Chapter 2 – The Cervix

Cervical ectropion

When viewed through a vaginal speculum the healthy cervix appears smooth and pink. The transformation zone may not be visible, especially in postmenopausal patients, and may be difficult or even impossible to sample. This is not thought to compromise a cervical screening test result, however (3) (see Figure 2.2).

A variation of this appearance is that of cervical ectropion (also called cervical ectopy) which in the past was often referred to as cervical erosion. This occurs when the transformation zone is visible on the ectocervix (see Figure 2.2 and Figure 2.3). It is seen when the columnar epithelium migrates onto the vaginal portion of the cervix due to hormonal changes.

A cervical ectropion can appear red and may look inflamed because the single layer of columnar epithelium makes the underlying blood vessels more apparent compared to the multiple layered squamous epithelium. The columnar epithelium may also secrete more mucus than the vaginal mucosa and may cause a physiological vaginal discharge. This is a normal finding in high-oestrogen states, such as in a young person, during pregnancy, or in patients using oestrogen therapy, including the combined oral contraceptive pill (see Figure 2.2).

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