Cervical stenosis may be congenital or acquired. The most common acquired causes are menopause, surgery (eg, conization, cautery), infection, cervical or uterine cancer, and radiation therapy. Cervical stenosis may be complete or partial. It may result in a hematometra (accumulation of blood in the uterus) or, in premenopausal women, retrograde flow of menstrual blood into the pelvis, possibly causing endometriosis. A pyometra (accumulation of pus in the uterus) may also develop, particularly in women with cervical or uterine cancer.
Common symptoms in premenopausal women include amenorrhea, dysmenorrhea, abnormal bleeding, and infertility. Postmenopausal women may be asymptomatic for long periods. Hematometra or pyometra may cause uterine distention or sometimes a palpable mass.
Diagnosis and Treatment
Diagnosis may be suspected based on symptoms and signs 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 cannot be passed into the uterine cavity. If cervical stenosis causes symptoms or uterine abnormalities, cervical cytology and endometrial biopsy should be done to exclude the respective cancers. In postmenopausal women with no history of abnormal Pap tests, no further evaluation is needed.
Treatment is indicated only if symptoms or uterine abnormalities are present and may involve cervical dilation.