Cervical Ectropion

Question 1

What is a cervical ectropion?

Answer 1

When there is eversion of the endocervix, exposing the columnar epithelium to the vaginal milieu

Question 2

What is a cervical ectropion also known as?

Answer 2

Cervical erosion (though no ‘erosion’ of cells actually occurs)

Question 3

Is cervical ectropion a benign or malignant condition?

Answer 3

Benign

Question 4

When is cervical ectropion commonly seen?

Answer 4

On examination of the cervix in adolescents, in pregnancy, and in women taking oestrogen containing contraceptives

Question 5

What is an important differential for cervical ectropion?

Answer 5

Cervical cancer and cervical intraepithelial neoplasia

Question 6

What do cervical cancer and CIN need to be excluded before?

Answer 6

Any treatment or reassurance to the patient is offered

Question 7

What is the cervix?

Answer 7

The lower portion of the uterus

Question 8

What is the cervix composed of?

Answer 8

• Ectocervix

- Endocervical canal

Question 9

What is the endocervical canal also known as?

Answer 9

Endocervix

Question 10

What is the endocervix?

Answer 10

The most proximal and ‘inner’ part of the cervix

Question 11

What is the endocervix lined by?

Answer 11

Mucus secreting simple columnar epithelium

Question 12

What is the ectocervix?

Answer 12

The part of the cervix that projects into the vagina

Question 13

What is the ectocervix lined by?

Answer 13

Stratified squamous non-keratinised epithelium

Question 14

What happens to the lining of the cervix in a cervical ectropion?

Answer 14

The stratified squamous cells of the ectocervix undergo metaplastic change to become simple columnar epithelium (same as endocervix)

Question 15

What induces the change in the epithelium of the ectocervix in cervical ectropion?

Answer 15

Thought to be induced by higher oestrogen levels

Question 16

What does the columnar epithelium contain in the endocervix?

Answer 16

Mucus secreting glands

Question 17

What is the result of the cervical columnar epithelium containing mucus secreting glands?

Answer 17

Some women with cervical ectropion experience increased vaginal discharge

Question 18

Why might cervical ectropion give rise to post-coital bleeding?

Answer 18

As fine blood vessels present within the epithelium are easily broken during intercourse

Question 19

What are the risk factors for cervical ectropion related to?

Answer 19

Things that cause high levels of oestrogenn

Question 20

What are the risk factors for cervical ectropion?

Answer 20

• Use of COCP
• Pregnancy
• Adolescence
• Menstruating age

Question 21

What are the most common clinical features of cervical ectropion?

Answer 21

Most commonly asymptomatic

Question 22

If symptomatic, how can cervical ectropion present?

Answer 22

• Post-coital bleeding
• Intermenstrual bleeding
• Non-purulent excessive discharge

Question 23

What is found on speculum examination in cervical ectropion?

Answer 23

Everted columnar epithelium has reddish appearance, usually arranged in ring around external os

Question 24

What are the differential diagnoses of cervical ectropion?

Answer 24

• Cervical cancer
• CIN
• Cervicitis
• Pregnancy

Question 25

How is the diagnosis of cervical ectropion made?

Answer 25

Clinical diagnosis, and the main role of any investigation to exclude other potential diagnoses

Question 26

What investigations may be done in suspected cervical ectropion?

Answer 26

- Pregnancy test - Triple swabs - Cervical smear

Question 27

When should triple swabs be performed in suspected cervical ectropion?

Answer 27

If there is any suggestion of infection (e.g. purulent discharge)

Question 28

What swabs should be taken if there is suggestion of infection in suspected cervical ectropion?

Answer 28

- Endocervical | - High vaginal swabs

Question 29

Why should cervical smears be done in suspected cervical ectropion?

Answer 29

Rule out cervical intraepithelial neoplasia

Question 30

What should be done if a frank lesion is observed in suspected cervical ectropion?

Answer 30

A biopsy should be taken

Question 31

When is management required for cervical ectropion?

Answer 31

If asymptomatic

Question 32

Why is management not required for cervical ectropion unless symptomatic?

Answer 32

It is regarded as a normal variant

Question 33

What is the first line treatment for cervical ectropion?

Answer 33

Stop any oestrogen containing medications

Question 34

What is the most common oestrogen containing medication taken by women with cervical ectropion?

Answer 34

COCP

Question 35

What management can be employed if symptoms persist in cervical ectropion?

Answer 35

The columnar epithelium can be ablated

Question 36

How can the columnar epithelium be ablated in cervical ectropion?

Answer 36

Typically using cryotherapy or electrocautery

Question 37

What is the problem with ablation of the columnar epithelium in cervical ectropion?

Answer 37

It will result in significant vaginal discharge until healing is completed

Question 38

What medications have been suggested to be useful in cervical ectropion?

Answer 38

Medication to acidify vaginal pH, such as boric acid pessaries