Cervical stenosis is narrowing of the passageway through the cervix (the lower part of the uterus).

• Infertility can occur, or the uterus can fill with blood or pus.
• The opening of the cervix can be widened to relieve symptoms.

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 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). If pus forms in the uterus (as it may in women with cervical or endometrial cancer), pus may accumulate in the uterus. Accumulation of pus in the uterus is called pyometra.

Symptoms

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.

Diagnosis

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) test or a variation of it (cervical cytology) or from the lining of the uterus (an endometrial biopsy)

Doctors confirm the diagnosis by trying to pass a probe through the cervix into the uterus.

No further tests are needed for the following:

• Postmenopausal women who have never had abnormal Pap test results
• Women who have no symptoms, no hematometra, and no pyometra

If cervical stenosis causes symptoms, a hematometra, or a pyometra, tissue samples are taken and examined under a microscope to rule out cancer. After treatment (which widens the cervix), doctors take samples from the cervix and from the uterine lining.

Treatment

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.

Last full review/revision December 2008 by S. Gene McNeeley, MD