Atlas of Colposcopy: Principles and Practice

The presence of columnar epithelium on the ectocervix is known as ectropion (also known as ectopy). This is a physiological condition induced by the effect of estrogen on the cervix.
An ectropion is visible as a red patch at the centre of the cervix and has a soft, velvety appearance.

The characteristics of the columnar epithelium (villi and fissures) are better visualized after application of acetic acid. Often, the SCJ is clearly demarcated as a thin white line.

The columnar epithelium on the ectocervix may have evidence of metaplastic changes of variable degrees. With advancing age, metaplastic epithelium gradually replaces the ectropion and the ectropion disappears.

The columnar epithelium does not stain with iodine and maintains its original red colour.

Sometimes stretching of the cervix by the blades of the speculum can give rise to the false appearance of ectropion. Closing the speculum blades allows the lips of the cervix to fall back, and the columnar epithelium is no longer visible.

Note: Ectropion is a physiological condition, and no treatment is required. However, the exposed columnar epithelium may become infected repeatedly, causing excessive vaginal discharge, or may cause bothersome post coital bleeding. In such situations, ablation of columnar epithelium by cryotherapy or thermal ablation may expedite the replacement of columnar epithelium with mature squamous epithelium.