From the Guidelines
Cervical ectropion is a normal developmental finding in adolescents, characterized by the presence of columnar epithelium on the exocervix, and typically does not require treatment unless it causes significant symptoms such as excessive vaginal discharge, post-coital bleeding, or intermenstrual spotting. When performing a speculum examination, it is essential to completely visualize the cervix to note the presence of any lesions, including an ectropion, as described in the American Academy of Pediatrics clinical report 1. The ectropion is usually a benign condition that can cause symptoms due to the exposure of columnar epithelium on the exocervix. Some key points to consider when evaluating cervical ectropion include:
- The condition is often asymptomatic and may resolve spontaneously, particularly after hormonal changes such as those following pregnancy or stopping hormonal contraception.
- If treatment is necessary, options include cauterization with silver nitrate, cryotherapy, electrocautery, or laser therapy, which work by destroying the columnar epithelium and allowing squamous epithelium to grow over the treated area, as noted in the context of managing abnormal cervical findings 1.
- It is crucial to differentiate cervical ectropion from other cervical lesions, such as those caused by infection or neoplasia, and to evaluate any concerning symptoms like persistent abnormal bleeding to rule out other causes.
- Women should be reassured about the benign nature of cervical ectropion, and education on the condition can help alleviate concerns and promote understanding of the need for regular gynecologic examinations to monitor for any changes or development of symptoms.
From the Research
Definition and Symptoms of Cervical Ectropion
- Cervical ectropion is a condition where the glandular cells lining the cervix extend onto the outer surface of the cervix 2.
- Symptoms of cervical ectropion include abundant leucorrhoea, postcoital bleeding, recurrent cervicitis, pelvic pain, and dyspareunia 2.
Treatment Options for Cervical Ectropion
- Cryotherapy is a commonly used treatment for symptomatic cervical ectropion [(2,3)].
- Cryotherapy has been shown to improve quality of life scores and symptom relief, including vaginal discharge, pelvic pain, and postcoital bleeding 2.
- Other treatment options include loop electrosurgical excision procedure (LEEP) and cold knife conization 4.
Effectiveness of Cryotherapy
- Cryotherapy has been shown to improve cervical mucus characteristics, including total cervical score and in vitro penetration tests 3.
- Cryotherapy is a feasible and effective treatment for symptomatic cervical ectropion, with significant improvements in quality of life scores and symptom relief 2.
- However, cryotherapy may not have a significant impact on female sexual function, with the exception of the pain domain 2.
Comparison with Other Treatments
- Excisional procedures, such as LEEP, are associated with adverse obstetric outcomes, including preterm delivery and perinatal mortality 4.
- Ablative therapies, such as cryotherapy, have less of an effect on adverse obstetric outcomes and are effective alternatives for treating cervical precancer in reproductive-aged women 4.
- Colposcopy is an essential diagnostic test for evaluating abnormal Pap tests and determining the location and extent of cervical intraepithelial lesions 5.