Cervical Ectropion (formerly Cervical Erosion)

Cervical ectropion is a common and normal physiological condition where the soft, glandular cells that usually line the inside of the cervix (endocervix) are present on the outer surface of the cervix (ectocervix). This condition was once commonly, but incorrectly, called 'cervical erosion.' This term is misleading because no tissue is actually eroded or ulcerated; it simply describes the appearance of the cervix. It is a normal finding in many women, particularly during adolescence, pregnancy, and in those using combined hormonal contraception, due to the influence of hormones like estrogen. Cervical ectropion is not a disease, an infection, or a pre-cancerous condition, and it does not increase your risk of cervical cancer.

Symptoms

Asymptomatic (no symptoms in the majority of cases)
Post-coital bleeding (bleeding after sex), which is the most common symptom due to the delicate nature of the glandular cells
Excessive vaginal discharge that is typically clear or white and non-purulent (not indicative of infection)
Intermenstrual bleeding or spotting (bleeding between periods)

Causes & Risk Factors

Physiological hormonal changes, primarily the influence of estrogen, which causes the glandular cells to grow and evert onto the outer cervix.
Puberty, due to naturally rising estrogen levels.
Pregnancy, due to high levels of circulating estrogen.
Use of combined hormonal contraceptives (e.g., birth control pills or patches) that contain estrogen.
Congenital factors, where some individuals are born with the squamocolumnar junction (the meeting point of cell types) naturally positioned further out on the cervix.
Hormonal status, particularly conditions or medications that increase estrogen levels.
Age, being common in women of reproductive age, especially adolescents.
Pregnancy, due to the significant hormonal changes.
Use of combined oral contraceptives or other estrogen-containing hormonal contraception.
Congenital ectropion, where the condition is present from birth.

Diagnosis

A discussion of your symptoms, medical history, menstrual cycle, and contraceptive use.
A physical examination, including a speculum examination, where a doctor visually inspects the cervix. Cervical ectropion appears as a red, velvety area, which may bleed easily when touched with a swab.
Cervical screening (Pap smear and/or HPV test) is essential to rule out cervical dysplasia (abnormal cell changes) or cervical cancer, which can sometimes mimic the appearance or symptoms of ectropion.
Colposcopy, a magnified examination of the cervix, may be recommended if cervical screening results are abnormal or if the cervix has a suspicious appearance.
Biopsy, where a small tissue sample is taken during colposcopy for laboratory analysis, if any abnormal areas are identified.
Infection screening, such as swabs for sexually transmitted infections (STIs), may be performed to rule out cervicitis as a cause of discharge or contact bleeding.

Treatment Options

Watchful waiting: For most women, especially those without bothersome symptoms, no treatment is needed. Cervical ectropion is benign and often resolves on its own, particularly after pregnancy or stopping hormonal contraception. Reassurance that the condition is normal and harmless is a key part of management.
Adjusting hormonal contraception: If symptoms are problematic and you are using combined hormonal contraception, your doctor may discuss trying a different contraceptive method (e.g., progestin-only or non-hormonal) to see if symptoms improve.
Ablative procedures: These treatments are reserved for women with persistent, bothersome symptoms (such as significant bleeding after sex or excessive discharge) after cervical malignancy and other causes have been definitively ruled out. These procedures aim to destroy the glandular cells on the outer cervix, allowing the tougher squamous cells to regrow.
Cryocautery (cryotherapy): This method involves freezing the affected area of the cervix.
Electrocautery (diathermy): This method uses heat to treat the affected area.
Silver nitrate: A chemical cauterant that is less commonly used today.
Treatment is generally deferred until after pregnancy for women who are pregnant.

Frequently Asked Questions

What is cervical erosion or ectropion?

Cervical ectropion is a normal condition where the soft, glandular cells from inside the cervix are found on its outer surface. It was previously, and incorrectly, called 'cervical erosion,' but no tissue is actually eroded.

