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 through the cervical os.
One-fifth of patients have a history of exposure to diethylstilbestrol whilst in utero. Often associated with endometriosis.
Women of reproductive age may have retrograde menses, raising the risk of endometriosis. Dysmenorrhea is present in up to 50% of patients with cervical stenosis. If the stenosis is severe enough it may result in proximal obstruction resulting in:
- hematometra: women of childbearing age with cervical stenosis are less likely to show evidence of hematometra than postmenopausal patients
Other potential consequences include:
- infertility 2
- impediment to assisted fertility techniques
- embryo transfer
- intrauterine insemination
Any pathological process that can cause inflammation of the cervical mucosa, resulting in erosion and regeneration can result in cervical stenosis. This includes:
- congenital cervical stenosis
- chronic infection (chronic cervicitis)
- stenosis secondary to a tumor/mass:
- post radiation therapy
- cervical endometriosis
Histology reflects etiology; essentially the basic pathological processes of inflammation, erosion, repair and regeneration at any stage may be visualized. 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 visualize the stenosis, visualization 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). There may be fluid distension of the endometrial cavity. If due to irradiation, the cervix may demonstrate loss of the normal zonal architecture.
Complications associated with cervical stenosis may be apparent, including hydro- and hematometra. Although the cervix may be normal in appearance, the uterine cavity may be fluid distended. Further complications such as hematosalpinges may also be visualized. Ancillary findings can point towards the underlying cause, such as an underlying mass lesion, or bowel wall thickening associated with radiation treatment.
Treatment and prognosis
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:
- 1. Brown MA, Mattrey RF, Stamato S et-al. MRI of the female pelvis using vaginal gel. AJR Am J Roentgenol. 2005;185 (5): 1221-7. doi:10.2214/AJR.04.1660 - Pubmed citation
- 2. Steinkeler JA, Woodfield CA, Lazarus E et-al. Female infertility: a systematic approach to radiologic imaging and diagnosis. Radiographics. 29 (5): 1353-70. doi:10.1148/rg.295095047 - Pubmed citation
- 3. Borgatta L, Sayegh R, Betstadt SJ et-al. Cervical obstruction complicating second-trimester abortion: treatment with misoprostol. Obstet Gynecol. 2009;113 (2 Pt 2): 548-50. doi:10.1097/AOG.0b013e318193bca7 - Pubmed citation
- 4. Houlard S, Perrotin F, Fourquet F et-al. Risk factors for cervical stenosis after laser cone biopsy. Eur. J. Obstet. Gynecol. Reprod. Biol. 2002;104 (2): 144-7. Eur. J. Obstet. Gynecol. Reprod. Biol. (link) - Pubmed citation
- 5. Penna C, Fambrini M, Fallani MG et-al. Laser CO2 conization in postmenopausal age: risk of cervical stenosis and unsatisfactory follow-up. Gynecol. Oncol. 2005;96 (3): 771-5. doi:10.1016/j.ygyno.2004.11.012 - Pubmed citation