Cervical Ectropion

 

Cervical ectropion can also be called cervical ectopy or cervical erosion. Cervical ectropion occurs when the columnar epithelium of the endocervix (the canal of the cervix) has extended out to the ectocervix (the outer area of the cervix). The lining of the endocervix becomes visible on examination of the cervix using a speculum. This lining has a different appearance to the normal endocervix. 

The cells of the endocervix (columnar epithelial cells) are more fragile and prone to trauma. They are more likely to bleed with sexual intercourse. This means cervical ectropion often presents with postcoital bleeding.

Cervical ectropion is associated with higher oestrogen levels, and therefore, is more common in younger women, the combined contraceptive pill and pregnancy.

 

Transformation Zone

The transformation zone is the border between the columnar epithelium of the endocervix (the canal), and the stratified squamous epithelium of the ectocervix (the outer area of the cervix visible on speculum examination). When the transformation zone is located on the ectocervix, it is visible during speculum examination as a border between the two epithelial types. 

 

Presentation

Many cervical ectropion are asymptomatic, and they are found incidentally during speculum examination for other reasons, for example, smear tests.

Ectropion may present with increased vaginal dischargevaginal bleeding or dyspareunia (pain during sex). Intercourse is a common cause of minor trauma to the ectropion, triggering episodes of postcoital bleeding.

Examination of the cervix will reveal a well-demarcated border between the redder, velvety columnar epithelium extending from the os (opening), and the pale pink squamous epithelium of the endocervix. This border is the transformation zone.

TOM TIP: It is worth looking up photographs of cervical ectropion and becoming familiar with the appearance. They are very common to see on speculum examination, and could look alarming the first time you see one. Ectropion is not associated with cervical cancer in any way. It is worth getting familiar with distinguishing them from the appearance of cervical cancer. Always ask about smears, and if in doubt, get a senior opinion and consider referring for colposcopy.

 

Management

Asymptomatic ectropion require no treatment. Ectropion will typically resolve as the patient gets older, stops the pill or is no longer pregnant. Having a cervical ectropion is not a contraindication to the combined contraceptive pill.

Problematic bleeding is an indication for the treatment of cervical ectropion. Treatment involves cauterisation of the ectropion using silver nitrate or cold coagulation during colposcopy.

 

Last updated June 2020
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