Cervix

Question 1

Cervical ectropion definition

Answer 1

cells from endocervical canal grow outside the cervix -> cells more friable -> bleed with trauma
no association with CA!!!!

associated with increased estrogen -> young, pregnant, COCP (not CI)

Question 2

Cervical ectropion SX

Answer 2

PCB
incidental on speculum 
IMB 
increased PV D/C
Dyspareunia

DX on speculum. refer to GYN for colposcopy if concerned

Question 3

Cervical Ectropion MX

Answer 3

Asymptomatic: no MX, self resolve with Age, COCP stop, pregnancy resolution

Problematic bleeding -> cauterisation using silver nitrate for cold coagulation during colposcopy

Question 4

Cervicitis definition

Answer 4

inflammation of the cervix due to infection (acute) or non infection (chronic)

Question 5

acute causes of cervicitis

Answer 5

Chlamydia, Gonorrhoea
HSV
Mycoplasma Genitalium
Vaginitis (trichomoniasis, bacterial vaginosis)

Question 6

chronic causes of cervicitis

Answer 6

GYN procedures
FBs (pessaries, barrier contraceptives)
chemical: douches, creams
allergens: latex

Question 7

SX of cervicitis

Answer 7

Vaginal D/C
IMB, PCB
mosly asymptomatic

Question 8

EX of cervicitis

Answer 8

Speculum: purulent or mucopurulent DC, cervical friability (bleeding after touching w swab), cervical erythema, edema

Cervical motion tenderness -> PID

Vesicles, vulvar/vaginal pain or ulceration -> HSV

Punctate haemorrhages -> trichomoniasis

Question 9

Cervicitis MX

Answer 9

STI screen: NAAT and HVS (opportunistically test people aged 15-29 for STIs)

Chlamydia: Azithromycin PO stat or Doxycycline BD 7days PO

Gonorrhoea: Azithromycin PO + IM ceftriaxone

if TX resistant -> r/o re-infection of C and G and then treat with moxifloxacin PO 14d for M genitalium coverage.

Question 10

Cervical polyps definition

Answer 10

Benign growths of the cervix and endocervix made of endometrial lining. often pedunculated

Rarely become malignant

1/4 women. common

Question 11

Cervical polyp SX + EX

Answer 11

PMB, IMB, PCB (physical disruption)

Can become infected -> purulent DC (leukorrhea)

Cervical polyps common cause PCB
Endometrial polyps commonly cause IMB

Speculum: red/pink glistening protrusion from the cervical os, <1cm in all dimensions, can be friable

Question 12

Cervical polyps MX

Answer 12

GP referral for GYN removal
benign, but send for path

Polypectomy: removed by grasping with sponge forceps and twisting on their pedicle during speculum. Can use AgNO3 if bleeding
Outpatient, no anesthetic

If bleeding or DC persists after polypectomy, endometrial BX is done to exclude CA

Question 13

Nabothian follicles

Answer 13

Fluid filled cysts seen on the surface of the cervix (also called mucinous retention cysts)

The columnar epithelium of the endocervix produces cervical mucus, when the squamous epithelium of the ectocervix slightly covers the mucous secreting columnar epithelium it becomes trapped & forms a cyst. Can occur following childbirth, minor trauma or cervicitis

Question 14

Nabothian follicles SX

Answer 14

incidental on speculum
when large -> pelvic fullness

speculum -> Smooth rounded bumps on the cervix near Os. Yellow/whitish appearance

Question 15

Nabothian follicles

Answer 15

When the Dx is clear, reassurance & nil further Mx, typically resolve spontaneously

If Dx uncertain → colposcopy referral +/- excision, Bx to exclude other pathology