Cervical stenosis is anomalous narrowing or obstruction of any part or the entirety of the cervical canal. It may be congenital or acquired as the result of aging, nulliparity, use of progestins, curettage, cervical surgery or any combination of these factors. Cervical stenosis is challenging to gynecologists in that it presents an additional complication to the completion of procedures that require examination of or passage through the cervical canal. Limited literature on overcoming cervical stenosis recommends both medical therapy using laminaria or misoprostol (with additional estrogen therapy in postmenopausal patients) and surgical therapy using a variety of tools including hysteroscope, grasping forceps, scissors, bipolar electrode, hysteroscopic morcellator, resectoscope, LEEP and incision. We present an exemplar case where use of medical therapy might have eliminated the need for or at least reduced the risk of the surgical therapy that the patient actually received. We recommend that gynecologists become familiar with the variety of methods currently in use for resolving cervical stenosis so that they may best advise patients that need such treatment and that medical therapy be attempted before surgical therapy is applied whenever possible.
Cervical stenosis, laminaria, misoprostol
The authors report no conflict of interest
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Skopec GS. A review of medical and surgical techniques for overcoming cervical stenosis. Proc Obstet Gynecol. 2018 Feb 28;8(1):Article 1 [7 p.]. https://doi.org/10.17077/2154-4751.1384. Free full text article.