Cervical Stenosis 

Cervical stenosis is narrowing  of the passageway through  the cervix (the lower part of  the uterus). 

• Infertility can occur, or  the uterus can fill with blood or pus. 
• The opening of the cervix can be widened to relieve symptoms. 

In cervical stenosis, the passageway through  the cervix (from the vagina to the main body  of the uterus) is narrow or completely closed. 

Some women are born  with cervical stenosis. In others, cervical stenosis results from a disorder or another condition, such  as the following: 

• Cancer (cervical or endometrial) 
• Surgery  to treat precancerous changes of the cervix (dysplasia) 
• Procedures that destroy or remove the lining of the uterus (endometrial ablation)  in women who have persistent vaginal bleeding 
• Radiation therapy to treat cancer of  the cervix or of  the lining of  the uterus (endometrial cancer) 
• Menopause, because  the tissues in  the cervix thin (atrophy) 

Cervical stenosis may result in an accumulation of blood in the uterus (hematometra). In women who are still menstruating, menstrual blood mixed with cells from the uterus may flow backward into the pelvis, possibly causing endometriosis (see Endometriosis).  If pus forms in the uterus (as  it may in women with  cervical or endometrial cancer), pus  may accumulate  in the uterus. Accumulation  of pus in  the uterus is called pyometra. 

Symptoms

Before menopause,  cervical stenosis may cause menstrual abnormalities, such as no periods (amenorrhea), painful periods (dysmenorrhea),  and abnormal bleeding.
 
Cervical stenosis can also cause infertility because sperm cannot pass through the cervix to fertilize the egg. 

After menopause,  cervical stenosis may be present but not cause symptoms. 

A hematometra or pyometra can cause pain or cause the uterus to bulge. Sometimes women feel  a lump in the pelvic area. 

Diagnosis 

Doctors suspect the diagnosis based on symptoms  and circumstances—for example: 

• When periods stop or become painful after surgery on the cervix 
• When doctors cannot insert  an instrument into the cervix  to obtain a sample of tissue from  the cervix for a Papanicolaou (Pap) test or a variation  of it (cervical cytology) or from the lining  of the uterus (an endometrial biopsy) 

Doctors confirm the diagnosis by trying  to pass  a probe through the cervix into the uterus. 

No further tests are needed for  the following: 

• Postmenopausal women who have never had abnormal Pap test results 
• Women  who have no symptoms, no hematometra,  and no pyometra 

If  cervical stenosis causes symptoms, a hematometra,  or a pyometra, tissue samples are taken  and examined under a microscope  to rule out cancer. After treatment (which widens the cervix), doctors take samples from the cervix  and from the uterine lining. 

Treatment

Cervical stenosis is treated only if women have symptoms, a hematometra, or a pyometra. Then,  the cervix may be widened (dilated) by inserting small, lubricated metal rods (dilators)  through its opening, then inserting progressively larger dilators. To try  to keep  the cervix open, doctors  may place a tube (cervical stent)  in the cervix for 4 to 6 weeks.