What is a cervical ectropion ?

Because of the raw-looking appearance when the inner lining of the cervical canal (columnar epithelium) comes out onto the part of the cervix that can be visualised with a speculum, this is called a cervical ectropion . It appears as a red, velvet-like area and it is this that is called a cervical ectropion .  Gynaecolgists now tend to use the term cervical ectopy, rather than cervical ectropion , to describe this condition. There is no 'cervical ectropion ' or ulceration - it is simply that the columnar epithelium is much thinner than the squamous epithelium and so the underlying blood vessels show through more clearly, making the area look red and raw.

The vaginal surface of the cervix has a covering of layers of flat cells (squamous epithelium) (Figures 21.1 and 21.2). The cervical canal is lined by columnar cells that produce mucus. The squamo-columnar

Cervical ectropion

Figure 21.1 - In a cervical ectropion , the squamo-columnar junction moves out onto the cervix and the columnar epithelium is more red.

Cervical ectropion

Figure 21.2 Cervical ectropion (Ectopy)

During puberty, when taking the pill and during pregnancy, the cervix enlarges and the columnar epithelium from the cervical canal seems to move out (almost like a flower opening) to cover part of the vaginal cervix. The clinician looking at the cervix sees a deep pink velvet-like appearance, which has been called ectropion , erosion
or an ectopy (Figure 21.3). The majority of women with cervical ectropion s have no problem but some are troubled by excessive discharge or bleeding after intercourse (post-coital bleeding).

During childbirth or miscarriage, the surface covering of the cervix can be damaged and become inflamed (cervicitis). Evidence of this inflammation can still be found even many years later. Sometimes small mucus filled cysts form on the cervix (Nabothian follicles). Chronic cervicitis may be associated with discharge or bleeding after intercourse. Cervical ectopy and cervicitis are not pre-malignant or malignant conditions.

What symptoms may occur with a cervical ectropion ?

Most young women, particularly if they are taking the combined oral contraceptive pill, have a cervical ectropion . Most women with a cervical ectropion have no symptoms. If there are no symptoms there is no reason to offer treatment for a cervical ectropion . It follows that many women with symptoms including vaginal discharge without evidence of infection will have a cervical ectropion . Another symptom that can sometimes be attributable to a cervical ectropion is bleeding after intercourse - postcoital bleeding. In these circumstances, it may be appropriate to treat the cervix by destroying the surface. No guarantee can be given that this treatment will reduce or alleviate symptoms.

Treatment of Cervical ectropion

Usually cervical ectopy causes no symptoms and needs no treatment. Sometimes it can cause a vaginal discharge or lead to slight bleeding after intercourse - postcoital bleeding. If these symptoms are troublesome then a simple treatment either freezing (cryotherapy) or cauterising (diathermy) the cervical ectropion will stop the problem. These treatments can be usually be done quite painlessly as an out-patient. It is essential to ensure that there is no pre-malignant change in the cervix before destroying the surface. A pap smear and / or colposcopy may be indicated if there is postcoital bleeding.

Cervical ectropion

Figure 21.4 Cryotherapy probe applied to the cervix to treat a cervical ectropion .

A twenty-five year old lady presented with vaginal discharge, intermenstrual bleeding (bleeding between periods - intermenstrual bleeding), post-coital bleeding (bleeding after sexual intercourse) and occasional deep dyspareunia (pain with intercourse -  painful sex). On examination she had florid cervical ectopy. Her PAP test (cervical smear) showed no abnormality and swab tests for infection were negative. There was some noticeable improvement following a course of Acijel (a mildly acidic jelly) but she still had some symptoms. The cervix was treated by cryotherapy and five months later she remains asymptomatic.

It used to be thought that cervical ectropion could lead to cervical cancer but this is now known not to be true. Cervical ectropion is a completely benign condition and that does not lead to cancer.



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