreases the functional length of the vaginal canal.
This change in geometry means the cervix, attached to the top of the vagina, is temporarily brought closer to the vaginal opening. Simultaneously, squatting increases intra-abdominal pressure, exerting a downward force onto all pelvic organs, including the uterus and cervix.
As the pelvic floor muscles relax or lengthen to accommodate deep hip flexion, they provide less upward support. This combination of increased downward pressure and temporary shortening of the vaginal canal results in a noticeable descent of the cervix. This temporary, position-dependent change is simply the organ moving within its normal anatomical range, and it is not a sign of structural failure. The cervix will return to its usual, higher resting position once the person stands upright and the pelvic structure returns to its neutral alignment.
Distinguishing Normal Visibility from Pelvic Organ Prolapse
The main concern when the cervix becomes visible is often the possibility of pelvic organ prolapse (POP), but there are clear differences between a normal positional change and a true prolapse. Pelvic organ prolapse is a condition where the pelvic floor’s supportive ligaments and tissues weaken, allowing an organ (such as the uterus, bladder, or rectum) to permanently descend into the vaginal canal. While a temporarily low cervix during a squat is normal, a prolapse involves a more persistent, structural descent.
A true prolapse often causes symptoms that are felt even when standing or walking, unlike the temporary visibility seen only during a deep squat. These symptoms include a persistent feeling of heaviness, pressure, or a dragging sensation in the lower abdomen or vagina. Individuals with prolapse may describe a feeling like sitting on a small ball, or they may feel or see a bulge that remains present outside the vagina when they are not squatting.
Prolapse can also be differentiated by associated changes in bladder or bowel function, such as difficulty fully emptying the bladder or bowels. The protruding tissue is often the wall of the vagina itself, potentially carrying the bladder (cystocele) or rectum (rectocele), or it may be the cervix and uterus (uterine prolapse). The temporary descent during a squat is a physiological response to movement, whereas prolapse represents a pathological loss of structural support.
When to Consult a Healthcare Provider
While seeing the cervix during a squat is often a benign event, certain associated symptoms warrant a professional evaluation to rule out underlying issues. It is advisable to consult a healthcare provider if the sensation of heaviness or pressure in the pelvis is constant and does not resolve when standing up. Any feeling that tissue is permanently protruding or bulging from the vaginal opening should also prompt a visit.
A deeper assessment of the pelvic floor and reproductive organs is necessary if you experience any of the following symptoms, regardless of the squatting position:
- Unexplained bleeding, especially bleeding that occurs between menstrual periods or after sexual intercourse.
- Persistent pelvic pain.
- Unusual discharge.
- New difficulties with urination or bowel movements, such as incontinence or the inability to empty the bladder.