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

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 like endometrial ablation.

• Radiational therapy for uterine or cervical cancer.

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• 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) - It is 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 blockage or restriction for inserting an instrument into the cervix.

The confirmation of the diagnosis is done 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 where 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 the lining of the uterus for testing.

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 4 weeks to 6 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 sperms 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 complication of cervical stenosis includes :

• 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 tupe 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. The symptoms are evident only in a few women. Proper diagnosis and treatment help to get rid of further complications.