Factors That Influence the Rate of Epithelial Maturation in the Cervix in Healthy Young Women



      To examine the longitudinal changes in the epithelial topography of the cervix in healthy young women; and to determine the sociodemographic, behavioral, and biological factors associated with the rate of cervical epithelial maturation.


      Healthy young women were enrolled from October 2000 to September 2002 as part of a larger study of human papillomavirus (HPV). At interval visits, interviews, infection testing, and colpophotography (3% acetic acid; 10x, 16x magnifications) were performed. Areas of total cervical face and cervical immaturity, defined as columnar and early squamous metaplasia, were quantitatively measured using computerized planimetry. Cervical immaturity was expressed as percentage of total cervical face. This analysis includes the first consecutive 145 women with greater than 10% immaturity at baseline. The rate of cervical maturation was defined as change in percent-immaturity. Predictors included sociodemographics, sexual behaviors, and infections. Data analyses included multivariate generalized linear models with repeated measures.


      The baseline mean age was 17.8 years. Colpophotographs were available from 815 total visits, representing 2.7 years mean follow-up per woman and 5.9-month mean intervals. Women began the study with a median of 39% immaturity and ended with 8% immaturity. After adjusting for time and baseline percent-immaturity, an increased rate of cervical maturation was associated with oral contraceptive pill use (parameter estimate −.023, p =.04) and smoking (−.039, p =.01).


