Cervical motion tenderness, also known as the chandelier sign, is a physical exam finding that can suggest that certain gynecologic diseases are present. As the name implies, patients who have this physical exam finding experience significant pain upon manipulation of the cervix. Performing this test has diagnostic utility in differentiating abdominal pain caused by pathology of the reproductive tract from that caused by pathology of the gastrointestinal tract. Although cervical motion tenderness is most commonly associated with a condition called pelvic inflammatory disease, it can also be associated with ectopic pregnancies or ovarian cysts.
To check for cervical motion tenderness, a pelvic exam is necessary, either using a speculum to localize the cervix, or using the examiner’s fingers to manipulate this structure. The cervix is an anatomic structure located between the uterus and the cavity of the vagina. In some ways, it can be considered as the end part of the uterus that extends into the vagina. To fully view this structure, a speculum is inserted into the vagina. The cervix typically comes into view at the tip of the speculum, and appears as cylindrical structure with a small central opening.
After visualizing the cervix with the use of a speculum, or after blindly feeling the cervix on physical exam, testing for cervical motion tenderness is easy. If moving the cervix causes significant pain, then the patient has cervical motion tenderness. The usefulness of performing this test is that it can help localize the region of the body affected by disease. For example, either appendicitis or an infection of the right ovary could cause pain in the lower right side of the abdomen. Typically, an infection such as appendicitis would not be associated with this sign, whereas other disease processes could cause this pain.
Most commonly, the finding of cervical motion tenderness is associated with pelvic inflammatory disease. Typically, this condition occurs when an infection of the vagina, such as a sexually transmitted disease, spreads and affects some of other female reproductive organs such as the ovaries, fallopian tubes, or the uterus. This disease can be dangerous if untreated, harming a woman’s future reproductive capabilities or in severe cases leading to death.
In other cases, cervical motion tenderness can be associated with other pathologic conditions of the female reproductive tract. Women with an ectopic pregnancy, which occurs when a recently fertilized embryo attaches itself to the incorrect region of the female anatomy, can cause pain on movement of the cervix. Ovarian pathology, including cyst formation or the twisting of an ovary around the fallopian tube, can also cause this physical exam finding.