Stenosis of the uterine cervix

Stenosis of the uterine cervix is the pathologic narrowing of the uterine cervix. The term cervical stenosis is clinically defined as cervical narrowing that prevents the insertion of a 2.5 mm wide dilator.

One-fifth of patients have a history of exposure to diethylstilbestrol while in-utero. Often associated with endometriosis.

If the stenosis is severe enough it may result in proximal obstruction resulting in:

  • haematometra: women of childbearing age with cervical stenosis are less likely to show evidence of haematometra than postmenopausal patients
  • hydrometra 
  • pyometra

Other potential consequences include:

  • infertility 2
  • impediment to assisted fertility techniques 
    • embryo transfer
    • intra-uterine insemination

It can result from many causes which include:

Histology reflects aetiology; essentially the basic pathological processes of inflammation, erosion, repair and regeneration at any stage may be visualised. Juxtaposed and closely abutting cervical stromal tissue may demonstrate adhesions.

May appear as narrowing of the endocervical canal (normal diameter: 0.5-3.0 cm), or it may manifest as complete obliteration of the cervical os, preventing insertion of the hysterosalpingographic catheter.

The endocervix may be thickened or normal in appearance. Although it is difficult on imaging to the directly visualise the stenosis, visualisation of an underlying mass in the appropriate location may suggest an accompanying stenosis especially if it is complicated by proximal dilatation of the female genital tract (see complications).

Complications associated with cervical stenosis may be apparent, including hydro- and haematometra. Although the cervix may be normal in appearance, the uterine cavity may be fluid distended. Further complications such as haematosalpinges may also be visualised. Ancillary findings can point towards the underlying cause, such as an underlying mass lesion, or bowel wall thickening associated with radiation treatment.

In selected situations, gradual dilatation of the cervix, often performed with ultrasound guidance, can be an effective treatment. Other treatment options include insertion of laminaria tent, hysteroscopic excision of cervical tissue; or in extreme circumstances total hysterectomy.

General considerations include:

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Article information

rID: 13334
Tag: cases, cases
Synonyms or Alternate Spellings:
  • Cervical stenosis (pelvis)
  • Uterine cervical stenosis

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