Association between cervical ectropion and high-grade cervical dysplasia in women of reproductive age

BACKGROUND: Cervical ectropion is a common anatomical condition in women of reproductive age. Although often considered a physiological variant, its potential role as a factor associated with epithelial alterations remains under debate. Exposure of immature columnar epithelium in the transformation zone may facilitate the persistence of human papillomavirus (HPV) and other infectious agents. METHODS: We conducted an analytical case-control study (1:2 ratio) at a referral hospital in Ica, Peru. Cases were women with histologically confirmed high-grade cervical dysplasia (CIN2-3), while controls had consecutive negative cytology results (NILM). Cervical ectropion was assessed by standardized colposcopy. Hierarchical multivariate logistic regression was used to adjust for demographic, behavioral, and infectious factors. RESULTS: A total of 276 women were included (92 cases and 184 controls). Cervical ectropion was observed in 33.0% of cases and in 10.3% of controls (p < 0.001). In multivariate analysis, ectropion remained significantly associated with high-grade cervical dysplasia (adjusted OR = 3.86; 95% CI: 1.74-8.53; p < 0.001). Significant associations were also found with bacterial vaginosis (adjusted OR = 2.47; 95% CI: 1.04-5.86; p = 0.041) and with a history of multiple sexual partners (adjusted OR = 3.55; 95% CI: 1.53-8.20; p = 0.003). CONCLUSIONS: Cervical ectropion was significantly associated with high-grade cervical dysplasia after adjustment for measured covariates and may constitute a potential clinical marker of epithelial vulnerability. However, residual confounding related to unmeasured HPV infection cannot be excluded. These findings support the importance of systematic screening and colposcopic surveillance, particularly in resource-limited settings where molecular HPV testing is not widely available.