Common Problems of the Cervix
There are many different conditions that can affect the neck of the womb (cervix), ranging from mild inflammation to cervical cancer. These can all cause different symptoms, such as abnormal bleeding from your vagina, or may not cause any symptoms at all. Some conditions are normal and do not need any treatment. The type of treatment, if needed, will depend on the underlying condition. Your doctor will be able to discuss with you the most appropriate treatment for you.
What is the cervix?
The cervix is the lower part of your womb (uterus) which extends slightly into the top of your vagina. The cervix is often called the neck of the womb.
A narrow passage called the cervical canal (or endocervical canal) goes from your vagina to the inside of your womb. This is normally kept tightly shut. However, it allows blood to flow out from your uterus during a period and sperm to travel inside when you have sex (intercourse). It opens very wide during labour when you have a baby.
The cervix is covered by two different types of cells. The surface of your cervix is covered with skin-like cells. There are also some tiny glands in the lining of cervical canal which make fluid called mucus.
What symptoms may occur?
Obviously the symptoms you may experience will depend on the underlying condition. Symptoms may include:
- Lower tummy (abdominal) pain.
- Vaginal discharge.
- Abnormal bleeding. For example, bleeding after having sex (intercourse) or bleeding in between your periods.
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.
There are various conditions that can affect the neck of your womb (cervix). Some are more common than others; some are more serious than others.
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. 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, a small sample of tissue is taken from a lump. The sample can then be examined under a microscope in the laboratory.
What infections can affect the cervix?
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. See the separate leaflet called Sexually Transmitted Infections for information about these. The most common sexually transmitted infections (STIs) which affect the cervix are:
- Genital herpes.
- Human papillomavirus (HPV). HPV is very common. Some types of HPV can lead to changes in the cells of the cervix and (very rarely) some types can increase the risk of developing cancer of the cervix. The NHS cervical screening programme now offers women with borderline and mild cell changes a test to check for HPV.
See the individual leaflets for further information on these infections.
This is not an STI. It is caused by an overgrowth of normal germs in your vagina. Some cases of bacterial vaginosis (BV) clear without treatment, whereas others can be treated with a course of antibiotic medication. See the separate leaflet called Bacterial Vaginosis for more information.
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.
- Radiotherapy - cervicitis can be a side-effect of radiotherapy which is used to treat some cancers
For cervicitis not caused by infections, there is usually no treatment. They settle when the cause is removed.
Polyps of the cervix
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). Polyps occur in around 4 out of 100 women and are most common in women in their 40s and 50s. They can also occur in pregnancy. Some women have more than one polyp.
They are not cancerous and do not change into cancer. They often cause no symptoms and are usually only noticed when you have a cervical smear or are examined by a doctor or nurse for an unrelated reason. If they do cause symptoms then these are most likely to be vaginal discharge or vaginal bleeding after sex (intercourse) or in between your periods.
When a polyp has been noticed, it is usually recommended that you have it removed. This is a simple procedure that does not cause pain. It is either done by your doctor or by a specialist who treats medical conditions affecting women and their reproductive organs (a gynaecologist). You do not need an anaesthetic for this procedure. Some women may have freezing treatment or laser treatment after their polyp is removed. This is done to prevent the polyp growing back.
Endometriosis is a condition in which the endometrium grows outside the lining of your womb (uterus). The endometrium is the tissue which makes up the inside surface of your womb. An area of endometriosis can occur on the neck of your womb (cervix) and usually won't cause any symptoms. It can sometimes cause bleeding after sex (intercourse). Most people with endometriosis in their cervix do not need any specific treatment.
Cervical ectropion (or erosion) is a harmless change. The thin layer of gland cells normally lining the inside of your cervical canal appears on the outside of the neck of your womb (cervix). These cells are more fragile causing vaginal discharge or bleeding, especially when having sex (intercourse).
It is related to a hormone called oestrogen and is therefore more common in young women, pregnant women and those taking combined oral contraceptive pills. It may cause no problems at all and often requires no treatment. However, sometimes you may experience increased vaginal discharge or bleeding. This can especially happen after any contact with the cervix, such as during sex or when having a cervical smear.
The ectropion can easily be treated with a burning technique (cautery), using an electrical current (diathermy). This treatment is under local anaesthetic (when you are awake).
It often causes you no problems at all and usually requires no treatment. It is not associated with cervical cancer. It only needs treating if vaginal discharge or bleeding is so frequent that it is a problem for you. If it needs treatment, the usual treatment is to freeze the area or treat it with diathermy, so that the top layer of cells on your cervix is cauterised. These treatments are done under a local anaesthetic in the outpatient department.
Nabothian cysts are tiny cysts that form on the surface of the neck of the womb (cervix). Nabothian cysts are filled with fluid (mucus), which is secreted by the glands of your cervix. These cysts can range in size from just a few millimetres to four centimetres wide. They appear white or yellow in colour and are smooth. They are fairly common and do not usually cause any symptoms. They are usually discovered when you have an internal examination or a smear test. They do not usually need any treatment.
Cancer of the cervix
Cancer of the cervix has been getting less common because of the cervical smear test This picks up changes in the cells before they become cancerous. It is also hoped that the programme of vaccination of teenage girls against HPV will reduce cases still further in the future. Cancer of the cervix is usually picked up on a smear test, in which case there will be no symptoms. Some women may experience symptoms such as bleeding after sex, bleeding between periods or a vaginal discharge. See your doctor if you develop any of these, although as you have read, there are more common, non-cancer causes for these symptoms.
Further reading & references
- Standards for the management of sexually transmitted infections; British Association for Sexual Health (BASHH) and HIV and Medical Foundation for HIV & Sexual Health (MEDFASH) (January 2014)
- Casey PM, Long ME, Marnach ML; Abnormal cervical appearance: what to do, when to worry? Mayo Clin Proc. 2011 Feb;86(2):147-50; quiz 151. doi: 10.4065/mcp.2010.0512. Epub 2011 Jan 26.
Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of medical conditions. Patient Platform Limited has used all reasonable care in compiling the information but makes no warranty as to its accuracy. Consult a doctor or other healthcare professional for diagnosis and treatment of medical conditions. For details see our conditions.
Dr Mary Harding
Prof Cathy Jackson