Cervical stenosis is narrowing of the passageway through the cervix (the lower part of the uterus).
In cervical stenosis, the passageway through the cervix (from the vagina to the main body of the uterus) is narrow or completely closed.
Some women are born with cervical stenosis. In others, cervical stenosis results from a disorder or another condition, such as the following:
Cancer (cervical or endometrial)
Surgery that involves the cervix—for example, done to treat precancerous changes of the cervix (dysplasia)
Procedures that destroy or remove the lining of the uterus (endometrial ablation) in women who have persistent vaginal bleeding
Radiation therapy to treat cancer of the cervix or of the lining of the uterus (endometrial cancer)
Menopause, because the tissues in the cervix thin (atrophy)
Cervical stenosis may result in an accumulation of blood in the uterus (hematometra). In women who are still menstruating, menstrual blood mixed with cells from the uterus may flow backward into the pelvis, possibly causing endometriosis (see Endometriosis).
Pus may accumulate in the uterus (as it does in some women with cervical or endometrial cancer). Accumulation of pus in the uterus is called pyometra.
Before menopause, cervical stenosis may cause menstrual abnormalities, such as no periods (amenorrhea), painful periods (dysmenorrhea), and abnormal bleeding. Cervical stenosis can also cause infertility because sperm cannot pass through the cervix to fertilize the egg.
After menopause, cervical stenosis may be present but not cause symptoms.
A hematometra or pyometra can cause pain or cause the uterus to bulge. Sometimes women feel a lump in the pelvic area.
Doctors suspect the diagnosis based on symptoms and circumstances, such as the following:
When periods stop or become painful after surgery on the cervix
When doctors cannot insert an instrument into the cervix to obtain a sample of tissue from the cervix for a Papanicolaou (Pap) or human papilloma virus (HPV) test (called cervical cytology testing) or a sample from the lining of the uterus for an endometrial biopsy
Doctors confirm the diagnosis by trying to pass a probe through the cervix into the uterus.
If cervical stenosis causes symptoms, tests are done to rule out cancer. If premenopausal women have a hematometra or pyometra, these tests may include cervical cytology testing (such as a Pap or HPV test) and endometrial biopsy. Before these tests can be done, doctors do a procedure—called dilation and curettage (D & C—see Diagnostic Procedures : Dilation and Curettage) widen or open the cervix. This procedure enables doctors to take samples from the cervix and from the uterine lining.
No further tests are needed if all of the following apply:
Cervical stenosis is treated only if women have symptoms, a hematometra, or a pyometra. Then, the cervix may be widened (dilated) by inserting small, lubricated metal rods (dilators) through its opening, then inserting progressively larger dilators. To try to keep the cervix open, doctors may place a tube (cervical stent) in the cervix for 4 to 6 weeks.