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Cervical Stenosis

by S. Gene McNeeley, MD

Cervical stenosis is stricture of the internal cervical os.

Cervical stenosis may be congenital or acquired. The most common acquired causes are

  • Menopause

  • Cervical surgery (eg, conization, cautery)

  • Endometrial ablation procedures to treat uterine abnormalities that cause menorrhagia

  • Cervical or uterine cancer

  • Radiation therapy

Cervical stenosis may be complete or partial. It may result in a hematometra (accumulation of blood in the uterus) or, in premenopausal women, retrograde flow of menstrual blood into the pelvis, possibly causing endometriosis. A pyometra (accumulation of pus in the uterus) may also develop, particularly in women with cervical or uterine cancer.

Symptoms and Signs

Common symptoms in premenopausal women include amenorrhea, dysmenorrhea, abnormal bleeding, and infertility. Postmenopausal women may be asymptomatic for long periods. Hematometra or pyometra may cause uterine distention or sometimes a palpable mass.

Diagnosis

  • Clinical evaluation

Diagnosis may be suspected based on symptoms and signs (particularly development of amenorrhea or dysmenorrhea after cervical surgery) or on inability to obtain endocervical cells or an endometrial sample for diagnostic tests (eg, for a Papanicolaou [Pap] test). Diagnosis of complete stenosis is established if a 1- to 2-mm diameter probe cannot be passed into the uterine cavity.

If cervical stenosis causes symptoms or uterine abnormalities (eg, hematometra, pyometra), cervical cytology and endometrial biopsy or D & C should be done to exclude cancer. For postmenopausal women with no history of abnormal Pap tests and for women without symptoms or uterine abnormalities, no further evaluation is needed.

Treatment

  • Dilation and stenting if symptomatic

Treatment is indicated only if symptoms or uterine abnormalities are present and typically involves cervical dilation and placement of cervical stent.

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