Understanding Cervical Ectropion: Causes & Treatments

Cervical ectropion is a condition whereby the cells on the outside of your cervix (vagina-facing) are replaced by the cells found a little bit further into the neck of the cervix due to inflammation.

The cells that replace the outer cells are mucous-producing but also quite delicate compared to the normal sort of cells, so more mucous is produced and unusual bleeding can occur.

Squamous epithelial cells are replaced by mucous-producing columnar epithelial cells

Cervical ectropion most often occurs in fertile-age women. Cervical ectropion is currently being researched for its links to cervical cancer, with no definitive link at this stage being found.

Causes of ‘cervical erosion¹‘ (cervical ectropion)

Chemicals
Injury (sexual trauma, accident)
Cancer
Infections, particularly left untreated for long periods of time
Oral contraceptive pill² (but not Depo Provera injection³)
Hormone-related conditions
Multiple childbirths
Tampons
Intrauterine devices (IUD), particularly if used for a long period of time⁴

Symptoms of cervical ectropion

Often no symptoms at all, but is found upon gynaecological examination
Copious vaginal discharge
Pain
Painful urination
Bleeding after sex

Diagnosis of cervical ectropion

The cell changes promote infections by opportunistic organisms, so it is important to keep on top of your cervical ectropion. Your GP or gynaecologist will examine your cervix, with changes looking red and grainy on inspection.

A pap smear may return normal (because these aren’t the same changes as caused by HPV) but the cervix may appear inflamed or infected, with some abnormal cells present. If further investigation is required after a pap smear, a cone biopsy may be performed.

Treatment of cervical ectropion

The treatment may be no treatment, but this will be discussed with you and your healthcare practitioner. Cervical ectropion can go away by itself. If your symptoms are uncomfortable or severe, like outrageous amounts of discharge or a lot of bleeding after sex, treatment is likely to be advised.

Any infections must be treated promptly. Medical treatment includes cryotherapy (burning the offending cells off with liquid nitrogen), electrocoagulation diathermy (using an electrical current to remove cells) or the same outcome is gained using lasers.⁵

Drugs can also be used. If the presentation with cervical ectropion occurs after menopause, it is usually treated as suspicious.

References^6,7

1.
Chang AR. ‘Erosion’ of the Uterine Cervix; an Anachronism. Aust NZ J Obst Gynaeco. Published online November 1991:358-362. doi:10.1111/j.1479-828x.1991.tb02822.x
2.
Bright PL, Norris Turner A, Morrison CS, et al. Hormonal contraception and area of cervical ectopy: a longitudinal assessment. Contraception. Published online November 2011:512-519. doi:10.1016/j.contraception.2011.02.002
3.
Kuhn L, Denny L, Pollack AE, Wright TC. Prevalence of visible disruption of cervical epithelium and cervical ectopy in african women using depo-provera®. Contraception. Published online June 1999:363-367. doi:10.1016/s0010-7824(99)00049-9
4.
Wright K, Mohammed A, Salisu-Olatunji O, Kuyinu Y. Cervical Ectropion and Intra-Uterine Contraceptive Device (IUCD): a five-year retrospective study of family planning clients of a tertiary health institution in Lagos Nigeria. BMC Research Notes. Published online 2014:946. doi:10.1186/1756-0500-7-946
5.
Baram A, Paz GF, Reuben Peyser M, Schachter A, Homonnai ZT. Treatment of cervical ectropion by cryosurgery: effect on cervical mucus characteristics. Fertility and Sterility. Published online January 1985:86-89. doi:10.1016/s0015-0282(16)48323-8
6.
Aggarwal P, Ben A. statpearls. Published online May 31, 2023. http://www.ncbi.nlm.nih.gov/books/NBK560709/
7.
Goldacre MJ, Loudon N, Watt B, et al. Epidemiology and clinical significance of cervical erosion in women attending a family planning clinic. BMJ. Published online March 25, 1978:748-750. doi:10.1136/bmj.1.6115.748