Cervical ectropion refers to the benign eversion of columnar endocervical epithelium onto the ectocervix. It is a physiological finding, commonly influenced by higher oestrogen states, and is not associated with cervical malignancy. Symptoms arise due to the increased friability and mucus production of the exposed columnar epithelium.

Pathophysiology

• On the ectocervix, the transformation zone marks the junction between stratified squamous and columnar epithelium
• High oestrogen states (ovulatory phase, pregnancy, combined oral contraceptives) increase the area of columnar epithelium on the ectocervix
• The term cervical erosion is now avoided; cervical ectropion is preferred
• It is a benign, non-premalignant condition

Features

• Vaginal discharge due to mucus production from exposed columnar epithelium
• Post-coital bleeding from increased cervical friability
• Intermenstrual bleeding is less common but can occur
• Speculum examination typically shows a well-demarcated red area around the os representing exposed columnar epithelium

Assessment

• Ensure cervical screening is up to date
• Exclude infection: chlamydia screen for all; consider gonorrhoea, BV, candida or trichomonas depending on symptoms
• Consider pregnancy as a physiological cause of ectropion

Management

• Reassurance if asymptomatic, as this is a normal variant
• Treat any identified infection first
• Ablative treatment (e.g. cold coagulation) only for troublesome or persistent symptoms
  • Avoid ablative treatment during pregnancy
• Symptoms often improve when oestrogen exposure is reduced (e.g. switching COC if appropriate)