From the Guidelines
A friable cervix is a condition that requires immediate medical evaluation to rule out underlying issues such as cervicitis, sexually transmitted infections, or cervical cancer, and the most recent evidence suggests that screening for cervical cancer every 3 years with cytology alone or every 5 years with hrHPV testing alone is recommended for women aged 21 to 65 years 1. The condition is characterized by fragile cervical tissue that bleeds easily when touched, often during sexual intercourse, pelvic examinations, or cervical screening. If a friable cervix is noticed, testing for STIs, including chlamydia, gonorrhea, and trichomoniasis, should be undergone. Treatment depends on the underlying cause, with antibiotics like azithromycin (1g single dose) or doxycycline (100mg twice daily for 7 days) for bacterial infections, antifungals for yeast infections, or metronidazole (500mg twice daily for 7 days) for trichomoniasis. Some key points to consider include:
- The importance of regular cervical screening to rule out more serious conditions like cervical dysplasia or cancer, as recommended by the USPSTF 1
- The need for individualized follow-up for women with risk factors, such as HIV infection, a compromised immune system, or previous treatment of a high-grade precancerous lesion or cervical cancer 1
- The availability of HPV vaccines, which can effectively prevent infection and disease associated with the vaccine HPV types, and have been shown to have a beneficial effect at the population level in reducing the incidence of high-grade cervical abnormalities and genital warts 1 The friability of the cervix occurs because inflamed or abnormal cervical tissue has more blood vessels near the surface and a thinner epithelial layer, making it more susceptible to bleeding when disturbed. In cases of cervical ectropion without infection, the condition may resolve on its own or require procedures like cryotherapy or cauterization if symptomatic. Overall, a friable cervix is a condition that requires prompt medical attention to determine the underlying cause and provide appropriate treatment, and regular cervical screening is essential to prevent and detect cervical cancer, as emphasized by the ESMO clinical practice guidelines for diagnosis, treatment, and follow-up of cervical cancer 1.
From the Research
Definition and Causes of Friable Cervix
- A friable cervix refers to a condition where the cervix is easily irritated and bleeds, often due to inflammation or infection 2, 3.
- The causes of a friable cervix can include cervicitis, which is an inflammation of the cervix, often caused by sexually transmitted infections such as Chlamydia trachomatis and Neisseria gonorrhoeae 2, 3.
Diagnosis and Examination
- Colposcopy is a procedure used to evaluate women with genital tract abnormalities and abnormal cervical cytology, which can help diagnose a friable cervix 4, 5.
- During a colposcopic examination, the cervix is examined under illumination and magnification before and after application of dilute acetic acid, and may include a biopsy of lesions with characteristics of malignancy and premalignancy 4, 5.
Treatment and Management
- Treatment of a friable cervix depends on the underlying cause, and may include antibiotic therapy for infections such as Chlamydia trachomatis and Neisseria gonorrhoeae 2, 3.
- In some cases, pain relief may be necessary during procedures such as colposcopy, and local anaesthetic infiltration with a vasoconstrictor (lignocaine plus adrenaline or prilocaine plus felypressin) may be used to reduce pain 6.