Benign Cervical Lesions - Types, Symptoms, Diagnosis, and Treatment

What Are Benign Cervical Lesions?

Clinicians encounter many cervical lesions during routine cervical investigations. Some of these lesions are non-cancerous as they do not metastasize or invade other body organs. These non-life-threatening lesions are called benign cervical lesions.

Examples of benign cervical lesions are-

1. Cervical polyps.

2. Cervical ectropion.

3. Cervical Stenosis.

4. Nabothian follicles.

5. Cervical fibroids (myomas).

Some other cervical lesions or abnormalities require further attention as they have the potential to turn cancerous (malignant). They are-

• Endometriosis.

• Adenomyosis.

• Cervicitis.

• Postcoital bleeding.

What Are the Symptoms of Benign Cervical Lesions?

Cervical lesions are usually present as bumps on the cervix. They can be asymptomatic or show a range of symptoms such as-

• Heavy or painful periods with spotting in between the periods.

• Vaginal discharge with a foul smell.

• The lower abdomen feels pressure or swelling.

• Frequent urge to urinate.

• Lower back and leg pain.

• Pelvic pain.

• Bleeding or pain during sexual intercourse.

How Are Benign Cervical Lesions Diagnosed?

First, a detailed medical and family history is recorded to diagnose any cervical lesions. The following tests can be performed-

• Physical examination.

• Ultrasound.

• Magnetic resonance imaging (MRI).

• Hysteroscopy (a thin tube-like device called a hysteroscope enters the body through the vagina and into the uterus).

• Laparoscopy (camera attached to the end of a thin tube to examine the female reproductive organs).

• Biopsy to detect the presence of precancerous or cancerous cells.

What Are the Different Types of Benign Cervical Lesions and Their Management?

1. Benign Cervical Polyps - These are the most common non-cancerous lesions of the cervix. These are the bulb-shaped growths developed on the cervix. They can be present in various sizes, shapes, and colors. Mainly occurs in postmenopausal women.

Causes: Mostly occur due to the following reasons-

• Increased levels of estrogen.

• Inflammation of the cervix, vagina, or uterus.

• Clogged blood vessels.

Symptoms: These are asymptomatic lesions. They can be ectocervical (outside the cervix) or endocervical (Inside the cervix).

Diagnosis: Usually accidentally diagnosed during a routine pelvic examination. To confirm the clinical findings and rule out other dangerous conditions, some tests can be done like- cervical smear, biopsy, or colposcopy.

Management: These benign polyps can be easily removed even without anesthesia and sent to a lab to evaluate the presence of any cancerous tissues. Antibiotics can be prescribed in case of infections.

2. Cervical Ectropion or Cervical Erosion - It is present as a bright red area around the external OS (external opening of the cervix). Cervical ectropion occurs due to changes in the outer lining of the cervix.

Causes: Mostly occur due to the following reasons-

• Chronic cervicitis - Infections and inflammation around the external OS.

• Congenital erosion.

• Hormonal erosion- Due to increased levels of estrogen.

Symptoms:

• Most of the patients have no complaints.

• Mucoid vaginal discharge.

• Brownish discharge in between menstruation.

• Bleeding after sex.

• Early pregnancy bleeding.

• Pain during or after the cervical screening.

Diagnosis:

• Usually diagnosed during a routine pelvic examination.

• Additional investigations like colposcopy, cervical smear, triple swabs, or biopsy can be done to exclude other possible conditions.

Management: Cervical ectropion is primarily asymptomatic and goes away on its own. In cases where symptoms persist, cauterization can be done.

3. Cervical Stenosis - It is a condition characterized by pathological narrowing down of the endocervical canal (passageway between the uterus and the vagina).

Causes: Mostly occur due to the following reasons-

• After surgery.

• Procedures like - cone biopsy or loop diathermy.

• Endometrial ablation.

• Trauma to the cervix.

• Cervical atrophy after menopause.

• Recurrent vaginal infections.

• Radiation.

Symptoms:

• It can be asymptomatic in postmenopausal women.

• Irregular menstrual cycle.

• Chronic pelvic pain.

• Dysmenorrhea.

