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Stenosis of Uterine Cervix - Causes, Symptoms, Diagnosis, and Treatment

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Stenosis of Uterine Cervix - Causes, Symptoms, Diagnosis, and Treatment

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Cervical stenosis is the narrowing or closure of the cervix. This article discusses the causes, symptoms, diagnosis, and treatment of cervical stenosis.

Written by

Dr. Asha. C

Medically reviewed by

Dr. Manwani Saloni Dilip

Published At July 21, 2022
Reviewed AtMay 20, 2024

What Is Stenosis of Uterine Cervix?

Stenosis of the uterine cervix occurs when the cervix (narrow opening in the lower end of the uterus) is either too narrow or completely closed, which leads to blockage of passage between the uterus and vagina. Stenosis of the cervix will affect the pregnancy and menstrual cycle of the women.

What Are the Causes of Cervical Stenosis?

Stenosis of the uterine cervix may occur during birth as a genetic defect or may occur due to other health issues or procedures.

  • Cervical cancer.

  • Uterine cancer.

  • Endometrial cancer.

  • Cervical dysplasia (abnormal cell growth occurring on the surface lining of the cervix).

  • A surgical procedure in the cervix.

  • Surgery that affects the uterine lining, such as endometrial ablation.

  • Radiational therapy for uterine or cervical cancer.

  • History of LEEP (loop electrosurgical excision procedure) in which a wire loop is heated by an electric current to detach abnormal cells in the cervix.

  • History of CKC (cold knife cone - a surgical procedure to treat or diagnose cervical dysplasia).

  • History of multiple D and C (dilation and curettage - a surgical procedure to remove tissue from the uterus).

  • Adherman’s syndrome (a condition in which scar tissues form inside the uterus and decrease the volume of the uterine cavity).

  • Atrophy of the cervix or vagina due to menopause.

  • Vaginal dryness that occurs after menopause.

What Are the Signs and Symptoms Caused by Stenosis of the Uterine Cervix?

Stenosis of the uterine cervix typically shows mild symptoms, especially in women who have reached menopause. The symptoms include:

  • Irregular periods or abnormal periods.

  • Amenorrhea (absence of periods).

  • Infertility happens when the stenosis is completely blocking the path of sperm to fertilize the egg.

  • Dysmenorrhea (painful cramps during periods).

  • Hematometra (retention of blood in the uterus) or pyometra (accumulation of pus in the uterus) can cause pain or bulge in the uterus.

How Is Stenosis of the Uterine Cervix Diagnosed?

Diagnosis of cervical stenosis is based on the symptoms and examination, such as the following:

  • If there are no periods or painful periods after a surgery involving the cervix.

  • If there is a blockage or restriction for inserting an instrument into the cervix.

The diagnosis is confirmed by passing a probe through the cervix into the uterus. If the patient appears with few symptoms of cervical stenosis, physicians suggest a few other tests to rule out cervical cancer.

This includes,

  • Cervical Cytology Testing - Tests like Papanicolaou (PAP) and human papillomavirus test (HPV) are done in premenopausal women with hematometra (retention of blood in the uterus) or pyometra.

  • Endometrial biopsy.

  • D and C (dilation and curettage) is a minor surgical procedure in which the cervix is dilated to reach the uterus. A thin instrument scrapes the uterus walls and removes the tissues. This procedure is used to take samples from the cervix and uterus lining for testing.

What Are the Radiographic Features of Stenosis of the Uterine Cervix?

  • Hysterosalpingogram: It could show up as a narrowing of the endocervical canal or cervical os obliteration, making it impossible to implant the hysterosalpingographic catheter.

  • Ultrasound: The endocervix may appear normal or thickened. Seeing a hidden mass in the right place may indicate an accompanying stenosis, even though it is not easy to directly detect the stenosis on imaging. This is especially true if the stenosis is compounded by proximal expansion of the genital canal. The endometrial cavity may be distended with fluid. The cervix may lack normal architecture if the cause is radiation.

  • Computed Tomography: The cervix could appear normal, but the uterine cavity might be enlarged with fluid. Associated abnormalities, including a mass lesion or thickening of the intestinal wall due to radiation treatment, can indicate the underlying etiology.

