Fairly common gynecological condition presenting as a "lump at vulva".

1. Yapa Wijeratne
Faculty of Medicine
University of Peradeniya

2. • The normal length of the cervix is about
2.5cm.
• The vaginal and the supravaginal parts are of
equal length.
• The elongation may affect either part of the
cervix.

4. Anatomy of the cervix.. In detail
• The cervix is narrower than the body of the uterus and
is approximately 2.5 cm in length.
• Due to antiflexion or retroflexion, the long axis of the
cervix is rarely the same as the long axis of the body of
the uterus.
• Anterior and lateral to the supravaginal portion is
cellular connective tissue, the parametrium.
• The posterior aspect is covered by peritoneum of the
pouch of Douglas.
• The ureter runs about 1 cm laterally to the supravaginal
cervix.
• The vaginal portion projects into the vagina to form the
fornices.

5. • The upper part of the cervix mostly consists of involuntary
muscle, whereas the lower part is mainly fibrous
connective tissue.
• The mucous membrane of the endocervix has anterior
and posterior columns from which folds radiate out,
known as the arbor vitae.
• It has numerous deep glandular follicles that secrete a
clear alkaline mucus, the main component of
physiological vaginal discharge.
• The epithelium of the endocervix is cylindrical and is also
ciliated in its upper two-thirds and changes to stratified
squamous epithelium around the region of the external
os.
• This squamocolumnar junction is also known as the
transformation zone and is an area of rapid cell division;
approximately 90% of cervical carcinoma arises in this
area.

6. Causes
• Elongation of the supravaginal part is
commonly associated with the uterine
prolapse.
• Vaginal part is always elongated congenitally.
Chronic cervicitis may produce some
hypertrophy and makes the cervix bulky.

7. Supravaginal
elongation of
cervix in prolapse

8. Mechanism
• Vaginal part —
– There is chronic congestion which may lead to hyperplasia and
hypertrophy of the fibromusculoglandular components.
– These lead to vaginal part becoming bulky and congested.
– Addition of infection leads to purulent or at times blood stained
discharge from ulceration.
• Supravaginal part —
– The supravaginal part becomes elongated due to the strain
imposed by the pull of the cardinal ligaments to keep the cervix
in position, whereas the weight of the uterus makes it fall
through the vaginal axis.
– Chronic interference of venous and lymphatic drainage favours
elongation.

9. Symptoms
• There is no specific symptom for supravaginal
elongation.
• However, congenital elongation of vaginal
part may present the following
1. Sensation of something coming down
2. Dyspareunia
3. Infertility

10. Congenital elongation of cervix

11. PELVIC EXAMINATION

12. Supravaginal
elongation
Congenital
elongation
Associated uterine
prolapse.
Fornix shallow deep.
Vaginal cervix normal length elongated
Uterine body normal in size normal in size
Uterocervical canal increased in length
evidenced by
introduction of an
uterine sound.
This indirectly proves
that the increase is in
the supravaginal part.
increased in length,
evidenced by uterine
sound.

13. Congenital elongation of cervix with
prolapse

14. Treatment
• Supravaginal elongation
• As it is associated with uterine prolapse, its
treatment protocol will be the same as that for
prolapse.
• Manchester repair
• Congenital elongation
• The excess length of the cervix is amputated
(cervical amputation). In presence of congenital
prolapse, some form of cervicopexy has to be
done.

15. Cervicopexy / Sling Operation
(Purandare’s Operation)
• The operation is indicated in congenital or
nulliparous prolapse without cystocele where
the cervix is pulled up mechanically through
abdominal route.
• Strips of rectus sheath of either side passed
extraperitoneally are stitched to the anterior
surface of the cervix by silk.

16. Reference
• Dutta-Gynecology
• Gynaecology by Ten Teachers 19th Ed