Cervical ectropion

Not to be confused with Ectropion.

Cervical Ectropion
Classification and external resources
ICD-10	N86

Cervical ectropion (or cervical erosion) is a condition in which the central (endocervical) columnnar epithelium protrudes out through the external os of the cervix and onto the vaginal portion of 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

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 oestrogen levels rise during puberty, the cervical os opens, exposing the endocerval 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

Cervical erosion is a normal phenomenon, especially in ovulatory phase on younger women, pregnant women, and those 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 normally present in the intrauterine life. 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

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 (after sexual intercourse) bleeding as fine blood vessels present within the columnar epithelium are easily traumatized.

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 the oral contraceptive pill, or by using ablation treatment under local anaesthetic. Ablation involves using a preheated probe (100 degrees Celsius) to destroy 3-4mm of the epithelium. Observation and re-examination is necessary for 3 months after labour in post-partum erosion.

References

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.