What Is the Treatment for Stenosis of Uterine Cervix?

In patients with stenosis of the uterine cervix, the following procedures are performed:

  • Hysteroscopic Evaluation of Cervical and Uterine Cavity: Hysteroscopy is a procedure to examine the inside of the cervix and uterus with the help of a thin, light, and flexible tube called a hysteroscope.

  • Dilation of the Cervix: Widening the cervix, also known as dilation, is the treatment for cervical stenosis. Usually, small, lubricated metal rods called dilators are inserted via the cervical opening, followed by the insertion of larger dilators progressively. This is done until the desired dilation is achieved. Sometimes, the physician also places a tube called a cervical stent in the cervix for four weeks to six weeks if a proper amount of dilation is not reached. Dilation of the cervix aids in the easy flowing of blood from the vaginal canal and prevents the risk of hematometra or pyometra. It also supports the mobility of sperm better, leading to successful fertilization of the egg.

  • Laser Treatment: Laser treatment is done to vaporize the scars in the tissues formed during the treatment of cervical stenosis. When doctors collect samples from the cervix to examine Papanicolaou (Pap) smear or endometrial biopsy, scar tissues are formed in the cervix due to the healing process. These scar tissues are the reason for cervical stenosis.

  • Intrauterine Device: In rare cases, an intrauterine device can be used to treat cervical stenosis with severe dysmenorrhea (painful menstruation). The device provides enough dilation required for draining the menstrual blood.

What Are the Complications Caused by Stenosis of the Uterine Cervix?

The complications of cervical stenosis include:

  • Hematometra (accumulation of blood in the uterus).

  • Pyometra (collection of pus in the uterus).

  • Hydrometra (fluid accumulation in the uterus).

  • Infertility.

How Is Stenosis of the Uterine Cervix Associated With Fertility?

Stenosis of the cervix leads to the following issues which may cause infertility.

  • Inflammation of the Uterus - When there is cervical stenosis, the menstrual blood is blocked completely, which causes the blood to get stuck in the uterus, causing inflammation of the uterine tissues. The uterus may sometimes be filled with pus; this condition is called pyometra.

  • Less Fertile Mucus - When scar tissues are formed during a biopsy in the cervix, these tissues stop the production of cervical mucus, which is required for the movement and survival of the sperm.

  • Blocked Passage for Sperm - It is hard for the sperm to reach the fallopian tube for fertilization due to cervical stenosis.

  • A Complication in the Fertility Treatment - Procedures like intrauterine insemination (placing sperm into the uterus using a small device called a catheter) and in vitro fertilization require placing the catheter in the cervix, which can be complicated when the cervix is blocked.

  • Risk of a Premature Baby or Pregnancy Loss - Treatment for cervical stenosis may weaken the cervix, which may cause pregnancy loss or premature birth of the baby.

Conclusion -

Stenosis of the uterine cervix happens when there is a narrowing or closure of the cervix, which affects the menstrual cycle and pregnancy. Because cervical stenosis obstructs sperm from entering the uterus, it may affect natural fertility. The application of intrauterine insemination (IUI) or in vitro fertilization (IVF) techniques may be complicated or impossible in connection with infertility therapies due to cervical stenosis. The symptoms are evident only in a few women. Proper diagnosis and treatment help to get rid of further complications.

Frequently Asked Questions

1.

Does Cervical Stenosis Cause Cancer?

Cervical stenosis is a condition in which the cervix of the vagina is narrowed. It does not cause cervical cancer but can be difficult to detect through Pap smears. Cervical cancer is caused by persistent infection with HPV (Human papillomavirus) and is not directly caused by cervical stenosis. It can increase the risk of cancer if the routine screening tests cannot detect precancerous or cancerous cells in the cervix.

2.

How Does Cervical Stenosis Appear on Ultrasound?

On ultrasound, cervical stenosis appears as a thickening or narrowing of the cervical canal, which can be seen as a decreased cervical canal diameter. In addition, cervical stenosis can lead to changes in the appearance of the cervix. It can be elongated, and the internal os (the opening between the cervix and uterus) may be challenging to visualize. In some cases, fluid collections in the cervical canal can be seen on ultrasound.

