Cervical ectropion is a pathological condition of the cervix, in which there is an eversion of the mucous membrane of the cervical canal into the vaginal cavity. Clinical manifestations of ectropion develop with the addition of inflammatory or precancerous lesions of the cervix: these may be white spots, contact spotting, menstrual dysfunction, pelvic pain. Cervical ectropion is diagnosed as a result of gynecological examination, extended colposcopy, cytological and morphological examination. Treatment of ectropion in congenital or minor lesions may include electrocoagulation, laser vaporization and cryodestruction; with pronounced changes – conization or excision of the cervix.
ICD 10
N86 Erosion and ectropion of the cervix
General information
Ectropion is considered in clinical gynecology as a complicated clinical form of cervical ectopia, combining pseudoerosion and scar deformation. Cervical ectropion can be a congenital or acquired (post-traumatic) disease. In most cases, it is detected in women of reproductive age who have given birth, less often occurs in puberty or postmenopause. Most often, an inversion of the lower segment of the cervix is diagnosed, but a more common lesion is also possible. Epidemiological data on the frequency of ectropion are not presented in the literature.
Causes
Congenital cervical ectropion in young women who have not previously had pregnancies and childbirth is a consequence of functional dishormonal disorders. Acquired (post-traumatic) ectropion most often occurs as a result of damage to the tissues of the cervix, which were not eliminated or were improperly sutured during childbirth. These may be bilateral lateral ruptures of the cervix during independent childbirth or after obstetric operations (application of special obstetric forceps, fetal extraction). Sometimes the development of ectropion is caused by cervical injuries during artificial termination of pregnancy at late gestation.
Pathogenesis
Rupture and subsequent scarring of the muscle fibers of the cervix are accompanied by a violation of microcirculation, innervation and trophic tissue structures of the cervical canal, which leads to its deformation – “gaping” of the external pharynx and inversion of the endocervix.
The mucous membrane of the cervical canal (endocervix), unlike the surface of the vaginal part of the cervix (exocervix), is represented by a cylindrical epithelium, the cells of which secrete a mucous secret. With ectropion of the cervix, the endocervix from its characteristic alkaline environment enters the acidic environment of the contents of the vagina, which disrupts the physiological secretion of the cervical glands and the barrier functions of the cervix, which are important for the prevention of infections and the reproduction process.
Ectropion of the cervix leads to the penetration of vaginal microflora into the mucous membrane of the cervical canal and the development of the inflammatory process. Most often, cervical ectropion is accompanied by endocervicitis, cervicitis, endometritis. The presence of chronic inflammation in cervical ectropion creates conditions for the development of other pathological conditions: true erosion, dysplasia, leukoplakia, cervical epithelial atrophy and cervical cancer.
Symptoms of cervical ectropion
With ectropion of the cervix, complaints may be absent, since the disease has no specific symptoms. In the case of the development of inflammatory, dystrophic or atypical processes accompanying ectropion of the cervix, there may be an increase in mucous transparent and milky discharge from the vagina, the appearance of pain in the lower abdomen and lower back, menstrual cycle disorders (menorrhagia), contact spotting.
Diagnostics
Recognition of the cervical ectropion is carried out according to gynecological examination using mirrors, extended colposcopy, cytological or histological studies.
- Gynecological examination. It allows you to detect deformation of the cervix: the presence of an eversion of the endocervix into the vaginal cavity, scarring changes in the injury sites. If necessary, the material is taken for cytological, bacterioscopic and bacteriological analysis, PCR diagnostics.
- Colposcopy. To study the nature of the surface and the type of folds of the area of the inversion of the mucous membrane of the cervical canal, to identify complications of the ectropion of the cervix, an extended colposcopy is performed. With congenital ectropion of the cervix, the folds of the mucous membrane are evenly spaced; with acquired ectropion, they are chaotic.
- Cervical biopsy. Detection of abnormal colposcopic signs, transformation zones is an indication for performing a targeted biopsy of cervical lesions with histological examination of biopsies.
- Additional studies. With congenital cervical extropion, the hormonal status of the patient is examined, functional diagnostic tests are carried out.
Treatment of cervical ectropion
Treatment of cervical ectropion consists in its destruction or removal, elimination of the concomitant inflammatory process with subsequent correction of the anatomy of the cervix and vaginal microflora and aims to restore the barrier and reproductive functions of the uterine pharynx, prevention of precancerous and tumor processes in the endocervix. Clinical gynecology is suitable for the choice of the method of treatment of cervical ectropion individually, depending on the age, the state of the patient’s reproductive system and the detected colposcopic and cytological changes.
Minimally invasive destruction
Destructive methods of ectropion treatment are indicated for moderate cervical deformity and allow the destruction of pathological tissue. Congenital ectropion of the cervix is destroyed by cryodestruction, and if ineffective, surgical treatment is used. Radioconidation or radioexcision is performed with pronounced ectropion, the presence of dysplasia and other precancerous processes and allows you to remove the affected fragment of the cervix and part of the cervical canal. Medication therapy is also prescribed, which is used in the treatment of cervical ectopia and includes antibacterial, antiviral, hormonal, immunomodulatory drugs.
Surgical treatment
Surgical methods make it possible to conduct a morphological examination of the removed samples. With significant deformation of the cervix due to ruptures and scarring processes, reconstructive plastic surgery is performed. During the rehabilitation period after surgical treatment of cervical ectropion, sexual rest for the first 4-6 weeks, restriction of physical activity, prohibition of douching, use of sanitary tampons, taking baths, visiting a bath, sauna, swimming pool are shown.
Prognosis and prevention
The prognosis for ectropion is favorable, but the asymptomatic course of cervical diseases dictates the need for annual preventive examinations by a gynecologist. Measures to prevent the development of cervical ectropion are rational management of childbirth, timely and adequate contraception to prevent abortions.