Complications:

• Hematometra (collection of blood in the uterus).

• Pyometra (infection in the uterus).

• Infertility (due to blockage of passage for sperm to reach the ovum).

Diagnosis:

• Passage of a probe through the cervix into the uterus.

• In complicated cases, cervical cytology or endometrial biopsy can be done.

Treatment:

• Physical widening of the cervix with the help of dilators under ultrasound or hysteroscopic guidance.

• Insertion of a cervical stent for about four to six weeks.

4. Nabothian Cyst or Uterine Cervix - These are present as small cysts filled with mucus on the surface of the cervix. These are also termed cervical cysts, mucinous retention cysts, or epithelial cysts. The nabothian cysts are prevalent and do not turn cancerous.

Causes: Mostly occur due to the following reasons-

• Secretions from the surrounding glandular lining get trapped below the surface of the cervix.

• After childbirth.

• Concomitantly with cervicitis.

• The normal deep enfolding of the endocervical epithelium.

Symptoms:

• Cysts range in size from a few millimeters to four centimeters in diameter.

• Whitish-yellow and smooth in appearance.

• Cysts are painless and show no symptoms.

• Some cases can experience bleeding between periods, unusual discharge, or pelvic pain.

Diagnosis:

• Pelvic examination.

• Visible on ultrasound, magnetic resonance induction (MRI), or computed tomography (CT) scan.

• A cyst can be broken, or a colposcopy can be done to confirm the diagnosis.

• Biopsy of the cyst.

Management:

• Nabothian cysts are usually symptomless and benign. They do not require any treatment.

• In rare cases, where the size of the cyst becomes too large that it distorts the shape and size of the cervix, removal of cysts can be done.

• Removal of cysts can be done by surgeries like- excision, electrocautery ablation, or cryotherapy.

5. Cervical Fibroids- Fibroids or myomas are tumors that usually develop in the muscle tissues of the uterus or sometimes the cervix. These are benign.

Symptoms:

• Mostly it remains asymptomatic.

• Abnormal heavy vaginal bleeding.

• Pain during and after sexual intercourse.

• Excessive bleeding can lead to anemia, fatigue, and weakness.

• If it becomes large, it can block urine passage, thus causing urinary drainage problems or urinary tract infections.

• Fibroids or myomas may get infected, causing pain, bleeding, or discharge from the vagina.

Diagnosis:

• Pelvic examination.

• Additional imaging tests like- ultrasonography or magnetic resonance imaging (MRI).

• Blood test to check for anemia.

• Cervical cytology tests to rule out cancer- Papanicolaou (pap smear test) or human papillomavirus (HPV) test.

Management:

• If cervical fibroids are small and cause no symptoms, then no treatment is needed.

• Medical management- Gonadotropin-releasing hormone (GnRH) agonist and antagonist medications to treat symptoms.

• If symptoms are present, the fibroids can be surgically removed. The procedure is known as myomectomy. If only the myoma or fibroid is removed, the woman can still bear a child.

• If the fibroid or myoma is enormous, then removal of the complete uterus (hysterectomy) is performed.

• Myomectomy or hysterectomy can be done by laparotomy (large incision made on the abdomen) or laparoscopy (instrument inserted through a small incision made near the navel).

Complications: Untreated fibroids can lead to-

• Infertility.

• Placental ablation.

• Preterm delivery.

• Miscarriage.

What Are the Risk Factors for Developing Benign Cervical Lesions?

Precise risk factors that cause benign cervical lesions are not known, but the following factors contribute to the risk-

• Birth control pills.

• Family history (hereditary).

• Cervical inflammation due to infections like- HPV (human papillomavirus), herpes, or yeast infection.

• Obesity.

• Weak immunity.

Conclusion:

The benign cervical lesions occur commonly and do not cause any harm. They are non-cancerous and mostly present without any symptoms. The outcome of these lesions is almost always good. Usually, the asymptomatic lesions go away on their own without any need for treatment. Lesions with symptoms can be managed by symptomatic relief or by surgical intervention. The benign cervical lesions can be prevented to some extent by maintaining a healthy weight, monitoring hormone levels, having a healthy lifestyle, and regular pelvic examinations.