Cervical Ectropion: What You Need to Know

Cervical ectropion is a situation in which the lining of the inner part of the cervix, the cervical canal, becomes visible to an examiner during speculum examination. Also called cervical ectopy and cervical erosion, the condition involves the lining of the cervix, a type of tissue known as epithelial tissue. This type of tissue lines surfaces throughout the body and consists of cells called epithelial cells, which come in a few different shapes that relate to their function. One type of epithelium, called columnar epithelium, consists of  somewhat elongated cells, lined up like columns into a layer. This type of epithelium normally covers the inner part of the cervix, but in cervical ectropion it also extends to part of the outer cervix, which normally is covered only with another type of epithelium, called squamous epithelium. This change gives the outer part of the cervix an altered appearance. It also makes the cervix vulnerable to trauma and thus more likely to bleed after sexual intercourse, a situation known as post-coital bleeding.

Cervical ectropion is associated with elevated levels of the hormone estrogen and is more common in younger women than in older women. It’s also more common in those taking combined oral contraceptives, meaning oral contraceptives containing both a progestin and an estrogen hormone. These are female hormones, each of which consists of molecules that can differ in small ways from the molecules of your own estrogen and progestin hormones, but they do essentially the same thing. They carry a message to a part of your brain called the hypothalamus and also carry a message to a gland within the brain, called the pituitary gland. The anterior (forward-facing) part of the pituitary manufactures hormones called gonadotropins, called luteinizing hormone (LH) and follicle-stimulating hormone (FSH). Meanwhile, the hypothalamus produces gonadotropin-releasing hormone (GnRH). When GnRH is produced, it stimulates the pituitary to release FSH and especially LH, which put the ovary through the ovulation cycle that causes your period and that can lead to pregnancy. The hormones of oral contraceptives prevent the hypothalamus from releasing GnRH, thus preventing the pituitary from being told to release gonadotropins. The contraceptive hormones also have a direct effect on the pituitary. It other words, they interfere in two ways with the process that otherwise sends gonadotropins to your ovaries. This prevents ovulation, a process that is necessary for the initiation of pregnancy.

Pregnancy also increases the chances of developing cervical ectropion. This is because estrogen levels are higher during pregnancy, during which most of the estrogen comes from the placenta. There is an important concept called a transformation zone. This is the border between the columnar epithelium of the inner part of the cervix (called the endocervix or the canal, which has a red, velvety appearance) and another kind of epithelium, called stratified squamous epithelium, which looks palish pink. The latter normally covers the outer part of the cervix (called the ectocervix) and consists of flattened cells. The different textures and colors of the two types of epithelia make it fairly straightforward for a doctor to identify cervical ectropion. If the transformation zone is on the outer part of the cervix, the zone will be visible and cervical ectropion will be diagnosed.

Now, many case of cervical ectropion are asymptomatic, meaning that you do not experience any symptoms, such as bleeding or other irritation. Such cases are discovered incidentally, when your doctor performs a speculum exam for some other reason. You might be getting a Pap smear, for instance. Apart from post-coital bleeding, other effects of ectropion may include vaginal discharge, vaginal bleeding (other than post-coital bleeding), and dyspareunia (painful sexual intercourse) is a common cause of minor.

While cervical ectropion is common and can look scary, it’s important to keep in mind that it is a benign condition. It is not associated with cervical cancer, nor with any other type of cancer. However, if ectropion is discovered on a speculum exam, the doctor may decide to perform  more revealing procedure, called colposcopy. As for treatment, when ectropion is asymptomatic ectropion, it generally requires no treatment and tends to resolve as you get older, or if you stop taking oral contraceptives, or once your pregnancy comes to an end. But the presence of cervical ectropion is not a contraindication to beginning oral contraceptives.

In cases of symptomatic ectropion, such as the kind featuring bleeding, there is an indication for treatment by way of cauterization using a chemical agent, called silver nitrate. Another way to treat it is with cold coagulation during colposcopy.

David Warmflash
Dr. David Warmflash is a science communicator and physician with a research background in astrobiology and space medicine. He has completed research fellowships at NASA Johnson Space Center, the University of Pennsylvania, and Brandeis University. Since 2002, he has been collaborating with The Planetary Society on experiments helping us to understand the effects of deep space radiation on life forms, and since 2011 has worked nearly full time in medical writing and science journalism. His focus area includes the emergence of new biotechnologies and their impact on biomedicine, public health, and society.

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