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DocSpot: Cervical ectropion

Dear Dr Margaret
When the nurse was taking a smear test, she told me that I had ‘abrasion to the neck of the womb’ and asked whether intercourse is painful. (It isn’t.) She advised me to see the doctor in a few months’ time and, if it hasn’t cleared up, I may need to get it cauterized. Can this abrasion cause any long-term damage or infertility? I’m 29.

From what the nurse said, you are probably imagining that the cervix (neck of the womb, at the top of the vagina) has somehow been scratched or scraped during sex, and that it needs to heal up. I don’t think this is the case at all. I think the nurse was probably seeing what gynaecologists call ‘ectropion’ of the cervix. This used to be called ‘erosion’ or ‘abrasion’, but gynaecologists don’t use these terms any more, because they suggest the cervix is damaged, which is untrue.
 
Normally, the cervix looks pink and shiny. It has a hole in the middle, where the menstrual blood passes out from the uterus (womb) into the vagina. In some women, the area round the hole looks red and velvety instead of pink and shiny. This is ectropion.
 
If you looked at a pink and shiny cervix under the microscope, you would see that it is covered with flat cells. The cells in an area of ectropion are different. They are taller – known as columnar (because each one looks like a tiny column) – and more transparent. Because they are transparent, blood shows through, which gives the red appearance.
 
The columnar cells of ectropion are perfectly normal. They are not cancerous or pre-cancerous. In fact, they line the inside of the cervical hole in all women. So an ectropion simply means that the columnar cells are around the outside of the hole as well as inside it.
 
It seems that cells on the cervix become columnar when there is a lot of the hormone oestrogen around. Therefore ectropion is most common in women on the contraceptive pill and during pregnancy.
 
So ectropion is perfectly normal, and nothing to worry about. It does not affect fertility, and does not become cancerous. However, the columnar cells are more fragile than the flat cells, so an ectropion may bleed after intercourse. If this is troublesome, it can be treated by heat cautery or by freezing. After treatment, flat cells grow over to heal the area. Treatment is not always successful, because columnar cells may grow again, especially if the woman is still on the pill. Of course, any woman who has bleeding after intercourse should see her doctor, to check that it is ectropion and not something more serious.
The nurse mentioned painful intercourse. As far as I know, cervical ectropion is not painful. For more information about painful intercourse, look at our section on pain during sex.
 

Last updated; Friday, February 5th 2010 at 5:52 am


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