What is the management for cervical ectropion?

Management of Cervical Ectropion

Cervical ectropion should be managed conservatively in asymptomatic patients, while symptomatic cases can be effectively treated with cryotherapy as the first-line intervention.

Understanding Cervical Ectropion

Cervical ectropion (also called cervical erosion) is a normal developmental finding where the columnar epithelium of the endocervix extends onto the ectocervix, creating a visible red area around the external os. It is characterized by:

• Exposure of glandular columnar cells on the ectocervix
• Common in adolescents, pregnant women, and hormonal contraceptive users
• Often a normal physiological finding that regresses with advancing gynecologic age 1

Diagnostic Approach

During speculum examination:

• Visualize the cervix completely to note the presence of ectropion (transition between columnar and squamous epithelium) on the exocervix
• Distinguish from other conditions:
  • Friability and hyperemia (may indicate STI)
  • White plaques (may indicate condyloma)
  • Red punctate lesions/strawberry cervix (may indicate trichomoniasis)
  • Cervical cyanosis (Chadwick sign in pregnancy)

Management Algorithm

1. Asymptomatic Ectropion

• No treatment required - this is a normal physiological finding
• Routine cervical screening as per age-appropriate guidelines

2. Symptomatic Ectropion

Common symptoms include:

• Abundant vaginal discharge (leukorrhea)
• Post-coital bleeding
• Dyspareunia
• Pelvic pain
• Recurrent cervicitis

First-line Treatment: Cryotherapy

• Cryotherapy using liquid nitrogen (double-freeze technique) is the most preferred treatment option 2
• Highly effective for symptom relief and improvement in quality of life
• Significantly improves physical and mental quality of life scores
• Particularly effective for reducing:
  • Vaginal discharge
  • Pelvic pain
  • Post-coital bleeding
  • Sexual pain (dyspareunia) 2

Alternative Treatments:

1. Tranexamic Acid

   • 400 mg effervescent vaginal tablets
   • Recent research shows equal effectiveness to cryotherapy
   • May be preferred due to ease of use, availability, and fewer side effects 3

2. Other Options

   • Microwave tissue coagulation - improves cervical appearance compared to laser therapy 4
   • Deoxyribonucleic acid (DRNA) 5 mg vaginal suppositories - shown to be effective in reducing ectropion size 5
   • Laser ablation - effective but may cause more bleeding during treatment than microwave therapy 4

Special Considerations

Impact on Sexual Function

• While cryotherapy significantly improves symptoms and quality of life, patients should be informed that it may not significantly improve overall sexual function
• Exception: Sexual pain domain scores typically improve after cryotherapy 2

Refractory Cases

• For cases resistant to standard treatments, consider referral to gynecology for specialized management
• In cases where ectropion causes persistent desquamative inflammatory vaginitis, cryotherapy of the cervix may provide complete resolution of symptoms 6

Follow-up

• Clinical reassessment 4-6 weeks after treatment
• If symptoms persist, consider repeat treatment or alternative approaches

Conclusion

Cervical ectropion is often a normal finding that requires no treatment when asymptomatic. For symptomatic cases, cryotherapy remains the gold standard treatment with proven effectiveness for symptom relief and improved quality of life. Tranexamic acid vaginal tablets offer a promising alternative with similar efficacy and potentially fewer side effects.