ConditionWomen's & pregnancy health
Cervical Disorders (Conditions of the Cervix)
A cervical disorder is any condition affecting the cervix, the narrow lower part of the uterus that opens into the vagina. Common ones include cervicitis (inflammation, often from infection), cervical ectropion, polyps, cysts, abnormal cell changes (dysplasia) caused by HPV, and cervical cancer. Many cause no symptoms and are found on routine screening. Others cause unusual discharge, bleeding after sex or between periods, or pelvic pain. Regular screening and HPV vaccination prevent most cervical cancers.
Also called: Disorders of the cervix, cervix problems, cervical disease
At a glance
- What it covers
- Inflammation, infection, benign growths, precancer and cancer of the cervix, plus pregnancy-related cervical weakness.
- Common symptoms
- Abnormal discharge, bleeding after sex or between periods, and pain during sex; many have none.
- Main cause of precancer
- Persistent infection with high-risk HPV.
- Key tests
- Pap test, HPV test, swabs for infection, colposcopy and biopsy.
- Prevention
- HPV vaccination, regular screening, and condoms to reduce sexually transmitted infections.
When to get help
Call 911 or go to the ER
- Heavy vaginal bleeding soaking a pad an hour, especially with dizziness or fainting
- Pregnant with fluid leaking, pressure low in the pelvis or bleeding in the second trimester (possible cervical insufficiency or preterm labor)
See a doctor within a day or two
- Pelvic pain with fever, abnormal discharge or pain during sex (possible pelvic inflammatory disease)
- Yellow or green discharge after a new sexual partner, or a partner diagnosed with an STI
- Bleeding after menopause
Book a routine appointment
- Bleeding after sex or between periods that happens more than once
- Persistent unusual discharge or odor
- An abnormal Pap or positive HPV result that needs follow-up
- Being overdue for cervical screening
About the cervix
The cervix is about 2.5 to 3.5 cm (1 to 1.5 inches) long. Its outer surface, visible on a speculum exam, is covered by flat (squamous) cells, while the canal is lined with mucus-producing glandular cells. The border between them, the transformation zone, is where most precancer and cancer start. The cervix keeps the uterus closed during pregnancy and dilates during labor.
The word "cervical" also refers to the neck. If you are looking for neck spine problems, see cervical spine disorders.
Common disorders of the cervix
| Condition | What it is | Typical symptoms |
|---|---|---|
| Cervicitis | Inflammation, often from chlamydia, gonorrhea, trichomonas or herpes | Discharge, bleeding after sex, often none |
| Cervical ectropion | Glandular cells on the outer surface; common with hormonal changes, pregnancy and the pill | Increased discharge, light bleeding after sex; harmless |
| Cervical polyps | Small benign growths from the canal | Bleeding after sex or between periods |
| Nabothian cysts | Small mucus-filled cysts | None; harmless |
| Cervical dysplasia | Precancerous cell changes, graded CIN 1 to 3 | None; found on screening |
| Cervical cancer | Cancer, usually squamous cell or adenocarcinoma | Bleeding after sex, between periods or after menopause; discharge; pelvic pain in advanced cases |
| Cervical insufficiency | Painless opening of the cervix in mid-pregnancy | Pressure, discharge, spotting; risk of pregnancy loss |
| Cervical stenosis | Narrowed canal, after surgery, radiation or menopause | Painful or absent periods, fluid build-up in the uterus |
The role of HPV
Human papillomavirus (HPV) is a very common sexually transmitted virus. Most infections clear within 1 to 2 years. Persistent infection with high-risk types, especially HPV 16 and 18, causes nearly all cervical cancers, usually through dysplasia over 10 to 20 years. Smoking and a weakened immune system make persistence more likely.
Symptoms to watch for
- bleeding after sex (postcoital bleeding)
- bleeding between periods (intermenstrual bleeding)
- bleeding after menopause
- discharge that is unusual in color, amount or smell
- pain during sex or pelvic pain
These symptoms usually have benign causes such as ectropion, polyps or infection, but they always deserve an examination.
Diagnosis
- Speculum examination to look at the cervix.
- Swabs or urine tests for chlamydia, gonorrhea and trichomonas.
- Cervical screening: a Pap test (cytology), an HPV test, or both together (co-testing).
- Colposcopy: a magnified look at the cervix after an abnormal screening result, with a small biopsy of any abnormal area.
- Ultrasound for pregnancy-related cervical length or pelvic problems.
US screening recommendations
| Age | Recommended screening |
|---|---|
| Under 21 | No screening |
| 21 to 29 | Pap test every 3 years |
| 30 to 65 | Primary HPV test every 5 years, co-testing every 5 years, or Pap test every 3 years |
| Over 65 | Stop if prior screening was adequate and normal and you are not high risk |
People who have had a hysterectomy with removal of the cervix for non-cancer reasons usually do not need screening. Self-collected HPV testing is now an option in some settings.
Treatment
- Cervicitis: antibiotics for the specific infection, with partner treatment and retesting.
- Ectropion: no treatment unless bothersome; cautery or freezing can reduce discharge or bleeding.
- Polyps: easily removed in the office and sent for testing.
- Low-grade dysplasia (CIN 1): often monitored, as most clear on their own.
- High-grade dysplasia (CIN 2 or 3): removal of the abnormal area by LEEP (loop electrosurgical excision), cone biopsy, or freezing or laser treatment.
- Cervical cancer: surgery, radiation and chemotherapy depending on stage.
- Cervical insufficiency: a cervical stitch (cerclage) or vaginal progesterone in pregnancy.
Prevention
- HPV vaccination: recommended at age 11 to 12 (can start at 9), with catch-up through age 26, and for some adults aged 27 to 45 after discussion.
- Regular cervical screening at the recommended intervals.
- Condoms reduce the risk of STIs and HPV.
- Not smoking.
Frequently asked questions
What is a cervical disorder?
A cervical disorder is any condition of the cervix, the lower part of the uterus. Common ones include cervicitis, ectropion, polyps, cysts, abnormal cell changes from HPV, and cervical cancer. Many cause no symptoms and are found on routine screening.
What are the symptoms of a problem with the cervix?
Possible symptoms include unusual vaginal discharge, bleeding after sex, bleeding between periods or after menopause, and pain during sex. Many cervical problems, including precancer, cause no symptoms at all, which is why screening matters.
Is bleeding after sex a sign of cervical cancer?
It can be, but it is more often caused by benign conditions such as cervical ectropion, polyps or infection. Bleeding after sex that recurs, or any bleeding after menopause, should be examined by a doctor, and screening should be up to date.
What does an abnormal Pap smear mean?
An abnormal Pap smear means some cervical cells look different. Most changes are minor and caused by HPV, and many clear on their own. Your doctor may repeat the test, test for HPV or arrange a colposcopy to look more closely.
Can cervical problems affect pregnancy?
Some can. Cervical insufficiency can cause painless opening of the cervix and pregnancy loss in the second trimester. Treatments for high-grade dysplasia, such as LEEP, slightly raise the risk of preterm birth. Tell your obstetrician about any past cervical treatment.
Sources
This guide was written from current patient and clinical guidance, including:
- ACOG: Cervical cancer screening (FAQ and practice advisory)
- US Preventive Services Task Force: Cervical cancer screening recommendation
- CDC: Cervicitis - STI Treatment Guidelines
- American Cancer Society: Cervical cancer early detection
- National Cancer Institute: Cervical cancer screening (PDQ)