What is Cervical Ectropion?
Cervical ectropion is a harmless condition typically seen in women of reproductive age. Simply put, with this condition, the kind of cells that normally line the inside of the cervix (glandular cells) are found on the outside of the cervix. This exposes these cells to the environment inside the vagina. The condition is sometimes referred to as cervical ectopy, cervical eversion or misleadingly, as cervical erosion. However, this last term is misleading because the cervix is not actually eroding.
This condition is often discovered during a regular pelvic exam of women of reproductive age. Cervical ectropion typically doesn’t cause symptoms but it has been linked to chronic inflammation of the cervix, known as chronic cervicitis. It’s a common condition especially among teenagers and pregnant women.
What Causes Cervical Ectropion?
Cervical ectropion often happens when there are high levels of the hormone estrogen in the body. The cervix, the lower part of the uterus, reacts to estrogen by changing the lining of the cervix.
So, cervical ectropion tends to be found when there’s a lot of estrogen, like when a woman is:
– A teenager
– Pregnant
– Using hormonal birth control
– Having her menstrual cycle, and this is especially common during the ovulatory phase, when an ovary releases an egg
Sometimes, cervical ectropion can happen from birth because the squamocolumnar junction, where the two types of cells in the cervix meet, stays in its initial newborn location. This can happen when the hormones the baby is exposed to from its mother stimulate the lining of the cervix and create cervical ectropion.
After menopause, when a woman’s period stops, cervical ectropion is less common. This is because estrogen levels drop, causing the cervix to shrink and invert, pulling the squamous cell epithelium, or the cells that line the cervix, into the endocervical canal, or the canal of the cervix.
Risk Factors and Frequency for Cervical Ectropion
Cervical ectropion is a common condition often seen in women’s health check-ups. It’s more frequent in sexually active young women and increases with the number of pregnancies they’ve had. After turning 35, the number of women with this condition starts to decrease. Cervical ectropion is also more commonly found in women taking contraceptive pills compared to those using barrier methods of contraception.
- Between 17% and 50% of women have cervical ectropion.
- Up to 80% of sexually active teenagers could have this condition.
- In women taking oral contraception or using intra-uterine copper devices in Benghazi, Libya, 54.9% were found to have cervical ectropion, making it the most common gynecological condition there.
- 43.2% of women in China reportedly have cervical ectropion.
- About 29% of premature female babies and 68% in the first month of life have this condition due to the transfer of maternal hormones through the placenta.
Signs and Symptoms of Cervical Ectropion
Cervical ectropion, also known as cervical erosion, is a condition that usually doesn’t cause symptoms. However, when symptoms do occur, they can include:
- Vaginal discharge, which can be white or yellow. This is due to an increase in the surface area of the cells that produce mucus in the cervix.
- Bleeding after sexual intercourse. This results from the delicate blood vessels in the cervix being easily torn during sexual activity. Cervical ectropion can be one of the reasons for vaginal bleeding during the last trimester of pregnancy.
- Bleeding between menstrual periods
- Pain during sexual intercourse
- Pelvic pain
- Frequent inflammation of the cervix
- Backache
- Problems with urination
On examination, the cervix may look red and this redness is laid out in a ring around the cervix opening. The symptoms of bleeding after intercourse and a reddish appearance of the cervix might confuse it with early stages of cervical cancer. It’s important to remember, though, that cervical ectropion is not a sign or a symptom of cervical cancer.
The symptoms of cervical ectropion can also overlap with those of a condition called desquamative inflammatory vaginitis. This is a long-term inflammation of the vagina that leads to vaginal discharge, discomfort, pain during sexual intercourse, and red spots on the cervix. There is, however, no established link between cervical ectropion and desquamative inflammatory vaginitis.
Testing for Cervical Ectropion
Cervical ectropion, which usually doesn’t show symptoms, is often discovered during a regular pelvic exam or a pap smear test. This condition can be seen as a reddish area around the opening of the cervix (called the cervical os) during a speculum examination.
