Cervical stenosis is a narrowing or occlusion (stricture) of the internal cervical os. It is typically asymptomatic but may cause dysmenorrhea or, rarely, infertility. Diagnosis is with pelvic examination. Treatment is expectant management or dilation.
Cervical stenosis may be congenital or acquired.
The most common acquired causes of cervical stenosis are
Menopause
Cervical surgery (eg, conization, cautery)
Endometrial ablation procedures to treat uterine abnormalities that cause menorrhagia
Cervical or uterine cancer
Radiation therapy
Cervical stenosis may be complete or partial.
It may result in the following:
Hematometra (accumulation of blood in the uterus), causing pelvic pain or dysmenorrhea
In premenopausal women, retrograde flow of menstrual blood into the pelvis, possibly causing endometriosis
Pyometra (accumulation of pus in the uterus), particularly in women with cervical or uterine cancer
Rarely infertility
Symptoms and Signs of Cervical Stenosis
Cervical stenosis is usually asymptomatic.
Symptoms, when present, can include amenorrhea, dysmenorrhea, abnormal bleeding, and infertility in premenopausal women. Postmenopausal women may be asymptomatic for long periods.
Hematometra or pyometra may cause uterine distention or sometimes a palpable mass.
Diagnosis of Cervical Stenosis
Pelvic examination using an instrument
Cervical stenosis is often diagnosed only when clinicians have difficulty accessing the uterine cavity during tests done for a different reason. It may be suspected based on symptoms and signs (particularly development of amenorrhea or dysmenorrhea after cervical surgery) or on inability to obtain endocervical cells or an endometrial sample for diagnostic tests (eg, for a Papanicolaou [Pap] test).
Diagnosis of complete stenosis is established if a 1- to 2-mm diameter probe (uterine sound or dilator) cannot be passed into the uterine cavity.
For postmenopausal women with no history of abnormal Pap tests and for women without symptoms or uterine abnormalities, no further evaluation is needed.
If cervical stenosis causes symptoms or uterine abnormalities (eg, hematometra, pyometra), cervical cytology and endometrial biopsy or dilation and curettage (D & C) should be done to exclude cancer.
Treatment of Cervical Stenosis
Dilation and stenting if symptomatic
Usually, cervical stenosis does not require treatment. Treatment is indicated only if symptoms or uterine abnormalities are present and typically involves cervical dilation and placement of a cervical stent.
Key Points
Cervical stenosis may be congenital or acquired (eg, caused by menopause, cervical surgery, endometrial ablation, cervical or uterine cancer, or radiation therapy).
Cervical stenosis is usually asymptomatic.
Suspect cervical stenosis based on symptoms and signs or on inability to obtain endocervical or endometrial samples for tests; inability to pass a 1- to 2-mm diameter probe into the uterine cavity confirms complete stenosis.
If symptoms or uterine abnormalities (eg, hematometra, pyometra) are present, exclude cancer by cervical cytology and endometrial biopsy or D & C, then dilate the cervix and place a stent.
