Cervical ectropian

• Cervical ectropion occurs when there is eversion of the endocervix, exposing the columnar epithelium to the vaginal milieu. It is also known as a cervical erosion, although no “erosion” of cells actually occurs.
• A cervical ectropion is the presence of everted endocervical columnar epithelium on the ectocervix. This change is thought to be induced by high levels of oestrogen, and does not represent metaplasia.
• The columnar epithelium contains mucus-secreting glands, and thus some individuals with cervical ectropion experience increased vaginal discharge.
• A cervical ectropion may also cause post-coital bleeding, as the fine blood vessels present within the epithelium are easily broken during intercourse
• It is thought that cervical ectropion is induced by high levels of oestrogen. Therefore, factors that increase the risk of ectropion are related to those that increase levels of oestrogen:

  • Use of the combined oral contraceptive pill
  • Pregnancy
  • Adolescence
  • Menstruating age (it is uncommon in post-menopausal women)
• Clinical features:

  • Most commonly asymptomatic
  • Post-coital bleeding
  • Intermenstrual bleeding
  • Excessive discharge
  • On speculum exam - everted columnar epithelium has a reddish appearance - usually in a ring around the external os
• Cervical ectropion is a clinical diagnosis. The main role of any investigation is to exclude other potential diagnoses:

  • Pregnancy test
  • Triple swabs – if there is any suggestion of infection (such as purulent discharge), endocervical and high vaginal swabs should be taken.
  • Cervical smear – to rule out cervical intraepithelial neoplasia. If a frank lesion is observed, a biopsy should be taken (note that biopsies are not performed as routine).
• Management:

  • Regarded as a normal variant and does not require treatment unless symptomatic
  • First line treatment is to stop any oestrogen containing medications
  • If symptoms persists the columnar epithelium can be ablated - cryotherapy or electrocautery
  • This will result in significant vaginal discharge until healing is completed
  • Medication to acidify the vaginal pH may help