Stenosis of uterine cervix explained

Cervical stenosis
Field:	Gynecology

Stenosis of uterine cervix should not be confused with cervical spinal stenosis.

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. A stenosis is any passage in the body that is more narrow than it should typically be.

Signs and symptoms

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 build up of blood inside the uterus which may cause infection, sporadic bleeding, or pelvic pain. Patients also have an increased risk of infertility and endometriosis.^[1]

Fertility

Cervical stenosis may impact natural fertility by impeding the passage of sperm 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.^[2]

Causes

Cervical stenosis may be present from birth or may be caused by other factors:

• Surgical procedures performed on the cervix such as colposcopy, cone biopsy, or a cryosurgery procedure^[3]
• Trauma to the cervix^[3]
• Repeated vaginal infections^[3]
• Atrophy of the cervix after menopause^[3]
• Cervical cancer^[1]
• Radiation^[1]
• Cervical nabothian cysts

Treatment

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.^[4] 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.^[5] Finally, the surgical enlargement of the cervical canal can be performed by hysteroscopic shaving of the cervical tissue.^[6]

Notes and References

1. The Merck Manual Home Edition. Last full review/revision December 2008 by S. Gene McNeeley. Cervical Stenosis
2. 10.1016/j.jmig.2005.06.003 . Pabuccu R . Ceyhan ST . Onalan G . Goktolga U . Ercan CM . Selam B . Sep–Oct 2005 . Successful treatment of cervical stenosis with hysteroscopic canalization before embryo transfer in patients undergoing IVF: a case series . Journal of Minimally Invasive Gynecology . 12 . 5 . 436–8 . 16213431.
3. Web site: Cervical Stenosis . Health Science Report . Alotek Supplement Company . 2007-02-10.
4. Web site: Dysmenorrhoea . Health24 . Media24 (Naspers) Group . 2007-02-10.
5. Baggish MS . Baltoyannis P . July 1987 . Carbon dioxide laser treatment of cervical stenosis . Fertility and Sterility . 48 . 1 . 24–8 . 10.1016/S0015-0282(16)59284-X . 3595913.
6. 10.1016/S0015-0282(99)00097-7 . Noyes . N . May 1999 . Hysteroscopic cervical canal shaving: a new therapy for cervical stenosis before embryo transfer in patients undergoing in vitro fertilization . Fertility and Sterility . 71 . 5 . 965–6 . 10231067. free .