Relief of Cervical Stenosis
Cervical stenosis is defined as a scarred endocervical canal measuring 1 mm or less in diameter. The stenosis ranges from mild at 2 mm to a pinhole opening of less than 0.5 mm (Fig. 48–1A through C). On occasion, the opening to the shrunken canal is marked only with a dimple. The cause of this problem is basically a quantitative reduction in cervical mucous glands secondary to obstetric trauma, sharp conization, electrosurgery, laser surgery, cryosurgery, or amputation. Dilatation and curettage, traumatic endocervical aspiration, and endocervical curettage more often lead to mild narrowing at the external os or adhesions rather than to true stenosis of the canal.
The diagnosis is made colposcopically and by the insertion of a small probe (Baby Hegar dilator) that measures 2 mm on one end and 1 mm on the other (Fig. 48–2). If required, a smaller lacrimal probe may be inserted into the canal with the intent to pass it along the canal’s axis into the endometrial cavity.
The simplest therapeutic measure is directed at gently and gradually dilating the canal. It is advised to start with the Baby Hegar dilator and continue the dilatation with tapered Pratt dilators. This procedure should be repeated weekly in the office setting for 4 weeks. The patient should be checked and, if necessary, redilated monthly for 6 months. This method is useful for mild stenosis but is generally ineffective in more severe cases.
Severe stenosis can be relieved by removing the fibrotic tissue, finding viable glandular cells, exteriorizing them, and finally enlarging the canal. This technique requires a precision microsurgical procedure, which can and should be done by means of a superpulse-capable carbon dioxide (CO2) laser coupled to the operating microscope via a micromanipulator. Small beam diameters (1 mm) must be used..
