Cervical endometriosis (CE) is a condition where lesions occur on the outside of your cervix. Most women with cervical endometriosis experience no symptoms. Because of this, the condition is often only discovered after a pelvic examination.

Unlike endometriosis, cervical endometriosis is very rare. In a 2011 study, 33 women out of 13,566 were diagnosed with the condition. Because CE doesn’t always cause signs and symptoms, getting diagnosed can be difficult.

For most women, CE causes no symptoms. You may first learn that you have the benign condition after a pelvic exam.

During an exam, your doctor may discover lesions on the outside of your cervix. These lesions are often blue-black or purple-red, and they may bleed when they’re touched.

Some women may also experience these symptoms:

  • vaginal discharge
  • pelvic pain
  • painful sexual intercourse
  • bleeding after intercourse
  • bleeding in between periods
  • abnormally heavy or prolonged periods
  • painful periods

It’s not clear what causes CE, but certain events increase your risk for developing it.

For example, having had a procedure that cut or removed tissue from the cervix increases your risk. Cryotherapy, biopsies, loop excision procedures, and laser treatments can all damage and scar the cervix, and they may increase your risk for the benign growths.

In the 2011 study, 84.8 percent of women with cervical cancer had either a vaginal delivery or curettage, which is a procedure that requires scooping or scraping the lining of the uterus. These types of procedures are more common today, so it’s possible the cases of CE are higher.

CE doesn’t always cause symptoms. For that reason, many women may not discover they have the lesions until a doctor discovers them during a pelvic exam. An unusual Pap smear may also alert you and your doctor to the issue.

If your doctor sees the lesions, they may perform a Pap smear to check for abnormal results. If the Pap result is irregular, they may perform a colposcopy. This procedure uses a lighted binocular microscope and allows the doctor to closely examine the cervix, vagina, and vulva for signs of diseases or lesions.

In many cases, a doctor may also take a biopsy of the lesion and have it tested to confirm a diagnosis. Examining the cells under a microscope can differentiate CE from other similar conditions.

Damage to the cervix from previous procedures may make lesion removal difficult. If your doctor confirms the lesions are from CE, you may not need to treat the lesions at all if you have no symptoms. If you do have symptoms, however, treatment may help stop them.

Many women with CE will not need treatment. Regular checkups and symptom management may be enough. However, women who are experiencing symptoms like abnormal bleeding or heavy periods may need treatment.

Two treatments are commonly used for CE:

  • Superficial electrocauterization. This procedure uses electricity to produce heat, which is applied to tissue to remove the abnormal tissue growth.
  • Large loop excision. A wired loop with an electrical current running through it can be passed along the surface of the cervix. As it moves along the tissue, it cuts away the lesions and seals the wound.

As long as the lesions are not causing symptoms or pain, your doctor may suggest not treating them. If symptoms become persistent or painful, however, you may need treatment to remove the lesions. In some cases, the lesions may return after they’re removed.

CE likely will not affect a woman’s chance of getting pregnant. In some cases, scar tissue on the cervix could prevent semen from entering the uterus to fertilize the egg. However, this is rare.

Talk with your doctor if you’re concerned that leaving lesions might impact your fertility, or that undergoing a procedure might reduce your chances of getting pregnant naturally.

CE is often confused for other benign or cancerous cervical lesions. In fact, another condition may be inadvertently diagnosed instead of CE because it’s so rare. A biopsy or close physical exam may be able to rule other conditions out.

These include:

  • firm growths of smooth muscle that develop on the cervix
  • inflammatory cyst
  • cervical polyp
  • fibroids that bulge into the uterine lining
  • melanoma (skin cancer)
  • cervical cancer

In addition, some conditions are commonly associated with CE. These conditions may occur at the same time and can complicate a diagnosis.

These include:

  • human papillomavirus (HPV) infection
  • bacterial infection
  • stiffening of cervical tissue

CE is rare, and it may not be a diagnosis doctors consider frequently when examining a patient. Many of the symptoms and signs of this condition can be attributed to other conditions, but a diagnosis will help you find the correct treatment.

If you’re experiencing symptoms that match CE, make an appointment with your doctor. During the exam, they will likely perform a pelvic exam, as well as a Pap smear. If lesions are seen, they may also take a tissue sample for a biopsy.

For many women diagnosed with this condition, treatment involves managing any breakthrough symptoms, such as spotting between periods, pelvic pain, and pain during sex. If the symptoms persist despite the treatment, or if they get worse, removing the lesions from the cervix may be necessary. These procedures are successful and safe. Once the lesions are gone, you should experience no symptoms, and many people remain lesion-free for years following the surgery.