To rule out other conditions, your doctor may do further tests. These might include:
1. Nucleic acid amplification tests to check for infections like chlamydia and gonorrhea, which can cause inflammation of the cervix.
2. A “triple swab” test, where the doctor takes swabs from the end of the cervix and upper part of the vagina. This test is often done if there is a pus-like discharge from the vagina.
It’s not always easy to tell the difference between cervical ectropion and precancerous changes or cancer of the cervix just by looking. Although cervical ectropion isn’t linked to cervical cancer, if there’s pain, spotting or a red, inflamed cervix, the doctor might run some tests to check for inflammation of the cervix, precancerous changes (known as cervical intraepithelial neoplasia or CIN), and cervical cancer. These tests can include a pap smear, colposcopy (where your doctor uses a special magnifying device to look closely at your cervix), and colposcopy with biopsy (where a small sample of tissue is taken for examination).
A urine test to check the level of a hormone called beta hCG can also be done, as changes in hormones during pregnancy can often lead to the development of cervical ectropion.
Treatment Options for Cervical Ectropion
Cervical ectropion is a condition that generally doesn’t require treatment unless it significantly impacts a patient’s everyday life. If the symptom does become bothersome, the first step is usually to stop using hormonal birth control methods, such as the contraceptive pill or depot medroxyprogesterone acetate, and switch to a nonhormonal contraception method.
If these steps aren’t effective, there are several treatment options available. One of these is cautery, which can be done in an outpatient clinic without the need for general or local anesthesia. There are two types of cautery. Electrocautery, also known as cold coagulation, involves using a cautery probe to heat the affected area for about 30 seconds and eliminate the abnormal cells. Cryotherapy uses a freezing technique instead of heat, which has been shown to improve the quality of cervical mucus and is safe to use during pregnancy.
Other treatment options include microwave tissue coagulation, which can cause less bleeding than other methods but mainly improves the appearance of the cervix without offering other benefits. Another method is laser therapy, where a carbon dioxide laser beam is used to destroy the abnormal cells. This procedure also happens in an outpatient clinic and often results in less post-procedure pain and faster healing.
Some treatments involve the insertion of suppositories. These could contain alpha interferon, which enhances the function of certain immune cells called T lymphocytes, or polydeoxyribonucleotide, which can lead to the regrowth of normal cells in the affected area. Boric acid suppositories, which make the pH acidic, can be another option.
There are also experimental therapies, such as the use of a patient’s own platelet-rich plasma, which can shorten healing time and reduce bleeding. Focused ultrasound is another promising approach that could potentially benefit many women.
Generally, treatment success is rated by improvements in the appearance of the cervix and a decrease in symptoms. A successful treatment also brings about improvements in the characteristics of cervical mucus and in the function of certain immune cells. It’s generally been seen that there’s a 92% success rate with cautery or microwave therapy and a 79% success rate with laser treatment.
If someone’s successfully treated cervical ectropion, any recurrence of symptoms like foul-smelling discharge or persistent bleeding should prompt them to contact their healthcare provider for possible reinfection or cervical abnormalities.
What else can Cervical Ectropion be?
There are a few conditions that can cause symptoms similar to cervical ectropion, and these may require further evaluation:
- Cervical cancer: Symptoms might include bleeding after sex, bleeding between periods, unusual vaginal discharge, problems with urination, and a red area around the opening of the cervix (seen during a speculum examination). Further tests may be required to rule out cervical cancer.
- Cervical Intraepithelial Neoplasia (CIN): A red area around the opening of the cervix during a speculum examination could be a sign of CIN and may require further analysis.
- Infectious cervicitis: This condition can cause increased vaginal discharge, which could be purulent (pus-filled), bleeding after sex, and bleeding between periods. If someone has recently had unprotected sex or has had infectious cervicitis in the past, these factors might contribute to a cervicitis diagnosis. Chronic cervicitis that is not caused by gonorrhea or chlamydia might also be considered.
