Cervical ectropion is a condition in which the cells from the 'inside' of the

cervical canal The cervical canal is the spindle-shaped, flattened canal of the cervix, the neck of the uterus. Anatomy The cervical canal communicates with the uterine cavity via the internal orifice of the uterus (or internal os) and with the vagina via the ...

, known as glandular cells (or columnar epithelium), are present on the 'outside' of the vaginal portion of the cervix. The cells on the 'outside' of the cervix are typically squamous epithelial cells. Where the two cells meet is called the transformation zone, also known as the stratified squamous epithelium. Cervical ectropion can be grossly indistinguishable from early

cervical cancer Cervical cancer is a cancer arising from the cervix. It is due to the abnormal growth of cells that have the ability to invade or spread to other parts of the body. Early on, typically no symptoms are seen. Later symptoms may include abnormal ...

and must be evaluated by a physician to determine risks and prognosis. It may be found incidentally when a vaginal examination (or pap smear test) is done. The area may look red because the glandular cells are red. While many women are born with cervical ectropion, it can be caused by a number of reasons, such as: *Hormonal changes, meaning it can be common in young women *Using

oral contraceptives Oral contraceptives, abbreviated OCPs, also known as birth control pills, are medications taken by mouth for the purpose of birth control. Female Two types of female oral contraceptive pill, taken once per day, are widely available: * The combin ...

*Pregnancy.

Signs and symptoms

Cervical ectropion can be associated with excessive, non-

purulent Pus is an exudate, typically white-yellow, yellow, or yellow-brown, formed at the site of inflammation during bacterial or fungal infection. An accumulation of pus in an enclosed tissue space is known as an abscess, whereas a visible collect ...

vaginal discharge due to the increased surface area of columnar epithelium containing mucus-secreting glands as well as

intermenstrual bleeding Intermenstrual bleeding, previously known as metrorrhagia, is uterine bleeding at irregular intervals, particularly between the expected menstrual periods. It is a cause of vaginal bleeding. In some women, menstrual spotting between periods occ ...

(bleeding outside of regular menses). It may also give rise to post- coital bleeding, as fine blood vessels present within the columnar epithelium are easily traumatized.

Causes

Cervical ectropion is a normal phenomenon, especially in the ovulatory phase in younger women, during pregnancy, and in women taking

oral contraceptive Oral contraceptives, abbreviated OCPs, also known as birth control pills, are medications taken by mouth for the purpose of birth control. Female Two types of female oral contraceptive pill, taken once per day, are widely available: * The combi ...

, which increases the total estrogen level in the body. It also may be a congenital problem by the persistence of the squamocolumnar junction which is normally present prior to birth. Mucopurulent cervicitis may increase the size of the cervical ectropion.

Mechanism

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 Estrogen or oestrogen is a category of sex hormone responsible for the development and regulation of the female reproductive system and secondary sex characteristics. There are three major endogenous estrogens that have estrogenic hormonal acti ...

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 In mammals, the vagina is the elastic, muscular part of the female genital tract. In humans, it extends from the vestibule to the cervix. The outer vaginal opening is normally partly covered by a thin layer of mucosal tissue called the hymen ...

and, through a process of

squamous metaplasia Squamous metaplasia is a benign non-cancerous change (metaplasia) of surfacing lining cells ( epithelium) to a squamous morphology. Location Common sites for squamous metaplasia include the bladder and cervix. Smokers often exhibit squamous ...

, transforms into stratified squamous epithelium.Standring: Gray's Anatomy, 40th ed.

Treatment

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, cryotherapy treatment, or by using ablation treatment under local anesthetic. Ablation involves using a preheated probe (100 °C) to destroy 3–4 mm of the epithelium. In

post-partum The postpartum (or postnatal) period begins after childbirth and is typically considered to end within 6 weeks as the mother's body, including hormone levels and uterus size, returns to a non-pregnant state. The terms puerperium, puerperal perio ...

erosion, observation and re-examination are necessary for 3 months after labour.

References

External links

{{DEFAULTSORT:Cervical Erosion Mammal female reproductive system