A friable cervix refers to cervical tissue that is unusually fragile and easily irritated, leading to bleeding upon light contact. This describes how the tissue can bleed readily when touched during a pelvic examination or sexual intercourse. This condition is not a diagnosis itself but a physical sign that points to an underlying issue. Friability is often discovered after a patient experiences unexpected spotting or a clinician observes bleeding during a routine Pap test, and it usually stems from treatable causes.
Understanding Cervical Friability and Common Symptoms
Cervical friability occurs when the delicate tissue lining the cervix becomes inflamed, structurally altered, or abnormally vascularized. When it becomes friable, the tissue has a reduced ability to withstand friction or minor trauma without rupturing small blood vessels.
The primary symptom of this fragility is abnormal vaginal bleeding. This most commonly presents as post-coital bleeding, which is light spotting immediately following sexual intercourse. Individuals may also notice intermenstrual spotting, which is minimal bleeding outside of their regular menstrual cycle. Another sign is bleeding after a routine pelvic or Pap smear exam, where the gentle contact of the instruments causes the fragile tissue to bleed.
Conditions That Lead to Tissue Fragility
Cervicitis (Inflammation)
One of the most frequent causes is cervicitis, which is inflammation of the cervix, often triggered by infection. Sexually transmitted infections (STIs) such as Chlamydia trachomatis, Neisseria gonorrhoeae, and trichomoniasis are common culprits. These infections cause the cervical lining to become red, swollen, and hypersensitive. Non-infectious cervicitis can also occur due to chemical irritants, such as those found in douches or spermicides, or from general physical irritation.
Cervical Ectropion (Hormonal Changes)
Another significant factor is the influence of hormones, particularly estrogen, which can lead to a condition known as cervical ectropion. Ectropion involves the glandular cells normally found inside the cervical canal migrating to the outer surface of the cervix. These glandular cells are naturally more delicate and have a richer blood supply than the robust cells that usually cover the external cervix. This makes the area more susceptible to bleeding upon friction. This condition is frequently observed in individuals with naturally high estrogen levels, such as those who are pregnant or using certain hormonal contraceptives.
Cervical Polyps (Abnormal Growths)
Cervical polyps also cause friability because they are benign, highly vascular growths that protrude from the cervical surface. These finger-like projections contain numerous tiny blood vessels and are easily irritated by contact. Although polyps are not cancerous, their presence makes the cervix prone to bleeding and spotting between periods or after sex. The underlying cause of polyps is not fully known but is associated with chronic inflammation and an abnormal response to elevated estrogen levels.
Investigating the Underlying Cause
Once a healthcare provider observes cervical friability, an investigation is necessary to pinpoint the exact cause. The initial step involves a detailed visual examination of the cervix using a speculum, where the provider looks for signs of inflammation, abnormal discharge, or the presence of growths like polyps. They will also note the specific location and pattern of the bleeding.
To rule out infectious causes, the provider performs swabs to test for common STIs, including chlamydia and gonorrhea, as well as other bacterial or fungal infections. Simultaneously, a Pap smear is often conducted to collect cells from the cervix to check for any precancerous or cancerous changes, such as cervical intraepithelial neoplasia (CIN).
If the visual examination reveals suspicious areas, or if the Pap smear results are abnormal, a colposcopy may be performed. This procedure uses a magnifying device for closer inspection of the cervical tissue. During a colposcopy, the physician may take a small tissue sample, known as a biopsy, from abnormal areas to confirm the nature of the inflammation, growth, or cellular change.
Treatment and Resolution Strategies
The resolution of cervical friability is tied to successfully treating the underlying condition. If the cause is cervicitis resulting from a bacterial infection, treatment involves a targeted course of antibiotics. For viral causes, such as herpes simplex virus, antiviral medication may be prescribed to manage the infection.
When hormonal factors, like cervical ectropion, are the source, the approach is often monitoring. If the patient is pregnant, the condition typically resolves after delivery. For those using hormonal contraception, the provider may suggest adjusting the type or dosage of birth control. If the friability is symptomatic and persistent, a procedure like cauterization, using a chemical agent like silver nitrate, may be used to seal off the fragile blood vessels.
If a cervical polyp is the source of the bleeding, it can usually be removed during a simple, in-office procedure. The removed tissue is then sent to a lab for analysis to confirm it is benign. For cases involving precancerous changes, such as CIN, treatment may require a Loop Electrosurgical Excision Procedure (LEEP) to remove the abnormal tissue.