Cervical ectropion 

occurs when there is eversion of the endocervix, exposing the columnar

epithelium to the vaginal milieu. It is also known as a cervical erosion, although no “erosion” of
cells actually occurs.

It is a benign condition, which is commonly seen on examination of the cervix in adolescents, in

pregnancy, and in women taking oestrogen containing contraceptives. However, cervical
cancer and cervical intraepithelial neolasia (CIN) need to be excluded before any treatment or
reassurance to the patient is offered.

In this article, we shall look at the clinical features, investigations and management of cervical
ectropion.
Aetiology and Pathophysiology
The cervix is the lower portion of the uterus. It is composed of two regions; the ectocervix and
the endocervical canal.

 Endocervical canal (endocervix) – the more proximal, and ‘inner’ part of the cervix. It is
lined by a mucus-secreting simple columnar epithelium.

 Ectocervix – the part of cervix that projects into the vagina. It is normally lined by
stratified squamous non-keratinized epithelium.

In cervical ectropion, the stratified squamous cells of the ectocervix undergo metaplastic

change to become simple columnar epithelium (the same as the endocervix). This change is
thought to be induced by high levels of oestrogen.

The columnar epithelium contains mucus-secreting glands, and thus some individuals with

cervical ectropion experience increased vaginal discharge. It may also give rise to post-coital
bleeding, as the fine blood vessels present within the epithelium are easily broken during
intercourse.

 By TeachMeSeries Ltd (2021)
 Fig 1 – The cervix can be divided into the endocervical canal and the ectocervix.
Risk Factors
It is thought that cervical ectropion is induced by high levels of oestrogen. Therefore, factors
that increase the risk of ectropion are related to those that increase levels of oestrogen:

 Use of the combined oral contraceptive pill

 Pregnancy
 Adolescence
 Menstruating age (it is uncommon in post-menopausal women)

Clinical Features
Cervical ectropion is most commonly asymptomatic. It can occasionally present with post-coital
bleeding, intermenstrual bleeding, or excessive discharge (non-purulent).

On speculum examination, the everted columnar epithelium has a reddish appearance – usually
arranged in a ring around the external os.

By Gynpath.ru [CC BY-SA 4.0], via Wikimedia Commons

 Fig 2 – Cervical ectropion on speculum examination.
Differential Diagnosis
In cases of suspected cervical ectropion, other diagnoses to consider are cervical cancer, cervical
intraepithelial neoplasia, cervicitis (inflammation of the cervix, typically caused by infection),
and pregnancy. These should be excluded using relevant investigations.
Investigations
Cervical ectropion is a clinical diagnosis. The main role of any investigation is to exclude other
potential diagnoses:

 Pregnancy test
 Triple swabs – if there is any suggestion of infection (such as purulent discharge),
endocervical and high vaginal swabs should be taken.

 Cervical smear – to rule out cervical intraepithelial neoplasia. If a frank lesion is

observed, a biopsy should be taken (note that biopsies are not performed as routine).

Management
Cervical ectropion is regarded as a normal variant, and does not require treatment unless
symptomatic.

First-line treatment is to stop any oestrogen containing medications – most commonly

the combined oral contraceptive pill. This is effective in the majority of cases.

If symptoms persist, the columnar epithelium can be ablated, typically using cryotherapy or
electrocautery. This will result in significant vaginal discharge until healing is completed.

Medication to acidify the vaginal pH has been suggested, such as boric acid pessaries.
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