Cervical ectropion (1481/1700)

A 35yo woman who usually has 4 days mid-cycle bleeding, had her period 10d ago. She has now presented with spots of blood. Her smear was normal 6m ago. Exam: cervical ectropion which doesn’t bleed on touch. What would you do?

a. Cervical smear
b. Endocervical swab
c. US guided biopsy
d. Laparotomy
e. Transvaginal US
f. Punch biopsy
g. Serum estradiol
h. Colposcopy





























answer: A (no signs of infection, exclude malignancy, 6 months is enough time for things to change)

Cervical ectropion/erosion

There is a red ring around the os because the endocervical epithelium has extended its territory over the paler epithelium of the ectocervix. Ectropions extend temporarily under hormonal influence

during puberty, with the combined Pill, and during pregnancy.

As columnar epithelium is soft and glandular, ectropion is prone to bleeding, to excess mucus production, and to infection. 

Once a normal cervical smear has been confirmed, it is actively managed only if there are symptoms. Over time, vaginal acidity promotes metaplasia to squamous epithelium when the symptoms will disappear.

Treatment:

Cryocautery will treat these if they are a nuisance; otherwise no treatment is required.