Management of Cervical Stenosis - Mechanical Dilatation Adjunct with Hormonal Therapy

Madam C was a 39-year-old primiparous lady having history of one IVF pregnancy delivered by Caesarean section (CS). She was found cervical intra-epithelial neoplasia (CIN) 2-3 with loop electro-excision procedure (LEEP) performed 6 months after her delivery while she was still breastfeeding. 1.8cm-thick, 2cmwide cervix was resected and diagnosed CIN 1. Two 6-monthly cervical smears were negative for CIN in the presence of transformation zone component. She presented to us 17 months after LEEP for severe lower abdominal pain which required pethidine for relief. She experienced hypomenorrhea with mainly brownish spotting, and intermenstrual spotting and dyspareunia since returning of menses 9 months after LEEP. Physical examination showed cervix was flushed with vault. Transabdominal (TAS) and transvaginal ultrasound scans (TVS) showed enlarged uterine cavity and endocervical canal filled with blood, up to 3.64cm. The clinical diagnosis was haematometra due to cervical stenosis after LEEP.