Cervical ectropion: symptoms, causes, bleeding after sex and treatment

The cervix is the lower part of the womb, connecting it to the vagina. Newcastle Hospitals explains that the outside of the cervix is covered with squamous cells, while the canal inside is lined with delicate glandular (columnar) cells. A cervical ectropion happens when these delicate cells come out onto the outside of the cervix. It appears red because the underlying blood vessels show through the thin layer of cells.

It was previously called cervical erosion or ectopy, and is sometimes called cervical eversion. Newcastle stresses that "erosion" is an incorrect name. Cambridge describes it as a normal occurrence, and Newcastle lists it as common, normal and not linked to cancer.

Cambridge University Hospitals says for the majority of women it does not cause any problems and may resolve on its own over time. Newcastle says some women have no symptoms and it is found incidentally on a speculum examination or after a smear test, and that an ectropion does not cause pain.

Because the glandular cells are delicate, touching or rubbing them can lead to light bleeding, especially in the middle of your cycle when oestrogen is at its highest. The cells also produce mucus, so you can have more discharge than usual.

• Light bleeding (spotting) or increased discharge during or after sex.

• Light bleeding after a cervical sample (smear test).

• Light bleeding in between regular periods.

• Light bleeding after exercise, running or horse riding.

• Increased discharge with no infection.

Bleeding between periods or after sex needs to be checked, because other causes must be ruled out, and an ectropion should only be assumed once that has been done. Newcastle Hospitals says you should always see your GP if you experience any of the following.

• A change to your daily vaginal discharge (volume, irritation, colour or smell).

• Heavier and/or longer bleeding after intercourse or between your periods.

• Pain during or after intercourse.

Cambridge says cervical ectropion is related to the hormone oestrogen and is therefore common in younger women, pregnant women and those taking the combined oral contraceptive pill. Newcastle adds that a lot of women are born with one, and that you are more likely to have one if you are having a natural response to increased oestrogen: younger women, going through puberty, pregnancy or having had a child, and taking the combined contraceptive pill.

Because it is linked to oestrogen, Cambridge lists pregnant women among those in whom it is common. Newcastle says it does not affect fertility or pregnancy. If you have bleeding in pregnancy, get it assessed by your midwife or GP rather than assuming it is due to an ectropion.

Newcastle says most people do not have any symptoms and do not need treatment, and that over time the ectropion may change in size and may no longer be visible, although how long this takes varies. If you have symptoms and take the combined pill you may wish to change to a different type. Cambridge says switching to a different contraception under medical review can sometimes help resolve a cervical ectropion.

If symptoms are troublesome, Cambridge says before any treatment it is important to rule out infection, inflammation and any possibility of abnormality, which may include swabs and occasionally a cervical biopsy. Treatment may then be offered. Newcastle says you can be referred by your GP to colposcopy. It cautions that the treatments do not always resolve the symptoms in all people and can sometimes make them worse.

Cambridge says treatments are effective in helping to improve symptoms, but in some cases the treated cervix may become infected, and you should contact your GP if discharge becomes heavy with an offensive odour. A minority of women have no improvement and may need further assessment, and there is a small risk of bleeding during the procedure that is easily controlled.

A cervical ectropion is not a reason to skip screening. Cambridge says it is important to attend for cervical screening within the recommended screening interval, and that bleeding at the time of a smear test can happen with an ectropion. Newcastle explains that the transformation zone where the two cell types meet is the area tested on a cervical sample.

Newcastle Hospitals describes Nabothian follicles (sometimes called Nabothian cysts) as firm, mucus-filled bumps on the surface of the cervix that range from a few millimetres to a few centimetres. They are normal, not linked to pre-cancer or cancer, usually cause no symptoms and usually need no treatment, and they are different from an ectropion.

On the NHS, most people with an ectropion need no treatment. If symptoms are troublesome, a GP can arrange swabs and refer to a gynaecology or colposcopy service for cautery. Private gynaecology consultations can offer quicker assessment. Either way, bleeding after sex or between periods should be properly assessed so that other causes are ruled out.