Is cervical ectropion a form of cancer or pre-cancer?

No, cervical ectropion is a benign (non-cancerous) physiological condition. It is not a form of cancer or pre-cancer.

Does having cervical ectropion increase my risk of getting cervical cancer?

No, cervical ectropion does not increase your risk of developing cervical cancer.

What causes bleeding after sex?

Bleeding after sex (post-coital bleeding) is the most common symptom of cervical ectropion. The glandular cells on the outer cervix are delicate and can bleed easily when touched during intercourse. However, persistent bleeding after sex should always be investigated by a doctor to rule out other causes.

Is it normal to have this condition?

Yes, cervical ectropion is a very common and normal finding, especially in adolescents, pregnant women, and those using combined hormonal contraception.

Does my birth control pill cause this?

Combined hormonal contraceptives, such as birth control pills, can contribute to the development of cervical ectropion due to their estrogen content.

Will it go away on its own?

Yes, cervical ectropion often resolves spontaneously. This commonly happens after pregnancy or after stopping combined hormonal contraception, as hormone levels change.

Do I need treatment if I don't have any symptoms?

No, if you do not have any bothersome symptoms, treatment for cervical ectropion is generally not needed. Reassurance that it is a normal, benign condition is usually sufficient.

What are the treatment options for symptomatic ectropion?

For persistent and bothersome symptoms like significant bleeding after sex or excessive discharge, and once other serious conditions are ruled out, treatment options include cryocautery (freezing), electrocautery (heating), or sometimes silver nitrate application.

Is the treatment painful?

Ablative treatments like cryocautery or electrocautery may cause some pain or cramping during and after the procedure. Your doctor can discuss pain management options with you.

What are the risks and side effects of treatment like cryotherapy?

Common side effects include pain or cramping, and a profuse watery vaginal discharge for several weeks. Less common risks include vaginal bleeding or spotting, and rarely, infection or cervical stenosis (narrowing of the cervical canal).

Can cervical ectropion affect my fertility or ability to get pregnant?

No, cervical ectropion does not affect your fertility or ability to get pregnant.

Is it safe to have cervical ectropion during pregnancy?

Yes, cervical ectropion is very common and physiological during pregnancy due to high hormone levels. It is generally safe and not associated with adverse pregnancy outcomes.

Can it cause problems with my baby or the delivery?

No, cervical ectropion is not associated with problems for your baby or with the delivery process. It can be a cause of minor bleeding during pregnancy, but this needs to be investigated to rule out other obstetric causes.

Why do I have more vaginal discharge with this condition?

The glandular cells on the outer cervix produce mucus. When these cells are present on the ectocervix, they can lead to an increase in normal, non-purulent, mucoid vaginal discharge.

Do I need to change my sexual activity because of this?

If you experience bleeding after sex due to ectropion, you might choose to adjust sexual activity. However, the condition itself does not require changes to sexual activity unless symptoms are bothersome. Always discuss persistent symptoms with your doctor.

How is this different from an STI or cervicitis?

Cervical ectropion is a normal physiological condition, not an infection. Cervicitis is an inflammation of the cervix, often caused by an infection (like an STI), and can cause similar symptoms such as discharge or bleeding. Your doctor will perform tests to differentiate between these conditions.

Will it come back after treatment?

Yes, symptoms of cervical ectropion can recur after treatment, especially if the underlying hormonal influences (such as continued use of combined hormonal contraception) persist.

Do I need special follow-up appointments for this?

For asymptomatic ectropion, no specific follow-up is required beyond your routine cervical screening. After treatment, a follow-up appointment may be scheduled to check for symptom resolution and any complications.

Why is it called 'erosion' if nothing is being eroded?

The term 'cervical erosion' is an outdated and misleading misnomer. It was used because the red, delicate appearance of the glandular cells on the outer cervix was mistakenly thought to be an 'erosion' or ulceration of tissue, when in fact, no tissue is actually eroded.