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What Does It Mean to Have a Friable Cervix and How Is It Treated?

What is a friable cervix?

Your cervix is the cone-shaped lower part of your uterus. It acts as a bridge between your uterus and vagina. The word “friable” refers to tissue that tears, sloughs, and bleeds more easily when touched.

If your cervix tissue becomes overly sensitive and easily irritated, it’s known as a friable cervix.

A friable cervix is usually a symptom of an underlying condition that can be treated.

Keep reading to learn more about the conditions that cause a friable cervix, how it’s diagnosed, and what you can expect of treatment.

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Symptoms

What are the symptoms?

If you have a friable cervix, you might experience:

  • spotting between periods
  • vaginal itching, burning, or irritation
  • unusual discharge
  • discomfort or pain during intercourse
  • bleeding after intercourse

Additional symptoms depend on the specific cause. It’s important to remember that all of these signs and symptoms can be caused by things other than a friable cervix. Also, it’s possible you won’t have any symptoms and a friable cervix will only be diagnosed by your doctor during a routine pelvic exam.

Causes

What can cause this?

The cause can’t always be determined, but there are quite a few reasons you might have a friable cervix. Some of them are:

Sexually transmitted diseases (STDs)

Cervicitis, an infectious or noninfectious inflammation of the cervix, is usually due to an STD. STD symptoms generally include vaginal discharge and bleeding between periods or after sex. Some STDs don’t have symptoms.

Some STDs that may cause cervicitis and friable cervix are:

  • Chlamydia: Chlamydia infects the cervix, which can make it more delicate. Symptoms include abnormal discharge and easily induced bleeding.
  • Gonorrhea: Gonorrhea can also infect the cervix. Symptoms include increased vaginal discharge, a burning sensation during urination, and bleeding between periods.
  • Herpes: Some women experience herpes only on the cervix. Signs include vaginal discharge, genital irritation, and genital sores.
  • Trichomoniasis: This parasite affects the lower genital tract, including the cervix. Symptoms can include discomfort during sex, burning, and unusual discharge.

Vaginal atrophy

Vaginal atrophy occurs when your vaginal lining starts to thin out and shrink. Eventually, the vagina can narrow and get shorter. This can make intercourse painful, or near impossible.

Vaginal atrophy can also lead to urinary problems, including urinary tract infections (UTIs) and increased urinary frequency. Vaginal atrophy is usually due to a hormonal imbalance.

Hormonal imbalance

The main female hormones are estrogen and progesterone, which are mostly produced in the ovaries. Estrogen is particularly important to maintaining the health of the vagina.

Some things that might cause hormonal fluctuations or a drop in estrogen are:

Low estrogen can cause:

  • vaginal dryness
  • thinning of vaginal tissues
  • vaginal inflammation
  • irritation and discomfort, especially during and after sexual activity

Some other symptoms of low estrogen are:

  • mood swings
  • problems with memory and concentration
  • hot flashes and night sweats
  • anxiety and depression
  • missed menstrual periods
  • dry skin
  • more frequent urination or urinary incontinence

Other causes

A friable cervix may also be caused by:

  • Cervical ectropion: This is a condition in which glandular cells from the inside of the cervical canal spread to the outer surface of the cervix. In addition to bleeding easily, you might notice more discharge than usual. Bleeding and pain during intercourse or a pelvic exam are possible.
  • Cervical polyps: These are typically noncancerous. Other than mild bleeding and discharge, polyps don’t generally cause symptoms.
  • Cervical intraepithelial neoplasia (CIN): This is a precancerous growth of abnormal cells that usually occurs after infection with the human papilloma virus (HPV). It doesn’t always cause symptoms and is usually discovered by a routine Pap test.
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Diagnosis

How is it diagnosed?

Your doctor will begin with a complete pelvic examination to look for lesions or other abnormalities that can be seen or felt.

Your doctor will start with a Pap test (Pap smear) to check for abnormalities of the cervical cells. A Pap test involves a simple swab of the cervix during a pelvic exam. Results can indicate a precancerous condition or cervical cancer.

Depending on what’s found and what symptoms you have, your doctor may also recommend:

  • A colposcopy, which is an examination of the cervix using a lighted magnifying tool called a colposcope. It can be done right in your doctor’s office.
  • A biopsy of any suspicious lesions to check for cancer. The tissue can be taken during the colposcopy.
  • STD testing, usually with blood and urine tests.
  • Hormone level testing, usually with a blood test.

