Cervical ectropion

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Cervical Ectropion
Classification and external resources
ICD-10 N86
DiseasesDB 2288

Cervical ectropion (or cervical eversion) is a condition in which the central (endocervical) columnar epithelium protrudes out through the external os of the cervix and onto the vaginal portion of the cervix, undergoes squamous metaplasia, and transforms to stratified squamous epithelium.[1] Although not an abnormality, it is indistinguishable from early cervical cancer; therefore, further diagnostic studies (e.g., Pap smear, biopsy) must be performed for a differential diagnosis.[2]

Formation[edit]

The squamocolumnar junction, where the columnar secretory epithelium of the endocervical canal meets the stratified squamous covering of the ectocervix, is located at the external os before puberty. As estrogen levels rise during puberty, the cervical os opens, exposing the endocervical columnar epithelium onto the ectocervix. This area of columnar cells on the ectocervix forms an area that is red and raw in appearance called an ectropion (cervical erosion). It is then exposed to the acidic environment of the vagina and, through a process of squamous metaplasia, transforms into stratified squamous epithelium.[3]

Causes[edit]

Cervical ectropion is a normal phenomenon, especially in the ovulatory phase in younger women, during pregnancy, and in women taking the oral contraceptive pill, which increases the total estrogen level in the body.[4] It also may be a congenital problem by persistence of the squamocolumnar junction which is normally present prior to birth. Additionally, it can be caused by scarring of the external os during vaginal intercourse.

Mucopurulent cervicitis may increase the size of the cervical ectropion.[5]

Symptoms[edit]

Cervical ectropion can be associated with excessive but non-purulent vaginal discharge due to the increased surface area of columnar epithelium containing mucus-secreting glands. It may also give rise to post-coital bleeding, as fine blood vessels present within the columnar epithelium are easily traumatised.

Treatment[edit]

Usually no treatment is indicated for clinically asymptomatic cervical ectropions. Hormonal therapy may be indicated for symptomatic erosion. If it becomes troublesome to the patient, it can be treated by discontinuing oral contraceptives, or by using ablation treatment under local anaesthetic. Ablation involves using a preheated probe (100 degrees Celsius) to destroy 3–4mm of the epithelium. In post-partum erosion, observation and re-examination are necessary for 3 months after labour.

References[edit]

  1. ^ Katz: Comprehensive Gynecology, 5th Edition.
  2. ^ Mosby's Guide to Physical Examination, 7th Edition. Page 558.
  3. ^ Standring: Gray's Anatomy, 40th ed.
  4. ^ Standring: Gray's Anatomy, 40th ed.
  5. ^ Bope: Conn's Current Therapy 2011, 1st Edition.