3.

How Serious Is Cervical Stenosis?

Stenosis of the uterine cervix is a condition in which the opening of the cervix is narrowed or blocked, often due to scarring or other damage. This can lead to various complications, such as difficulty getting pregnant, menstrual problems, or an increased risk of infection. Whether or not stenosis of the uterine cervix is considered a severe condition depends on the severity of the blockage and the specific symptoms experienced by the individual.
 

4.

What Is the Most Effective Treatment for Cervical Stenosis?

The best treatment for uterine cervical stenosis can be cervical dilation. This involves using a dilator to widen the cervix, which is done by inserting small, lubricated metal rods followed by larger ones until the desired dilation is achieved. Sometimes, cervical stenting can be done, followed by hormonal therapy.

5.

What Is the Recovery Rtate of Cervical Stenosis?

The recovery rate of uterine cervix stenosis varies depending on the severity of the condition and the treatment used. In many cases, cervical stenosis can be effectively treated with cervical dilation or other conservative measures, and patients can expect complete recovery within a few days to weeks after treatment. Recovery time also depends on the patient’s age, overall health, and other medical conditions.

6.

What Are the Diagnostic Procedures for Cervical Stenosis?

The diagnosis involves:
- Patient medical history.
- Physical examination.
- Imaging tests such as hysteroscopy.

7.

What Is the Size of Cervical Stenosis?

The degree of cervical stenosis can be measured using hysterosalpingography (HSG) or ultrasound. The size of the stenosis is generally described in millimeters )mm) based on the width of the cervical opening. Mild cervical stenosis may have an opening of four to six millimeters, while more severe stenosis may have an opening of less than 4mm.

8.

Is It Possible to Treat Cervical Stenosis Naturally?

Some natural remedies can help alleviate the pain or symptoms associated with stenosis of the uterine cervix but cannot treat it completely. Stenosis of the uterine cervix requires a proper diagnosis and treatment plan from a healthcare provider. Treatment options include cervical dilation, cervical stenting, or surgical removal of the affected tissue. The treatment depends on the severity of the stenosis and the individual’s needs.

9.

Can Cervical Stenosis Be Treated Without Surgery?

The treatment of stenosis of the uterine cervix depends on the underlying cause and severity of the condition. Some mild cases may not require treatment. However, medical intervention may be necessary in cases where stenosis is causing significant discomfort or affecting fertility. Surgery is a standard treatment option for severe stenosis cases. Sometimes, non-surgical treatments such as cervical dilation or stenting may be effective.

10.

Is Walking Recommended in Case of Cervical Stenosis?

Walking or any physical activity is generally recommended for overall health and well-being.  However, in the case of uterine cervical stenosis, it is important to discuss any kind of physical exercise or walking with the healthcare provider. Depending on the severity of stenosis, the doctor will recommend avoiding or following certain physical activity types.

11.

Is Cervical Stenosis a Permanent Condition?

Uterine cervix stenosis can be a permanent condition in some cases, while in other cases, it can be temporary and reversible with proper treatment. The severity of stenosis, the underlying cause, and the treatment options used will all play a role in whether or not the condition is permanent. Stenosis caused by scarring or damage can be permanent and require ongoing management or treatment to alleviate the symptoms.

12.

What Are the Precautions to Be Taken to Prevent Cervical Stenosis?

There are no sure preventive measures for uterine cervical stenosis. However, a few steps can help - 
- Regular gynecological exams.
- Proper cervical care.
- Safe sex practices.
- Avoid procedures that may damage the cervix.
- Maintaining a healthy lifestyle.

13.

Is Cervical Stenosis Painful?

Uterine cervix stenosis may or may not be painful, depending on the severity of the condition and the underlying cause. In some cases, stenosis can cause discomfort or pain during sexual intercourse or pelvic examinations, especially if the cervix is very narrow. The pain can be caused due to pressure or friction in the affected area.
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Dr. Manwani Saloni Dilip
Dr. Manwani Saloni Dilip

Obstetrics and Gynecology

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