Cervical ectropion

Not to be confused with Ectropion.
Cervical ectropion (or cervical eversion) is a condi-
tion in which the central (endocervical) columnar epithe-
lium protrudes out through the external os of the cervix
and onto the vaginal portion of the cervix, undergoes
squamous metaplasia, and transforms to stratied squa-
mous epithelium.[1] Although not an abnormality, it is in-
distinguishable from early cervical cancer; therefore, fur-
ther diagnostic studies (e.g., Pap smear, biopsy) must be
performed for a dierential diagnosis.[2]
1 Formation
The squamocolumnar junction, where the columnar se-
cretory epithelium of the endocervical canal meets the
stratied squamous covering of the ectocervix, is located
at the external os before puberty. As estrogen levels
rise during puberty, the cervical os opens, exposing the
endocervical columnar epithelium onto the ectocervix.
This area of columnar cells on the ectocervix forms an
area that is red and raw in appearance called an ectro-
pion (cervical erosion). It is then exposed to the acidic
environment of the vagina and, through a process of
squamous metaplasia, transforms into stratied squamous
epithelium.[3]
ing, as ne blood vessels present within the columnar ep-
ithelium are easily traumatised.
4 Treatment
Usually no treatment is indicated for clinically asymp-
tomatic cervical ectropions. Hormonal therapy may be
indicated for symptomatic erosion. If it becomes trouble-
some to the patient, it can be treated by discontinuing oral
contraceptives, cryotherapy treatment, or by using abla-
tion treatment under local anaesthetic. Ablation involves
using a preheated probe (100 C) to destroy 34 mm of
the epithelium. In post-partum erosion, observation and
re-examination are necessary for 3 months after labour.
5 References
[1] Katz: Comprehensive Gynecology, 5th Edition.
[2] Mosbys Guide to Physical Examination, 7th Edition.
Page 558.
[3] Standring: Grays Anatomy, 40th ed.
[4] Standring: Grays Anatomy, 40th ed.
[5] Bope: Conns Current Therapy 2011, 1st Edition.

2 Causes
Cervical ectropion is a normal phenomenon, especially
in the ovulatory phase in younger women, during preg-
nancy, and in women taking the oral contraceptive pill,
which increases the total estrogen level in the body.[4]
It also may be a congenital problem by persistence of
the squamocolumnar junction which is normally present
prior to birth.
Mucopurulent cervicitis may increase the size of the cer-
vical ectropion.[5]

3 Symptoms
Cervical ectropion can be associated with excessive but
non-purulent vaginal discharge due to the increased sur-
face area of columnar epithelium containing mucus-
secreting glands. It may also give rise to post-coital bleed-

1
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