Cervical stenosis means that the opening in the cervix (the endocervical canal) is more narrow than is typical. In some cases, the endocervical canal may be completely closed. Cervical stenosis may be present from birth or may be caused by other factors such as cervical cancer, dysplasia, endometrial ablation or menopause.

Treatment of cervical stenosis involves opening or widening the cervical canal. The condition may improve on its own following the vaginal delivery of a baby. Cervical canal widening can be temporarily achieved by the insertion of dilators into the cervix. If the stenosis is caused by scar tissue, a laser treatment can be used to vaporize the scarring. Finally, the surgical enlargement of the cervical canal can be performed by hysteroscopic shaving of the cervical tissue.

Associated diseases 

Complications 

Cervical stenosis takes on particular importance because of the clinical repercussions that are associated with its occurrence, such as dysmenorrhea, amenorrhea, infertility and lesions during labor. The condition is also a concern because it prevents both adequate cytological follow-up and collection of endometrial cytology for carcinoma screening.

Risk factors 

  • surgical procedures performed on the cervix such as colposcopy (a medical diagnostic procedure to examine an illuminated, magnified view of the cervix and the tissues of the vagina and vulva), cone biopsy, or a cryosurgery procedure
  • trauma to the cervix
  • repeated vaginal infections
  • atrophy of the cervix after menopause
  • cervical cancer
  • radiation

Cervical stenosis may impact natural fertility by impeding the passage of semen into the uterus. In the context of infertility treatments, cervical stenosis may complicate or prevent the use of intrauterine insemination (IUI) or in vitro fertilization (IVF) procedures.

Non-existing.

Symptoms depend on whether the cervical canal is partially or completely obstructed and on the patient's menopausal status. Pre-menopausal patients may have a buildup of blood inside the uterus which may cause infection, sporadic bleeding, or pelvic pain.

Non-existing.

Pharmacotherapy

Misoprostol

Misoprostol is a medication used to start labor, prevent and treat stomach ulcers, and treat postpartum bleeding due to poor contraction of the uterus. Misoprostol prior to hysteroscopy for cervical dilation appears to facilitate an easier and uncomplicated procedure only in premenopausal women.

Surgical therapy 

Cervical dilatation

Cervical dilatation is a common procedure in gynaecological practice that is used for both therapeutic and diagnostic procedures, such as hysteroscopy, explorative curettage or placement of intrauterine contraceptive devices. The most common method for cervical dilatation is to use Hegar dilators. This method requires significant force, which may lead to permanent damage of the cervical canal. Other methods of cervical dilatation involve the use of osmotic dilators or prostaglandin analogues, which are impractical, often nonfunctional and cause undesirable effects such as cervical haemorrhage or uterine cramping.
Other therapies

Intrauterine device (IUD)

The application of an IUD for cervical stenosis might be effective because the dilation required for device insertion allows menstrual blood to drain. The levonorgestrel-releasing intrauterine system (LNG-IUS) is used not only for contraception but also for dysmenorrhea- or endometriosis-related pain. The LNG-IUS exerts strong progesterone activity, which leads to profound thinning and atrophy of the endometrium. Estrogen receptors are suppressed during LNG use, also contributing to reduced menstrual bleeding. Therefore, LNG-IUS insertion may be expected to be effective for severe cervical stenosis with dysmenorrhea because of the sustained dilation of stenotic tissue with easy drainage of menstrual blood, or because of the direct effect of progesterone on the endometrium.

Find more about related issues

Sources

Stenosis of uterine cervix ―sourced from Wikipedia licensed under CC BY-SA 3.0
Cervical stenosis following electrosurgical conization ―by Monteiro and Russomano licensed under CC BY-NC 4.0
Cervical dilation ―sourced from Wikipedia licensed under CC BY-SA 3.0
Misoprostol ―sourced from Wikipedia licensed under CC BY-SA 3.0
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