- Vulvovaginitis, pelvic inflammatory disease: These conditions can trigger fever, painful periods, painful bowel movements, itching or burning in the vulvovaginal area, pus-filled or blood-stained vaginal discharge, pelvic pain, tenderness in the cervix, infertility, and a history of infectious cervicitis. All of these factors might point towards a pelvic inflammatory disease diagnosis.
- Desquamative inflammatory vaginitis: This is a chronic inflammatory vaginitis, most common in women around menopause. Treatments often include vaginal clindamycin 2% cream, vaginal hydrocortisone 10% cream, or cortisone acetate 25 mg vaginal suppositories. Ablation (surgical removal) might also be beneficial in tough cases.
- Pregnancy: Pregnancy can also cause similar symptoms.
It’s important for doctors to assess these possible conditions when diagnosing cervical ectropion.
What to expect with Cervical Ectropion
Cervical ectropion, also known sometimes as cervical erosion, usually doesn’t lead to medical problems. Research indicates that there’s no real benefit from routinely treating cervical ectropion unless a woman is experiencing significant symptoms. Generally, it will clear up naturally over time.
However, it is worth noting that having cervical ectropion can make a woman more likely to contract sexually transmitted infections, including chlamydia, gonorrhea, and HIV. Studies have found that treating cervical ectropion can be beneficial for some groups, such as women who are at a higher risk of contracting these infections. Yet, for most women, treatment for cervical ectropion offers little protection against these infections, especially considering the large number of women who would need to be treated.
While cervical ectropion can create conditions that might make it easier for the human papillomavirus (HPV) infection to take hold, it doesn’t increase the risk of cervical intraepithelial neoplasia (an abnormal growth of cells on the surface of the cervix) or cervical cancer. Instead, a process called squamous metaplasia, in which the cells of the cervix change from one type to another, can make a person more susceptible to a particularly dangerous type of HPV (HPV 16) infection, due to the changes this process can create in the host cell.
Lastly, there’s no need to worry about cervical ectropion being a cause of infertility. It doesn’t have any harmful effects on getting pregnant or on the health of the fetus during pregnancy.
Possible Complications When Diagnosed with Cervical Ectropion
Cervical ectropion, although it tends to resolve on its own over time, can make a woman more prone to various sexually transmitted infections, with chlamydial cervicitis being the most common. This condition can be quite uncomfortable for women who deal with undue vaginal discharge or frequent bleeding. However, effective treatments exist that can alleviate these symptoms.
Minor complications might arise after the ablation treatment, which is a common treatment for this condition. These may include:
- Slight vaginal bleeding
- Vaginal irritation
- Minimal vaginal discharge
- Crampy pelvic pain
These side effects are typically temporary and not too disruptive to daily life. Often, they clear up a few weeks after the procedure. The benefits of this treatment method, like long-term symptom relief and the convenience of being an outpatient procedure, outweigh these minor risks. Moreover, it’s safe, straightforward, and affordable.
Preventing Cervical Ectropion
If you are diagnosed with cervical ectropion during a regular pelvic exam or a pap smear, you might not have known about it before. Some concerning symptoms, like vaginal bleeding, pain during sex, or unusual vaginal discharge, can be alarming. It’s completely natural to worry about it possibly linking to cervical cancer, inflammation of the cervix (cervicitis), or fertility issues.
It’s important to understand that cervical ectropion is not a harmful condition. It’s not associated with any serious health problems. However, you may need additional tests to make sure there aren’t any other conditions causing your symptoms. You should be fully informed about your treatment options and you may be offered treatment if your symptoms are making you uncomfortable. Knowing this can help reduce the fear of unnecessary costs or the impact of frequent hospital visits on your work, as well as concerns about your reproductive and sexual health.