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CERVICAL STENOSIS(BLOCKED CERVIX) AND TREATMENT



CERVICAL STENOSIS(BLOCKED CERVIX) AND TREATMENT

The cervix is the doorway between your vagina and uterus. It’s the bottom part of your uterus located at the very top of your vagina and looks kind of like a small doughnut. 

The opening in the center of the cervix is called the os.

The cervix works like a gatekeeper, controlling what is allowed and isn’t allowed through the os.

When you aren’t pregnant, your cervix produces mucus, known as vaginal discharge. During most of the month, your cervix produces a thick mucus that clogs up the os, making it difficult for sperm to enter your uterus.

When you ovulate, however, your cervix produces a thin, slippery mucus. Your cervix may also soften or change position, and the os may open slightly. This is all a calculated effort to make it easier for sperm to enter your uterus.

In the days before your period begins, your cervix may harden or change position. The os may narrow and prepare to close in the event of a pregnancy. If there isn’t a pregnancy, the cervix will relax and the os will open to allow the lining of your uterus to exit your body through your vagina.

A closed cervix can sometimes happen temporarily during part of each menstrual cycle. Other times, the cervix may always seem to be closed. This is known as cervical stenosis. It happens when the os becomes unusually narrow or completely blocked off. Some women are born with cervical stenosis, but others develop it later on.

SYMPTOMS OF BLOCKED CERVIX:

Depending on your age and whether or not you’re trying to become pregnant, you might not have any symptoms of a closed cervix or cervical stenosis.

If you haven’t gone through menopause, you might notice your periods becoming more irregular or painful. A closed cervix can also cause infertility because sperm can’t travel into the uterus to fertilize an egg.

If you’ve already gone through menopause, you might not have any symptoms. But complications can cause abdominal pain. You may also feel a lump in your pelvic area.

Abnormal menstrual bleeding

No period or very light spotting

Intense menstrual cramps

If these symptoms occur after cervical surgery, cervical stenosis is strongly suspected.

Infertility is also a possible symptom of cervical stenosis.

During fertility testing, cervical stenosis may be suspected if there is difficulty completing an HSG. An HSG is a specialized x-ray that involves transferring a dye via the cervix up into the female reproductive system. Usually, a catheter is placed inside the external os of the cervix. A dye is released, and then, the doctor takes x-rays. The x-rays should show whether the fallopian tubes are open and look at the shape of the uterine cavity.

However, if the catheter can’t be placed, is very painful, or the dye doesn’t make it past the cervix, cervical stenosis may be an issue. If this happens, a hysteroscopy is usually ordered next. This fertility test can also be used to possibly correct cervical stenosis.

It’s possible for cervical stenosis to be discovered during fertility treatment itself. (If you’re wondering how it could be missed during testing, it is possible for corrected cervical stenosis to reoccur after treatment).

During IUI or IVF, if there is trouble placing the catheter for insemination or embryo transfer, cervical stenosis may be an issue.

What causes a closed cervix?

While you can be born with a closed cervix, it’s more likely to be triggered by something else.

CAUSES OF BLOCKED CERVIX:

uterine surgeries or procedures, including endometrial ablation, cervical procedures, including cone biopsy and other precancerous treatments cervical cancer cysts or abnormal growths

*radiation treatments

*scarring

*endometriosis

Sperm passage blocked or limited: If the cervical opening is blocked or narrower than it should be, sperm can’t travel up to the fallopian tubes(where they meet and fertilize the egg).

Uterine inflammation and endometriosis risk:

 Menstrual bleeding can be blocked completely (in severe cases) or held back and not able to easily flow outward. This can cause the uterus to fill up with blood, causing pain and inflammation. This is known as a hematometra.

If infection occurs, the uterus can become filled with pus. The medical term for this is pyometra.

Even if the cervix is slightly open and blood can flow outward, menstrual blood may occasionally backwash up through the fallopian tubes. This can lead to endometrial lesions and endometriosis.

The most common cause of cervical stenosis is from prior surgery of the cervix.

If a pap smear finds abnormal cells, your doctor may need to remove a slice of tissue from your cervix. This may be done as a cone biopsy or LEEP (loop electrocautery excision procedure).

When your body is healing from the biopsy, scar tissue can form over the cervical opening. This can lead to cervical stenosis.

Other possible causes of cervical stenosis include:

*Congenital (born with a closed or narrow cervix)

*Cervical dysplasia (precancerous cells)

*Cervical or endometrial cancer

*Infection of the uterus or cervix

*Radiation therapy to the cervical area

*Asherman’s syndrome.

Endometrial ablation surgery (treatment done to reduce heavy periods, not recommended for those who plan to have children in the future)

*Menopause

COMPLICATIONS:

Having cervical stenosis can lead to several complications, including:

*infertility

*irregular periods

*accumulation of fluid.

A closed cervix can also lead to hematometra, which happens when menstrual blood builds up in your uterus.

 This can cause endometriosis, a condition in which uterine tissue grows in places outside the uterus.

Cervical stenosis may also result in a condition called pyometra. Pyometra is an accumulation of pus inside the uterus. If this happens, you’ll feel pain or tenderness in your abdomen.

Less fertile cervical mucus: 

Cervical stenosis is most commonly caused by scar tissue. The scar tissue can interfere with the production of cervical mucus.

 Sometimes, surgery that caused the scare tissue involved the removal of cervical tissue, and that further limits cervical mucus production. Without adequate cervical mucus, sperm may have trouble moving and surviving.

In either case, if the cervical opening is blocked or too narrow for the catheter to pass through, treatment can become complicated. It’s not possible (or advised) to force the catheter through. There are, however, options for creating a pathway. (More on this below.)

Increased risk of pregnancy loss and premature birth:

 Cervical stenosis treatment may weaken the cervix or cause cervical tissue damage. Later, during pregnancy, this may lead to incompetent cervix. Incompetent cervix is when the cervix is not closed or strong enough to keep the pregnancy secure. It may lead to a second-trimester pregnancy loss or premature birth. There are options to reduce this risk, however. (See more below.)

The bottom line

A closed cervix tends to happen during pregnancy, but it can also happen if you aren’t pregnant.

You can feel this part of your cervix with your fingers. In fact, some women track cervical changes as a way of detecting ovulation.


The cervical canal continues past the external os, creating a sort of tunnel from the vagina up to the uterus. The “tunnel” of the cervix is known as the endocervical canal.


At the end of the endocervical canal is the internal os, or internal opening of the cervix. This is where your cervix ends and your uterus begins.


Cervical stenosis can occur at any of these areas, or even at all of them at once. Most commonly, though, the problem is found at the external os. The cervix plays a few key roles in fertility and pregnancy:

During menstruation, endometrial tissue exits the uterus through the cervix.

It is the passage for sperm to swim from the vagina up into the reproductive system.

It contains mucus-producing tissue. Cervical mucus is needed to help sperm move effectively up into the cervix during ovulation and helps to prevent infection and keep unwanted microorganisms out.

During pregnancy, the cervix creates a mucus plug to protect the fetus. It also remains tightly closed, acting as a seal, until the time of birth.


TREATMENT

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