[37] Cervical Ectropion Flashcards
What is a cervical ectropion?
When there is eversion of the endocervix, exposing the columnar epithelium to the vaginal milieu
What is a cervical ectropion also known as?
Cervical erosion (though no ‘erosion’ of cells actually occurs)
Is cervical ectropion a benign or malignant condition?
Benign
When is cervical ectropion commonly seen?
On examination of the cervix in adolescents, in pregnancy, and in women taking oestrogen containing contraceptives
What is an important differential for cervical ectropion?
Cervical cancer and cervical intraepithelial neoplasia
What do cervical cancer and CIN need to be excluded before?
Any treatment or reassurance to the patient is offered
What is the cervix?
The lower portion of the uterus
What is the cervix composed of?
- Ectocervix
- Endocervical canal
What is the endocervical canal also known as?
Endocervix
What is the endocervix?
The most proximal and ‘inner’ part of the cervix
What is the endocervix lined by?
Mucus secreting simple columnar epithelium
What is the ectocervix?
The part of the cervix that projects into the vagina
What is the ectocervix lined by?
Stratified squamous non-keratinised epithelium
What happens to the lining of the cervix in a cervical ectropion?
The stratified squamous cells of the ectocervix undergo metaplastic change to become simple columnar epithelium (same as endocervix)
What induces the change in the epithelium of the ectocervix in cervical ectropion?
Thought to be induced by higher oestrogen levels
What does the columnar epithelium contain in the endocervix?
Mucus secreting glands
What is the result of the cervical columnar epithelium containing mucus secreting glands?
Some women with cervical ectropion experience increased vaginal discharge
Why might cervical ectropion give rise to post-coital bleeding?
As fine blood vessels present within the epithelium are easily broken during intercourse
What are the risk factors for cervical ectropion related to?
Things that cause high levels of oestrogenn
What are the risk factors for cervical ectropion?
- Use of COCP
- Pregnancy
- Adolescence
- Menstruating age
What are the most common clinical features of cervical ectropion?
Most commonly asymptomatic
If symptomatic, how can cervical ectropion present?
- Post-coital bleeding
- Intermenstrual bleeding
- Non-purulent excessive discharge
What is found on speculum examination in cervical ectropion?
Everted columnar epithelium has reddish appearance, usually arranged in ring around external os
What are the differential diagnoses of cervical ectropion?
- Cervical cancer
- CIN
- Cervicitis
- Pregnancy
How is the diagnosis of cervical ectropion made?
Clinical diagnosis, and the main role of any investigation to exclude other potential diagnoses
What investigations may be done in suspected cervical ectropion?
- Pregnancy test
- Triple swabs
- Cervical smear
When should triple swabs be performed in suspected cervical ectropion?
If there is any suggestion of infection (e.g. purulent discharge)
What swabs should be taken if there is suggestion of infection in suspected cervical ectropion?
- Endocervical
- High vaginal swabs
Why should cervical smears be done in suspected cervical ectropion?
Rule out cervical intraepithelial neoplasia
What should be done if a frank lesion is observed in suspected cervical ectropion?
A biopsy should be taken
When is management required for cervical ectropion?
If symptomatic
Why is management not required for cervical ectropion unless symptomatic?
It is regarded as a normal variant
What is the first line treatment for cervical ectropion?
Stop any oestrogen containing medications
What is the most common oestrogen containing medication taken by women with cervical ectropion?
COCP
What management can be employed if symptoms persist in cervical ectropion?
The columnar epithelium can be ablated
How can the columnar epithelium be ablated in cervical ectropion?
Typically using cryotherapy or electrocautery
What is the problem with ablation of the columnar epithelium in cervical ectropion?
It will result in significant vaginal discharge until healing is completed
What medications have been suggested to be useful in cervical ectropion?
Medication to acidify vaginal pH, such as boric acid pessaries
