Overview of Cervical Ectropion

This common condition is not as alarming as it sounds

Gynecologist performing a cervical smear or pap test on a teenage patient
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Cervical ectropion is a non-cancerous condition that occurs when the endocervix (the canal of the cervix) turns outward, exposing the cells that normally reside inside the cervix to the acidic vaginal environment.

The everted or inside-out parts of the endocervix appear red, raw, and are often covered with a yellow discharge—this can be visualized by a doctor during a pelvic exam using a speculum.

You may have heard cervical ectropion being called cervical erosion.

Despite its name, the cervix is not actually eroding. Instead, those "eroded-looking" areas are parts of the cervix where the normal squamous cells of the outer cervix (ectocervix) are replaced by columnar cells of the inner cervix (endocervix).

What Causes Cervical Ectropion?

In the past, it was thought that various types of physical trauma that caused infection might eventually lead to cervical ectropion. Such sources of trauma included sexual intercourse, the use of tampons, the insertion of a speculum, or the insertion of other objects into the vagina.

Other assumed causes included sexually transmitted infections (STIs) such as herpes or early syphilis. It was also thought that vaginal douches or other chemicals, such as contraceptive creams or foams, might cause cervical erosion.

Today, these theories have lost ground as experts now believe that cervical ectropion is a normal anatomic phenomenon that some women are born with.

Researchers have also found that it can be caused by hormonal changes, making it more prevalent among adolescent women, pregnant women, or women who are taking an estrogen-containing contraceptive like the pill. The common denominator here is an increase in estrogen levels in the body, which can change or remodel the cervix.

What Are the Symptoms of Cervical Ectropion?

While there are generally no symptoms associated with cervical ectropion, some women may experience light bleeding that is not part of menstruation, like bleeding after sexual intercourse. Bleeding after a pelvic exam when a cervical speculum is inserted into the vagina or during a bimanual examination, may also occur. This is because the exposed columnar tissue has blood vessels that are fragile and bleed easily when even lightly touched.

Some women with cervical ectropion also experience a clear or yellowish vaginal discharge that has no odor and does not resemble pus—this would indicate an infection, which cervical ectropion is not. 

Of course, it's important to note that these symptoms, like postcoital bleeding, could very well be something else, like cervicitis, cervical cancer, or cervical polyps. This is why it's important to be evaluated by a doctor if you notice any abnormal bleeding or discharge. 

What Is the Treatment for Cervical Ectropion?

The good news is that for the majority of women, cervical ectropion is not bothersome. In fact, experts do not recommend treatment unless a woman experiences excessive discharge or spotting, which is rare.

 

This is because treatment can be invasive, may lead to worsening of discharge (although this is temporary until healing is complete), and can cause cervical stenosis, a condition in which the endocervical canal, or the tunnel within the lower part of the uterus, is narrowed. Cervical stenosis may lead to fertility problems, as well as menstrual problems like painful periods (called dysmenorrhea) or no periods (called amenorrhea)

If therapy is decided upon, a doctor will first need to rule out cervical cancer, as it can mimic cervical ectropion. This requires a pap smear and potentially a colposcopy and/or cervical biopsy.

Cervical cancer is obviously a very serious medical condition, unlike cervical ectropion, which is not pathologic. 

If you and your doctor decide it's best to proceed with treatment, it usually entails an ablative procedure using either electrocautery or cryotherapy. Another option is the use of an acidifying vaginal suppository called boric acid at nighttime.

A Word From Verywell

While the term cervical ectropion or erosion sounds worrisome, it's not. That being said, it can only be diagnosed by a doctor. So if you are experiencing bleeding with intercourse or new vaginal discharge, it's important to get it checked out. A number of conditions can mimic the symptoms and/or experience of cervical erosion like an infection of the cervix or vagina or cervical cancer. 

Sources:

Casey PM, Long ME, Marnach ML. Abnormal cervical appearance: What to do, when to worry? Mayo Clin Proc. 2011 Feb;86(2):147-51.

Tarney CM, Han J. Postcoital bleeding: A review on etiology, diagnosis, and management. Obstet Gynecol Int. 2014;2014:192087

Wright KO, Mohammed AS, Salisu-Olatunji, Kuyinu YA. Cervical ectropion and intra-uterine contraceptive device (IUCD): a five-year retrospective study of family planning clients of a tertiary health institution in Lagos Nigeria. BMC Res Notes. 2014;7:946.

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