Treatment

What treatment options are available?

Your doctor will likely want to determine the cause before making a recommendation. Treating the underlying condition may resolve your symptoms.

In the meantime, ask if you can use lubricants or creams to make yourself more comfortable.

Chlamydia can be cured with antibiotics. Gonorrhea can also be cured with medication, although the disease can cause permanent damage. There’s no cure for herpes, but with treatment, you can cut down on symptoms and frequency of outbreaks. Trichomoniasis can be treated with medication.

For vaginal atrophy and hormonal imbalance, your doctor can recommend lotions and oils that can ease dryness. You can also use a dilator, which helps to slowly widen the vagina, to make it easier to have sex without pain. Topical or oral hormone therapy can relieve symptoms, thicken cervical and vaginal tissues, and restore bacterial and acid balances.

Cervical ectropion may clear up on its own, but the area can be cauterized if necessary.

Cervical polyps and CIN can be removed during a colposcopy. The tissue will then be sent to a laboratory to be tested for cancer.

If your friable cervix is caused by medications or cancer treatment, it should clear up when your treatment is complete.

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Complications

Are complications possible?

A friable cervix doesn’t necessarily cause any serious complications. But if you don’t get treated for conditions such as cervicitis and certain STDs, infection can spread into your uterus or fallopian tubes. This can lead to pelvic inflammatory disease (PID).

If left untreated, CIN can eventually develop into cervical cancer.

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Pregnancy

Friable cervix in pregnancy

Pregnancy causes changes to hormone levels, so it’s possible to develop a friable cervix in pregnancy. Spotting or bleeding during pregnancy should be taken seriously.

Your doctor will check for signs of cervical infection, inflamed cervix, or growths on the cervix.

A friable cervix alone doesn’t jeopardize your pregnancy. But your doctor will probably want to check for weak cervical tissue, a condition called cervical insufficiency (incompetent cervix).

This condition can cause your cervix to open too soon, leading to premature delivery. An ultrasound can help determine if this is the case. Cervical insufficiency can be treated with medications.

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Cancer

Friable cervix and cancer

Friable cervix can cause pain during sex, bleeding after sex, and spotting between periods. Although this can be due to infection, hormone imbalance, or another condition, these can also be symptoms of cervical cancer. That’s why it’s so important to see your doctor without delay.

Testing for cervical cancer may include:

  • Pap test
  • colposcopy
  • cervical biopsy

Treatment for cervical cancer depends on the stage at diagnosis and may include:

  • surgery
  • chemotherapy
  • radiation therapy
  • targeted drug therapies

Outlook

What’s the outlook?

In some cases, a friable cervix can clear up all on its own, even without treatment.

Your individual outlook is determined by the cause and the treatments that are available. By taking your entire health profile into consideration, your doctor will be able to give you some idea of what to expect.

Ask your doctor about when and how often to follow up.

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Prevention

Can it be prevented?

A friable cervix is usually a symptom of infection or other condition. Although there’s no particular prevention for it, you can lower your chances of developing some of the conditions that lead to a friable cervix.

For example, reduce your chances of contracting an STD by using condoms and practicing mutual monogamy.

If you have pain or bleeding during or after intercourse, see your doctor. Early treatment of infection and STDs can prevent complications of PID.

And be sure to see your doctor or gynecologist for regular checkups.

Article resources
  • Casey PM, et al. (2011). Abnormal cervical appearance: What to do, when to worry? DOI:
  • Cervical ectropion (cervical erosion). (2015).
  • Cervical intraepithelial neoplasia (CIN). (2014).
  • Chlamydia [Fact sheet]. (2017).
  • Gonorrhea [Fact sheet]. (2017).
  • Herpes. (2014).
  • How hormone depletion affects you. (n.d.).
  • Kaunitz AM. (2016). Approach to abnormal uterine bleeding in nonpregnant reproductive-age women.
  • Mayo Clinic Staff. (2017). Bleeding during pregnancy: Causes.
  • Mayo Clinic Staff. (2015). Incompetent cervix: Definition.
  • McNeeley SG. (n.d.). Polyps of the cervix.
  • Signs and symptoms of cervical cancer. (2016).
  • Soper DE. (2015). Cervicitis.
  • Tarney CM, et al. (2014). Postcoital bleeding: A review on etiology, diagnosis, and management. DOI:
  • Trichomoniasis [Fact sheet]. (2017).
  • Vaginal atrophy. (2014).
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