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      Cervical Ectropion and Intra-Uterine Contraceptive Device (IUCD): a five-year retrospective study of family planning clients of a tertiary health institution in Lagos Nigeria

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          Abstract

          Background

          Cervical ectropion (also known as cervical erosion) is a common finding on routine pelvic examination during the fertile years. The decision to treat or not remains controversial. According to studies in support of routine treatment of cervical erosion, there is a possible relationship between squamous metaplasia and squamous cell carcinoma of the cervix. To determine the prevalence of cervical ectropion and associated risk factors among clients with intra-uterine contraceptive devices (IUCDs) attending a family planning clinic of a tertiary health institution in Lagos, Nigeria.

          Methods

          A 5-year retrospective study was conducted by assessing existing clinic records from years 2007–2011. Clients with IUCDs undergo routine pelvic examination during check-up visits. A total of 628 clients’ records were seen within the stated time frame. This study was approved by the ethical committee of the Lagos State University Teaching Hospital (LASUTH) and the collected data were analyzed using SPSS version 19.0.

          Results

          The mean age of the IUCD users was 34.7 ± 6.52 years, while 517 (82.3%) had secondary education. On routine pelvic examination, seventy-nine clients (12.6%) had cervical ectropion. Thirty-nine (6.2%) clients had presented with a history of abnormal vaginal bleeding while 12.1% had vaginal discharge. Treatments offered to cases of cervical ectropion include cervical painting with gentian violet (89.9%) and antibiotics prescription (58.2%). On bivariate analysis, previous hormonal contraceptive use (P = 0.041) and vaginal discharge (P < 0.001) were significantly associated with developing cervical ectropion. Clients with ectropion were significantly more likely to receive prescriptions for antibiotics (P < 0.001).

          Conclusion

          Less than one fifth of the clients had cervical erosion. However, routine pelvic examination could aid the detection and control of latent reproductive health problems such as cervical ectropion which may require further investigations for example, pap smears, to exclude potentially lethal conditions and to determine appropriate treatment modality.

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          Most cited references27

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          Analysis of risk factors associated with uterine perforation by intrauterine devices.

          E Caliskan, N. Ozturk, S Dilbaz … (2003)
          To determine the risk factors for intrauterine devices (IUDs) being displaced into the abdominal cavity. This prospective follow-up study was conducted between 1996 and 2002, at the family planning clinic of a referral hospital. All 8343 women who had a copper T-380A IUD inserted underwent ultrasound examination after 1 year. Relative risk estimates and logistic regression analyses were performed to determine the risk factors associated with uterine perforation by intrauterine devices. Eighteen uterine perforations occurred during the study, giving an incidence of 2.2 per 1000 insertions. When the time elapsed after the last delivery until IUD insertion is considered, postplacental insertion and insertion after 6 months postpartum were found not to increase the risk of uterine perforation. However, IUD insertion 0-3 months postpartum increased the risk of uterine perforation (odds ratio (OR) 11.7, 95% confidence interval (CI) 2.8-49.2) as did insertions at 3-6 months postpartum (OR 13.2, CI 2.8-62). Increasing parity decreased the risk (OR 0.04, CI 0.01-0.1) and increasing number of abortions increased the risk (OR 2.1, CI 1.2-3.6). It is safer to postpone IUD insertion until 6 months after delivery.
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            Hormonal contraceptive use, cervical ectopy, and the acquisition of cervical infections.

            Jonathan D Blumenthal, Camilla Wong, Cynthia Kwok … (2004)
            Several previous studies have suggested that hormonal contraception could be associated with increased risk of cervical infections. However, few high-quality prospective studies have examined this relationship. The goal of this study was to measure the effect of oral contraceptives (OC) and depot-medroxyprogesterone acetate (DMPA) on the acquisition of cervical chlamydial and gonococcal infections. Women attending 2 reproductive health centers in Baltimore, MD, were enrolled into a prospective cohort study. Participants were 15 to 45 years and were initiating OCs or DMPA or not using hormonal contraception. Interviews, physical examinations, and testing for incident cervical infections were conducted at 3, 6, and 12 months. The analysis included 819 women. Most were single (77%) and nulliparous (75%); 43% were black. Median age was 22 years. During the study, 45 women acquired a chlamydial or gonococcal infection (6.2 per 100 women-years). DMPA use (hazard ratio [HR], 3.6; 95% confidence interval [CI], 1.6-8.5), but not OC use (HR, 1.5; 95% CI, 0.6-3.5), was significantly associated with increased acquisition of cervical infections after adjusting for other risk factors. Cervical ectopy was not an important mediator of cervical infection risk. DMPA use, but not OC use, appeared to be significantly associated with increased acquisition of cervical chlamydial and gonococcal infections.
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              Determinants of cervical ectopia and of cervicitis: age, oral contraception, specific cervical infection, smoking, and douching.

