Narrowing Of The Uterine Cervix – Causes Of Cervical Stenosis And Its Effect On Fertility

Narrowing Of The Uterine Cervix – Causes Of Cervical Stenosis And Its Effect On Fertility

Planning for starting a family is a huge step forward for any couple. Most of the people assume that they know almost everything about infertility. But some conditions can remain obscure for long until you figure out that this was the cause of your infertility.

To become pregnant is an awesome experience but some unfortunate women face hurdles in their way of becoming a proud mom. One such obstacle is cervical stenosis which we will discuss below in detail.

Cervical Stenosis

The word stenosis means ‘narrowing of a body canal’. The condition refers to narrowing of the canal or passageway that goes through the cervix, the lower part of the uterus. Cervical stenosis is most commonly known as stenosis of the uterine cervix. In cervical stenosis, the opening in the cervix also known as endocervical canal is more narrow than normal.

In a few cases, this endocervical canal can be completely closed causing a range of complications. Cervical stenosis is often found in older adult women.

Causes and risk factors of cervical stenosis in women

The most common cause for cervical stenosis is complication arising prior to surgery such as after conducting biopsy or LEEP (loop electrocautery excision procedure). After the biopsy, especially that for treating dysplasia (abnormal development of organs or cells) and cervical cancer, when the body starts healing, scarring can occur on the opening of the cervix. This can result in cervical stenosis.

Some women may have this condition present right from birth. Some other experts relate cervical stenosis to other conditions such as:

Menopause

During the menopausal phase, the tissues in the cervix becomes thin (atrophy). So it may be the cause behind narrowing of the canal.

Cervical or Endometrial Cancer  

Stenosis can be a complication of cancer of the cervix or endometrium.

Radiation Therapy 

Cervical stenosis can occur as a complication of radiation therapy used for treating cervical or endometrial cancer

Endometrial Ablation 

This operation involves removing or destroying the uterine lining in women who are persistently suffering from vaginal bleeding. This procedure can contribute in narrowing the cervical canal.

Persistent Vaginal infections 

A women suffering with stubborn vaginal infection can experience cervical stenosis.

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Complications – Can cervical stenosis cause infertility in women?

Cervical stenosis becomes an important part of the discussion, especially when keeping in mind the clinical impacts it can bring such as infertility, dysmenorrhea (painful periods) or amenorrhea (absence of periods). Cervical stenosis can bring following complications:

  • Since the canal or passageway becomes narrow or completely blocked, sperm cannot reach the egg for fertilization, hence fewer chances of becoming pregnant
  • Obstruction of menstruation flow to the canal can cause blood to build up in the uterus, a condition known as hematometra.
  • Menstruation blood can mix up with the uterine cells and may flow backward into the pelvis. This can cause endometriosis, which is another infertility disorder.
  • Accumulation of blood or pus in the uterus can cause infection. This can lead to a life threatening infection called as pyometra. Though cases of pyometra are rare in humans.
  • Increased chances of pregnancy loss or premature birth.
  • Increased risk of incompetent cervix.

Signs and Symptoms of cervical stenosis

Symptoms in this condition will depend whether the narrowing of the passageway is partial or complete. Symptoms may also depend on the health preference of a woman whether she is menstruating or around menopause.

Women who are in the premenopausal phase can experience blood accumulation in the uterus which may lead to irregular bleeding and pain in the pelvis. Menstruating women can experience painful periods, abnormal bleeding or no periods at all. Being infertile could be another symptom of cervical stenosis.

Some conditions such as pyometra and hematometra can cause the uterus to swell, causing pain. Some other women may feel a lump-like mass in the pelvic region.

How cervical stenosis is diagnosed?

If you are experiencing any of the above-mentioned symptoms, your primary objective would be to seek an appointment with the doctor. At the first meet, the doctor will ask you about your medical history and other questions related to your health.

The doctor then would be thoroughly evaluating the pelvis. For this, he can suggest ultrasound and CT scan tests for more clarity on the condition. Sometimes, cervical stenosis is detected based on situations such as when testing for infertility, the doctor is unable to insert a catheter into the cervix through the vagina, it may indicate cervical stenosis.

The doctor could order some test to rule out cancer if he suspects that cervical stenosis is causing symptoms. These tests include:

Cytology 

A urine microscopic test to look for cells and their functionality

Endometrial biopsy

A medical procedure that involves taking a sample tissue of the uterine lining for examination in the lab

Before these procedures, the doctor would be conducting another procedure known as dilation and curettage. This procedure first widens (dilate) the cervix and then extract sample tissue (curettage) from the inside of the cervix.

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Treatment of cervical stenosis

There could be several treatment options. Cervical stenosis can sometimes only be treated when a woman has symptoms.

Dilation and curettage

Dilation and curettage, that wide open the cervix, may give respite from symptoms. For this, the doctor may use metal rods (dilators) until the cervix wide open to its normal position.

Cervical tent

In some cases, doctors may also place a cervical stent or a tube in the cervix for 4-6 weeks to prevent the cervix from re-closing itself.

Laser therapy

Laser therapy can be used if the cervical stenosis is due to scarring.

Hysteroscopic surgery

If anything mentioned above isn’t effective, the doctor may use hysteroscopic surgery to shave off the cervical tissue and enlarge the cervix. During this procedure, a lighted instrument is inserted through the vagina to pass tools for required for surgery.

Intrauterine device

For women who are not planning a child, IUD (Intrauterine device) can be placed after the treatment of cervical stenosis. This will prevent scar reformation. The IUD can be removed later if a woman wants to get pregnant in future.

In other cases, when a woman with cervical stenosis gives birth (vaginal) to a baby, the condition can improve on its own.

Here it is important to note that depending on the type of treatment of cervical stenosis, there are potential risks such as infection, uterine puncture, and incompetent cervix. So, it is important to consult your gynecologist and clear your queries about cervical stenosis and infertility.