Cervical Ectropion

Question 1

What is cervical ectropion?

Answer 1

Cervical ectropion can also be called cervical ectopy or cervical erosion. Cervical ectropion occurs when the columnar epithelium of the endocervix (the canal of the cervix) has extended out to the ectocervix (the outer area of the cervix). The lining of the endocervix becomes visible on examination of the cervix using a speculum. This lining has a different appearance to the normal endocervix.

Question 2

Why does cervical ectropion present with post-coital bleeding?

Answer 2

The cells of the endocervix (columnar epithelial cells) are more fragile and prone to trauma. They are more likely to bleed with sexual intercourse. This means cervical ectropion often presents with postcoital bleeding.

Question 3

What is cervical ectropion associated with?

Answer 3

Cervical ectropion is associated with higher oestrogen levels, and therefore, is more common in younger women, the combined contraceptive pill and pregnancy.

Question 4

Briefly describe the transformation zone

Answer 4

The transformation zone is the border between the columnar epithelium of the endocervix (the canal), and the stratified squamous epithelium of the ectocervix (the outer area of the cervix visible on speculum examination). When the transformation zone is located on the ectocervix, it is visible during speculum examination as a border between the two epithelial types.

Question 5

How will cervical ectopion present on examination?

Answer 5

Examination of the cervix will reveal a well-demarcated border between the redder, velvety columnar epithelium extending from the os (opening), and the pale pink squamous epithelium of the endocervix. This border is the transformation zone.

Question 6

What is shown in the image?

Answer 6

Cervical ectropion.

Question 7

What is shown on the image?

Answer 7

Cervical ectopion.

Question 8

Briefly describe the management of cervical ectropion

Answer 8

Asymptomatic ectropion require no treatment. Ectropion will typically resolve as the patient gets older, stops the pill or is no longer pregnant. Having a cervical ectropion is not a contraindication to the combined contraceptive pill.

Question 9

Briefly describe the management of problematic bleeding in cervical ectropion

Answer 9

Problematic bleeding is an indication for the treatment of cervical ectropion. Treatment involves cauterisation of the ectropion using silver nitrate or cold coagulation during colposcopy.