              D Eschenbach, C Critchlow, L Koutsky … (1995)
              Our purpose was to assess determinants of cervical ectopia and cervicitis, specifically after adjustment for cervical infection. A cross-sectional study was conducted with colposcopic, cytologic, and microbiologic examination of 764 randomly selected women attending a sexually transmitted disease clinic and 819 consecutive college students undergoing routine annual examination. After we controlled for potential confounders, cervical ectopia was positively associated with oral contraception and Chlamydia trachomatis infection and negatively associated with aging in both populations, with recent vaginal douching in patients with sexually transmitted diseases, and with current smoking in college students. Oral contraception wa also associated with the radius of ectopia, and among users of oral contraception ectopia was associated with duration of oral contraception. Cervicitis (evaluated by Gram stain, Papanicoloau smear, and colposcopy) was associated with cervical infection by C. trachomatis and cytomegalovirus (both populations) and with gonorrhea and cervical herpes simplex virus infection (patients with sexually transmitted diseases). Cervicitis was independently associated with ectopia but not with oral contraception after we adjusted for these four cervical infections. However, oral contraception was associated with edema and erythema of the zone of ectopia among women without cervical infection. Oral contraception, aging, cervical infection, smoking, and douching have effects on cervical ectopia that may influence the acquisition, transmission, or effects of sexually transmitted agents. Ectopia is associated with young age, oral contraception, and cervical infection; cervicitis is associated with ectopia and cervical infection by C. trachomatis, Neisseria gonorrhoeae, herpes simplex virus, and cytomegalovirus. In women without cervical infection, edema and erythema of the zone of ectopia are associated with oral contraception.
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                Author and article information

                Contributors
                Kikelomo Ololade Wright: loladewright@yahoo.com
                Ahmadu Shehu Mohammed: ahmadumohd@yahoo.com
                Olajumoke Salisu-Olatunji: jmksal25@gmail.com
                Yetunde Abiola Kuyinu: yetundekuyinu@yahoo.com
                Journal
                Journal ID (nlm-ta): BMC Res Notes
                Journal ID (iso-abbrev): BMC Res Notes
                Title: BMC Research Notes
                Publisher: BioMed Central (London )
                ISSN (Electronic): 1756-0500
                Publication date (Electronic): 23 December 2014
                Publication date Collection: 2014
                Volume: 7
                Issue: 1
                Electronic Location Identifier: 946
                Affiliations
                [ ]Department of Community Health and Primary Health Care, Lagos State University College of Medicine, Ikeja, Lagos Nigeria
                [ ]Department of Community Health and Primary Health Care, Lagos State University Teaching Hospital (LASUTH), Ikeja, Lagos Nigeria
                Article
                Publisher ID: 3463
                DOI: 10.1186/1756-0500-7-946
                PMC ID: 4307624
                PubMed ID: 25539789
                SO-VID: b9e47f23-18b1-48de-b480-c7d01873e1d1
                Copyright © © Wright et al.; licensee BioMed Central. 2014
                License:

                This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                Date received : 27 December 2013
                Date accepted : 17 December 2014
                Categories
                Subject: Research Article
                Custom metadata
                issue-copyright-statement © The Author(s) 2014

                ScienceOpen disciplines: Medicine
                Keywords: cervical,ectropion,intra-uterine contraceptive device
                Data availability:
                ScienceOpen disciplines: Medicine
                Keywords: cervical, ectropion, intra-uterine contraceptive device

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