Merck Manual

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Cervical Stenosis

By

Charlie C. Kilpatrick

, MD, MEd, Baylor College of Medicine

Last full review/revision May 2019| Content last modified May 2019
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NOTE: This is the Professional Version. CONSUMERS: Click here for the Consumer Version

Cervical stenosis is stricture of the internal cervical os.

Cervical stenosis may be congenital or acquired.

The most common acquired causes of cervical stenosis 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 the following:

  • Hematometra (accumulation of blood in the uterus)

  • In premenopausal women, retrograde flow of menstrual blood into the pelvis, possibly causing endometriosis

  • Pyometra (accumulation of pus in the uterus), particularly in women with cervical or uterine cancer

Symptoms and Signs

Cervical stenosis is usually asymptomatic.

Symptoms, when present, can include amenorrhea, dysmenorrhea, abnormal bleeding, and infertility in premenopausal women. Postmenopausal women may be asymptomatic for long periods.

Hematometra or pyometra may cause uterine distention or sometimes a palpable mass.

Diagnosis

  • Clinical evaluation

Cervical stenosis is often diagnosed only when clinicians have difficulty accessing the uterine cavity during tests done for a different reason. It 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.

For postmenopausal women with no history of abnormal Pap tests and for women without symptoms or uterine abnormalities, no further evaluation is needed.

If cervical stenosis causes symptoms or uterine abnormalities (eg, hematometra, pyometra), cervical cytology and endometrial biopsy or dilation and curettage (D & C) should be done to exclude cancer.

Treatment

  • Dilation and stenting if symptomatic

Usually, cervical stenosis does not require treatment. Treatment is indicated only if symptoms or uterine abnormalities are present and typically involves cervical dilation and placement of cervical stent.

Key Points

  • Cervical stenosis may be congenital or acquired (eg, caused by menopause, cervical surgery, endometrial ablation, cervical or uterine cancer, or radiation therapy).

  • Cervical stenosis is usually asymptomatic.

  • Suspect cervical stenosis based on symptoms and signs or on inability to obtain endocervical or endometrial samples for tests; inability to pass a 1- to 2-mm diameter probe into the uterine cavity confirms complete stenosis.

  • If symptoms or uterine abnormalities (eg, hematometra, pyometra) are present, exclude cancer by cervical cytology and endometrial biopsy or D & C, then dilate the cervix and place a stent.

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NOTE: This is the Professional Version. CONSUMERS: Click here for the Consumer Version
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