Cervical stenosis is narrowing or closing of the passageway through the cervix (the lower part of the uterus).
Cervical stenosis often causes no symptoms.
Cervical stenosis may cause menstrual abnormalities or, rarely in premenopausal women, infertility.
Doctors can usually diagnose cervical stenosis during a pelvic examination.
The cervix can be widened to relieve symptoms.
In cervical stenosis, the passageway through the cervix (from the vagina to the main body of the uterus) is narrow or completely closed.
Cervical stenosis usually results from a disorder or another condition, such as the following:
Menopause, because the tissues in the cervix thin (atrophy)
Cancer of the cervix or cancer of the lining of the uterus (endometrial cancer)
Surgery that involves the cervix—for example, done to treat precancerous changes of the cervix (dysplasia)
Procedures that destroy or remove the lining of the uterus (endometrial ablation) in women who have persistent vaginal bleeding
Radiation therapy to treat cervical cancer or endometrial cancer
In women who are still menstruating, menstrual blood mixed with cells from the uterus may flow backward through the fallopian tubes into the pelvis, possibly causing endometriosis.
Rarely, cervical stenosis results in an accumulation of blood in the uterus (hematometra).
Also rarely, pus accumulates in the uterus, particularly if the cause of stenosis is cervical or endometrial cancer. Accumulation of pus in the uterus is called pyometra.
Symptoms of Cervical Stenosis
Cervical stenosis often causes no symptoms.
Before menopause, cervical stenosis may cause menstrual abnormalities, such as no periods (amenorrhea), painful periods (dysmenorrhea), and abnormal bleeding. Rarely, cervical stenosis causes infertility because sperm cannot pass through the cervix to fertilize the egg.
A hematometra or pyometra can cause pain or cause the uterus to bulge. Sometimes women feel a lump in the pelvic area.
Diagnosis of Cervical Stenosis
Pelvic examination
Sometimes tests to rule out cancer
Doctors may suspect the diagnosis based on symptoms and circumstances, such as the following:
When periods stop or become painful after surgery on the cervix
When doctors cannot insert an instrument into the cervix for another test—for example, to obtain a sample of tissue from the cervix for a Papanicolaou (Pap) or human papilloma virus (HPV) test (called cervical cytology testing) or a sample from the lining of the uterus for an endometrial biopsy
Doctors confirm the diagnosis by trying to pass a probe through the cervix into the uterus and being unable to do so.
If a woman has cervical stenosis and abnormal vaginal or uterine bleeding, she may need tests to rule out cancer., For example, cervical cytology testing (such as a Pap or HPV test) or an endometrial biopsy may be done.
No further tests are needed if all of the following apply:
Women are postmenopausal (menstrual periods have stopped).
They have no symptoms and no hematometra or pyometra.
Results of cervical cytology tests are normal.
Treatment of Cervical Stenosis
Widening of the cervix
Cervical stenosis is treated only if women have symptoms, a hematometra, or a pyometra. Then, the cervix may be widened (dilated) by inserting small, lubricated metal rods (dilators) through its opening, then inserting progressively larger dilators. To try to keep the cervix open, doctors may place a tube (cervical stent) in the cervix for 4 to 6 weeks.
