WHAT ARE NONMALIGNANT CERVICAL DISORDERS?
Nonmalignant disorders of the cervix (the narrow opening at the mouth of the uterus) include cervicitis, cervical eversion, cervical polyps, and cervical dysplasia. Cervicitis is a broad term for an inflammation or infection of the cervix. Cervical eversion, also known as ectropion (often mistakenly termed cervical erosion), is the migration of cells from the lining of the endocervical canal (endocervix) to the outer portion of the cervix (ectocervix). The cells from the endocervical canal are more delicate than the cells of the ectocervix and thus more susceptible to infection. Actual erosion or abrasion of cervical tissue is quite rare but may occur following childbirth, certain medical procedures, sexual intercourse, or the use of an intrauterine birth control device (IUD).
Cervical polyps are grapelike growths from the surface cells lining the cervix. They may occur singly or in groups, and in some women, large polyps may interfere with conception by creating a barrier to sperm migration. Rarely do cervical polyps become malignant. Cervical dysplasia is the presence of abnormal cells on the surface of the cervix and may be classified as mild, moderate, or severe, depending upon the extent of the cellular abnormality. Although dysplasia (at any stage) is not cancerous and milder degrees may go away spontaneously, it can be the first step in the eventual development of cervical cancer and thus warrants prompt attention.
WHAT CAUSES NONMALIGNANT CERVICAL DISORDERS?
- Cervicitis may be caused by vaginal infections, sexually transmitted diseases, and pelvic inflammatory disease. Tears or lacerations in the cervix occurring during childbirth or abortion may lead to cervicitis.
- The cause of cervical eversion is not known. The condition is normal in early puberty, and some women are born with it. Pregnancy and long-term use of oral contraceptives may increase risk.
- The growth of cervical polyps may be triggered by injury to the cervix, vaginal infections, or hormonal changes. They tend to recur after removal, but are almost always benign.
- The cause of cervical dysplasia is not known, although it may be linked to cervical eversion and sexually transmitted diseases, especially those associated with the human papillomavirus. Women who have had many sexual partners are at greater risk (see Cervical Cancer for more information).
SYMPTOMS OF NONMALIGNANT CERVICAL DISORDERS
- Cervicitis symptoms include clear, gray, or yellow vaginal discharge; vaginal bleeding after intercourse or between periods; post menopausal bleeding; burning and itching of external genitalia. Simultaneous infections of adjacent organs may produce additional symptoms of frequent and urgent need to urinate, painful urination, and lower abdominal or back pain.
- Cervical eversion symptoms include white or slightly bloody vaginal discharge, often appearing one week prior to a period; vaginal bleeding after intercourse or between periods.
- Symptoms of cervical polyps include heavy, watery, and bloody vaginal discharge; vaginal bleeding after intercourse, between periods, or after a bowel movement; heavy bleeding during periods; pelvic cramps.
- Cervical dysplasia does not cause symptoms. A Pap smear is necessary to detect it.
PREVENTION of NONMALIGNANT CERVICAL DISORDERS
- Women should have regular Pap smears for early detection of any irregularities of the cervix. Cervix screening (Pap smear) can detect early changes in the cervix. Early detection and treatment of these changes can help prevent cervical cancer.
- Prompt treatment should be obtained for any vaginal infection or sexually transmitted disease.
- Women should wear cotton undergarments. Nylon fibers, which cannot “breathe,” create a warm, moist environment that may encourage infections.
DIAGNOSIS of NONMALIGNANT CERVICAL DISORDERS
- A Pap smear (microscopic examination of a small sample of cells scraped from the cervix and upper vagina) is necessary.
- A sample of vaginal discharge, if any is present, may be taken for analysis (including culture or microscopic examination).
- Colposcopy (inspection of the vagina and cervix with a special scope) can identify abnormalities.
- A biopsy of cervical tissue may be performed, as well as a scraping of tissue from the endocervical canal, usually during colposcopy.
HOW TO TREAT NONMALIGNANT CERVICAL DISORDERS
- Cervicitis: Your doctor may prescribe antibiotics, or antifungal or antiviral agents. If symptoms persist, the affected area of the cervix may be painlessly eliminated by heat (cauterization), applications of liquid nitrogen (cryosurgery), or laser surgery. If the infection has penetrated deeply into the cervical tissue, the affected tissue may be surgically removed in a conical section (conization).
- Cervical eversion: The affected tissues may be eliminated by cauterization, cryosurgery, or laser surgery. Treatment is unnecessary if the condition produces no symptoms.
- Cervical polyps: Polyps are removed surgically. Single growths may be removed under a local anesthetic in the doctor’s office. Removal of clusters of larger polyps may require brief hospitalization.
- Cervical dysplasia: Mild cervical dysplasia may disappear without treatment. Surgery for persistent cervical dysplasia may include laser surgery, cryosurgery, cauterization, or conization. In severe cases, which border on cervical cancer, a hysterectomy may be advised
WHEN TO CALL A DOCTOR
- Make an appointment with a gynecologist if you experience symptoms of any cervical disorders.
- See your gynecologist regularly for Pap smears.
Johns Hopkins Symptoms and Remedies: The Complete Home Medical Reference
Simeon Margolis, M.D., Ph.D., Medical Editor
Prepared by the Editors of The Johns Hopkins Medical Letter: Health After 50
Updated by Remedy Health Media