Cervical ectropion happens when soft glandular cells from inside the cervical canal are found on the outer surface of the cervix. It is a common, benign cervical finding and is sometimes called cervical erosion, although the cervix is not actually eroded.
Cervical ectropion is often linked to hormone changes, especially higher estrogen levels. It is more common during the reproductive years, during pregnancy, and in people who use hormonal birth control.
Many cases cause no symptoms and do not need treatment. When symptoms are bothersome, they may include increased vaginal discharge, spotting, or bleeding after sex, and a doctor may suggest treatment after ruling out other causes.
Main symptoms
Cervical ectropioncan lead to changes related to the cervix and vaginal discharge, which can present with symptoms such as:
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Increased vaginal discharge
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Clear, white, or yellowish discharge
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Spotting between periods
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Bleeding after sex
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Light bleeding after a pelvic exam or Pap test
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Pelvic discomfort in some cases
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Pain during sex in some cases
These symptoms can also happen with infections, cervical polyps, abnormal cervical cell changes, or other gynecologic conditions, so medical assessment is important when bleeding or unusual discharge occurs.
Common causes
Cervical ectropion can be caused by:
1. Hormonal changes
Hormones, especially estrogen, can affect the cervix and make glandular cells more visible on the outer surface. These cells are more delicate than the cells normally found on the outside of the cervix, which is why they may bleed more easily.
This is one reason cervical ectropion is more common in younger people and those of reproductive age. It can also be seen during times when estrogen levels are higher.
2. Pregnancy
Cervical ectropion can appear during pregnancy because hormone levels change significantly. The cervix also has increased blood flow during pregnancy, which may make light bleeding more noticeable.
In many cases, cervical ectropion during pregnancy is harmless. However, bleeding in pregnancy should always be assessed to rule out other causes.
3. Hormonal contraceptives
Hormonal birth control, especially methods that contain estrogen, can contribute to cervical ectropion in some people. This may include the combined oral contraceptive pill.
When symptoms are linked to hormonal contraception, a doctor may discuss whether changing the contraceptive method could help. This decision depends on symptoms, preferences, and whether other causes have been ruled out.
4. Normal cervical cell changes
Cervical ectropion can also be a normal variation in how cervical cells are arranged. The glandular cells from inside the cervix can extend outward and become visible during an exam.
These glandular cells are not cancer. Cervical ectropion is also not considered a cause of infertility.
Confirming a diagnosis
Cervical ectropion is usually diagnosed during a pelvic exam with a speculum. A doctor may see a reddish area around the cervical opening, caused by glandular cells being visible on the outside of the cervix.
The diagnosis also involves checking that symptoms are not being caused by something else. Depending on the case, this may include cervical screening, STI testing, vaginal swabs, pregnancy testing, or referral for colposcopy.
Doctors look for features that fit cervical ectropion, such as a benign-looking red area on the cervix with symptoms like discharge or contact bleeding. Further testing may be needed if there is unexplained bleeding, abnormal cervical screening results, an unusual-looking cervix, or symptoms that do not match a simple benign finding.
Treatment options
Treatment for cervical ectropion is not always needed. Many cases are managed with reassurance, especially when there are no symptoms or symptoms are mild.
Some treatment approaches may include:
1. Monitoring and reassurance
Cervical ectropion is benign and often does not require treatment. If it is found during an exam and there are no concerning symptoms, a doctor may simply explain the finding and continue routine cervical care.
Symptoms may improve over time, especially if hormone levels change. Monitoring is often enough when bleeding is light and other causes have been excluded.
2. Changing hormonal contraception
If symptoms appear to be linked to hormonal birth control, a doctor may discuss changing to a different contraceptive method. This may be considered when discharge or bleeding is persistent and bothersome.
This approach is not suitable for everyone and should be weighed against the benefits of the current contraceptive method. Other causes of symptoms should be checked before assuming contraception is the only reason.
3. Cautery
Cautery may be offered when symptoms are persistent, especially frequent bleeding after sex or troublesome discharge. This treatment seals or removes the delicate glandular cells on the outer cervix so that sturdier surface cells can grow back.
Different cautery methods may be used, including silver nitrate, cold coagulation, or diathermy. The procedure is usually done in a clinic, and mild cramping, watery discharge, or light bleeding may occur afterward.
4. Cryotherapy
Cryotherapy uses cold treatment to freeze the affected glandular cells. It may be used for symptomatic cervical ectropion when conservative care has not helped.
After cryotherapy, watery discharge and mild discomfort can happen while the cervix heals. Follow-up advice may include avoiding sex, tampons, or swimming for a short time, depending on the clinic’s instructions.
When to see a doctor
Medical assessment is recommended when there is bleeding after sex, bleeding between periods, bleeding after menopause, pelvic pain, pain during sex, or a change in vaginal discharge. These symptoms can be caused by cervical ectropion, but they can also be linked to infections, cervical polyps, abnormal cervical cells, or other conditions.
A doctor should also assess symptoms that are persistent, worsening, or associated with a foul smell, fever, or significant pelvic discomfort. Routine cervical screening should continue according to the recommended schedule, even when cervical ectropion has been diagnosed.