Cervical Ectropion and Cervical Erosion Are the Same Condition
Cervical ectropion and cervical erosion are identical terms describing the same benign anatomical finding—the term "cervical erosion" is an outdated misnomer that should be abandoned in favor of "ectropion" or "ectopy." 1
Terminology and Definition
The term "cervical erosion" is an anachronism that incorrectly implies tissue destruction or ulceration, when in fact no erosive process occurs 1
Cervical ectropion (also called ectopy) is the accurate medical term that describes the eversion of endocervical columnar epithelium onto the exocervix, making it visible during speculum examination 2, 1
This represents the transition zone between columnar and squamous epithelium (the squamocolumnar junction) being located on the visible portion of the cervix rather than within the endocervical canal 2
Clinical Characteristics
Normal Developmental Finding
Cervical ectropion is a normal physiological finding in adolescents and women of reproductive age, not a pathological condition requiring treatment 2
The ectropion typically regresses into the cervical canal with advancing gynecologic age as squamous metaplasia occurs 2
When prominent, the ectropion can cause significant vaginal discharge due to the mucus-producing columnar epithelium being exposed to the vaginal environment 2, 3
Appearance on Examination
The cervix appears reddened or "raw-looking" because the single-layer columnar epithelium is more vascular and translucent than the surrounding squamous epithelium 2
This red appearance historically led to the misleading term "erosion," though no actual tissue damage is present 1
Clinical Significance and Management
When Treatment Is NOT Needed
Asymptomatic cervical ectropion requires no treatment and restriction of hormonal contraceptive use is unnecessary 2
Cervical ectropion is not a risk factor for cervical cancer and does not require intervention in the absence of symptoms 2
When Treatment May Be Considered
Treatment is only indicated for symptomatic ectropion causing bothersome leukorrhea, postcoital bleeding, dyspareunia, pelvic pain, or recurrent cervicitis 3, 4, 5
Cryotherapy is the most commonly used treatment for symptomatic cases, with an 84-86% success rate in resolving symptoms and cervical appearance 3, 5
Tranexamic acid vaginal tablets (400 mg) represent an equally effective alternative to cryotherapy, with similar cure rates (86% vs 84%) and fewer side effects 3
Cervical painting with gentian violet and antibiotics are also used in some settings, though evidence is limited 4
Important Clinical Pitfalls
Avoid Overtreatment
The decision to treat remains controversial, and routine treatment of asymptomatic ectropion is not recommended despite historical concerns about squamous metaplasia and cervical cancer risk 4
Most cases resolve spontaneously with time as hormonal influences change and squamous metaplasia progresses 2
Rule Out Pathology First
Always exclude cervical intraepithelial neoplasia, cervical cancer, and sexually transmitted infections before attributing symptoms to benign ectropion 2, 4
Friability and hyperemia can indicate infection with STIs rather than simple ectropion 2
Pap smears and further investigation may be needed to exclude potentially serious conditions before treating presumed symptomatic ectropion 4