      Cervical maturation was documented during relatively short time periods for the vast majority of these women. Oral contraceptive pills and smoking may accelerate the maturational process, representing increased cell proliferation and thus a possible greater vulnerability to HPV.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of Adolescent Health
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Centers for Disease Control and Prevention. (U.S. Department of Health and Human Services)
        Sexually transmitted disease surveillance, 2006.
        Centers for Disease Control and Prevention, Atlanta, GeorgiaNovember 2007
        • Dunne E.F.
        • Unger E.R.
        • Sternberg M.
        • et al.
        Prevalence of HPV infection among females in the United States.
        J Am Med Assoc. 2007; 297: 813-819
        • Pixley E.
        • Singer A.
        Morphology of the fetal and prepubertal cervicovaginal epithelium.
        in: Jordan J. Singer A. Jones H. Shafi M. The Cervix. 2nd ed. Blackwell Publishing, Boston2006: 65-80
        • Moscicki A.B.
        • Singer A.
        The cervical epithelium during puberty and adolescence.
        in: Jordan J. Singer A. Jones H. Shafi M. The Cervix. 2nd ed. Blackwell Publishing, Boston2006: 81-101
        • Vanrompay D.
        • Hoang T.Q.
        • De Vos L.
        • et al.
        Specific-pathogen-free pigs as an animal model for studying Chlamydia trachomatis genital infection.
        Infect Immun. 2005; 73: 8317-8321
        • Moorman D.R.
        • Sixbey J.W.
        • Wyrick P.B.
        Interaction of Chlamydia trachomatis with human genital epithelium in culture.
        J Gen Microbiol. 1986; 132: 1055-1067
        • Pearce W.A.
        • Buchanan T.M.
        Attachment role of gonococcal pili. Optimum conditions and quantitation of adherence of isolated pili to human cells in vitro.
        J Clin Invest. 1978; 61: 931-943
        • Singer A.
        The uterine cervix from adolescence to the menopause.
        Br J Obstet Gynaecol. 1975; 82: 81-99
        • Coppleson M.
        • Reid B.
        Preclinical carcinoma of the cervix uteri.
        Pergamon Press, Oxford1967
        • Moscicki A.B.
        • Ma Y.
        • Holland C.
        • Vermund S.H.
        Cervical ectopy in adolescent girls with and without human immunodeficiency virus infection.
        J Infect Dis. 2001; 183: 865-870
        • Kiviat N.B.
        • Paavonen J.A.
        • Wolner-Hanssen P.
        • et al.
        Histopathology of endocervical infection caused by Chlamydia trachomatis, herpes simplex virus, Trichomonas vaginalis, and Neisseria gonorrhoeae.
        Hum Pathol. 1990; 21: 831-837
        • Critchlow C.W.
        • Wolner-Hanssen P.
        • Eschenbach D.A.
        • et al.
        Determinants of cervical ectopia and of cervicitis: Age, oral contraception, specific cervical infection, smoking, and douching.
        Am J Obstet Gynecol. 1995; 173: 534-543
        • Harrison H.R.
        • Costin M.
        • Meder J.B.
        • et al.
        Cervical Chlamydia trachomatis infection in university women: Relationship to history, contraception, ectopy, and cervicitis.
        Am J Obstet Gynecol. 1985; 153: 244-251
        • Goldacre M.J.
        • Loudon N.
        • Watt B.
        • et al.
        Epidemiology and clinical significance of cervical erosion in women attending a family planning clinic.
        Br Med J. 1978; 1: 748-750
        • Jacobson D.L.
        • Peralta L.
        • Farmer M.
        • et al.
        Cervical ectopy and the transformation zone measured by computerized planimetry in adolescents.
        Int J Gynaecol Obstet. 1999; 66: 7-17
        • Kuhn L.
        • Denny L.
        • Pollack A.E.
        • Wright T.C.
        Prevalence of visible disruption of cervical epithelium and cervical ectopy in African women using Depo-Provera.
        Contraception. 1999; 59: 363-367
        • Mauck C.K.
        • Callahan M.M.
        • Baker J.
        • et al.
        The effect of one injection of Depo-Provera on the human vaginal epithelium and cervical ectopy.
        Contraception. 1999; 60: 15-24
        • Hellberg D.
        • Nilsson S.
        • Haley N.J.
        • Hoffman D.
        • Wynder E.
        Smoking and cervical intraepithelial neoplasia: Nicotine and cotinine in serum and cervical mucus in smokers and nonsmokers.
        Am J Obstet Gynecol. 1988; 158: 910-913
        • McCann M.F.
        • Irwin D.E.
        • Walton L.A.
        • et al.
        Nicotine and cotinine in the cervical mucus of smokers, passive smokers, and nonsmokers.
        Cancer Epidemiol Biomarkers Prev. 1992; 1: 125-129
        • Appleby P.
        • Beral V.
        • Berrington de Gonzalez A.
        • et al.
        Cervical cancer and hormonal contraceptives: Collaborative reanalysis of individual data for 16,573 women with cervical cancer and 35,509 women without cervical cancer from 24 epidemiological studies.
        Lancet. 2007; 370: 1609-1621
        • Appleby P.
        • Beral V.
        • Berrington de Gonzalez A.
        • et al.
        Carcinoma of the cervix and tobacco smoking: Collaborative reanalysis of individual data on 13,541 women with carcinoma of the cervix and 23,017 women without carcinoma of the cervix from 23 epidemiological studies.
        Int J Cancer. 2006; 118: 1481-1495
        • Scott M.E.
        • Ma Y.
        • Farhat S.
        • Shiboski S.
        • Moscicki A.B.
        Covariates of cervical cytokine mRNA expression by real-time PCR in adolescents and young women: Effects of Chlamydia trachomatis infection, hormonal contraception, and smoking.
        J Clin Immunol. 2006; 26: 222-232
        • Moscicki A.B.
        • Shiboski S.
        • Hills N.K.
        • et al.
        Regression of low-grade squamous intra-epithelial lesions in young women.
        Lancet. 2004; 364: 1678-1683
        • Amsel R.
        • Totten P.A.
        • Spiegel C.A.
        • et al.
        Nonspecific vaginitis. Diagnostic criteria and microbial and epidemiologic associations.
        Am J Med. 1983; 74: 14-22
        • Gravitt P.E.
        • Peyton C.L.
        • Apple R.J.
        • Wheeler C.M.
        Genotyping of 27 human papillomavirus types by using L1 consensus PCR products by a single-hybridization, reverse line blot detection method.
        J Clin Microbiol. 1998; 36: 3020-3027
        • Coppleson M.
        • Pixley E.
        • Reid B.
        Colposcopic morphology. Colposcopy: A Scientific and Practical Approach to the Cervix, Vagina, and Vulva in Health and Disease.
        3rd ed. Charles C. Thomas, Springfield, Illinois1986 (189–222)
        • Moscicki A.B.
        • Burt V.G.
        • Kanowitz S.
        • et al.
        The significance of squamous metaplasia in the development of low grade squamous intraepithelial lesions in young women.
        Cancer. 1999; 85: 1139-1144
        • Remoue F.
        • Jacobs N.
        • Miot V.
        • et al.
        High intraepithelial expression of estrogen and progesterone receptors in the transformation zone of the uterine cervix.
        Am J Obstet Gynecol. 2003; 189: 1660-1665
        • Farin F.M.
        • Bigler L.G.
        • Oda D.
        • et al.
        Expression of cytochrome P450 and microsomal epoxide hydrolase in cervical and oral epithelial cells immortalized by human papillomavirus type 16 E6/E7 genes.
        Carcinogenesis. 1995; 16: 1391-1401
        • DeMarini D.M.
        Genotoxicity of tobacco smoke and tobacco smoke condensate: A review.
        Mutat Res. 2004; 567: 447-474
        • McNeill A.D.
        • Jarvis M.J.
        • Stapleton J.A.
        • et al.
        Prospective study of factors predicting uptake of smoking in adolescents.
        J Epidemiol Community Health. 1989; 43: 72-78
        • Coppleson M.
        • Pixley E.
        • Reid B.
        Natural History of Squamous Metaplasia and the Transformation Zone. Colposcopy: A Scientific and Practical Approach to the Cervix, Vagina, and Vulva in Health and Disease.
        3rd ed. Charles C. Thomas, Springfield, Illinois1986