Synonyms :: cervical eversion, pseudoeversion secondary to DES adenosis
What is Cervical ectropion (cervical erosion)?
Cervical ectropion is common in teenagers and may be seen in pregnancy, and in women on oral contraceptives. Normally, the cervix looks pink and shiny. It has a hole in the middle, where the menstrual blood passes out from the uterus (womb) into the vagina. In some women, the area round the hole looks red and velvety instead of pink and shiny.
The columnar cells of ectropion are perfectly normal. They are not cancerous or pre-cancerous. In fact, they line the inside of the cervical hole in all women. So an ectropion simply means that the columnar cells are around the outside of the hole as well as inside it. It seems that cells on the cervix become columnar when there is a lot of the hormone oestrogen around. Therefore ectropion is most common in women on the contraceptive pill and during pregnancy.
Cervical Ectropion Causes
In teens it is common because the glandular epithelium has not fully receded under the chronic acidity of the vaginal fluids after menses start. In women whose mothers were exposed to diethylstilbesterol (DES) in utero, the glandular tissue stays on the outside of the cervix and even sometimes over onto the vagina as a developmental birth defect. Common causes includes :-
- Antibiotic therapy
- Immunosuppression, eg. steroid therapy or HIV infection
- Wearing tight nylon clothing
- Through intercourse, tampon insertion.
- Foreign objects in the vagina.
Cervical Ectropion Symptoms
- The most common clinical feature is vaginal or vulval itching.
- Vaginal discharge.
- Vulval oedema.
Treatment for Cervical ectropion
Cervical ectropion it can be treated by heat cautery or by freezing. After treatment, flat cells grow over to heal the area. This may be topical, with either vaginal pessaries or creams; or systemic, with oral fluconazole therapy. If symptoms are recurrent and not responding to treatment, it is important to outrule any underlying causes. It may be necessary in some cases to also assess and treat partners.
Treatment is not always successful, because columnar cells may grow again, especially if the woman is still on the pill. Of course, any woman who has bleeding after intercourse should see her doctor, to check that it is ectropion and not something more serious.