Common problems of the cervix

Uterus and cervix

Problems affecting the cervix

• Endometriosis. This can also affect the uterus, fallopian tubes and other sites in the pelvis and around the body.

• Cervical ectropion. Cervical ectropion (or erosion) is a harmless change. It is related to oestrogen and is therefore more common in young women, pregnant women and those taking combined oral contraceptive pills. It may cause increased vaginal discharge or bleeding. If an ectropion is causing no symptoms it does not need treating, but if a healthcare professional is not sure that what they are seeing is definitely an ectropion they may refer you for a further opinion to be sure. An ectropion which is causing symptoms can be safely treated with a burning technique (cautery), using an electrical current (diathermy). This treatment is under local anaesthetic (when you are awake).

• Nabothian cysts. Nabothian cysts are tiny cysts that form on the surface of the neck of the womb (cervix). They are fairly common and do not usually cause any symptoms. They do not usually need any treatment, but if a healthcare professional is not sure that what they are seeing is definitely a Nabothian cyst, they may refer you for a further opinion to be sure.

• Cancer of the cervix.

• Infections.

• Polyps of the cervix (cervical polyps). A polyp is a small growth which arises from a stalk on either the surface or the inside of the neck of your womb (cervix). They are not usually cancerous, although very rarely they can be due to cancer. For this reason, any polyp which is removed must be sent to the lab to check that it is benign (not caused by cancer).

The symptoms you may experience will depend on the underlying condition. Some women will not have any symptoms at all. A problem with the neck of the womb (cervix) may be detected by the doctor or nurse who is examining them for another reason. For example, when a cervical smear test is taken.

Symptoms may include:

• Lower tummy (abdominal) pain.

• Pelvic pain.

• Vaginal discharge.

• Abnormal vaginal bleeding. For example, bleeding after having sex (intercourse) or bleeding in between your periods.

• Dyspareunia (pain when having sex).

Most conditions that affect your cervix can be diagnosed by examining you. However, it is sometimes necessary for other tests to be undertaken. For example:

• Internal swabs may be taken by your GP or in a hospital clinic. A swab is a small ball of cotton wool on the end of a thin stick. It can be gently rubbed on your cervix to obtain samples.

• A biopsy may be carried out. In this procedure, done in hospital, a small sample of tissue is taken from a lump. The sample can then be examined under a microscope in the laboratory.

Other tests may also be carried out, depending on your symptoms. These tests may include blood tests and an ultrasound of your womb and ovaries.

Colposcopy is a test to look at your cervix in more detail. A colposcopy is often done if your cervical smear test finds any changes to the cells of your cervix. See also the separate leaflet called Colposcopy and cervical treatments.

Infections are caused by germs such as bacteria and viruses and lead to inflammation of the neck of the womb (cervix). Inflammation of your cervix is called cervicitis. The most common symptom in women with cervicitis is vaginal discharge. Other symptoms can include pain on passing urine, lower tummy (abdominal) pain and bleeding in between periods.

Sexually transmitted infections

Infections of your cervix are usually caught through having sex. The most common sexually transmitted infections (STIs) which affect the cervix are:

• Gonorrhoea.

• Chlamydia.

• Genital herpes.

• Trichomonas.

Human papilloma virus

Human papillomavirus (HPV) is transmitted by sex but is not thought of in the same way as other STIs. 80% of people who are sexually active will get HPV at some point in their life, and their body may clear it naturally. No treatment is needed and you do not need to tell their partner or suggest that they are tested, as you would do with any other STI.

Some types of HPV can lead to changes in the cells of the cervix; 99.7% of all cervical cancer is linked to HPV. The NHS cervical screening programme now has a different process to in the past - the process is as follows:

• The sample is tested for HPV - if this is negative, it is discarded and you go back to normal recall (three or five years depending on your age and the country of the UK in which you live, one year if you have HIV).

• If the HPV test is positive then your sample is examined under the microscope (cytology), where abnormal cells (called squamous or glandular cells) may be found.

• If the cytology shows abnormalities then you will be referred to a colposcopy clinic.

• If the cytology is normal then you will have another smear in one year. If this happens three years in a row (positive HPV test but negative cytology) then you will also be referred to a colposcopy clinic.

Bacterial vaginosis

Bacterial vaginosis is not an STI, but can cause a smelly discharge - typically described as a fishy smell. It is caused by an overgrowth of normal germs in your vagina and is usually treated with antibiotics.

Other causes of inflammation of the cervix

Inflammation of the neck of the womb (cervix), called cervicitis, can also be caused by other conditions. These include:

• Allergies - for, example to condoms or to spermicides.

• Irritation - for example, from tampons, particularly if one is left in for a long time.

• Radiotherapy - cervicitis can be a side-effect of radiotherapy which is used to treat some cancers.

Symptoms of cervicitis include discharge, bleeding between the periods or after sex, and pelvic pain.

For cervicitis not caused by infections, there is usually no treatment. They settle when the cause is removed.

See the links for further information about endometriosis and cancer of the cervix.