Cervical erosion is a defect, damage to the flat epithelium of the cervix on its vaginal part around the external pharynx. It occurs more often as a result of endocervicitis and other inflammatory diseases of the genital area, hormonal disorders in the female body. The course may be asymptomatic or manifest itself with pathological secretions of a mucopurulent, sometimes bloody nature, pulling pains in the sacrum. It is a risk factor for cervical neoplasms (polyps, cancer). The main ways to diagnose cervical erosion are cervical examination in mirrors and colposcopy. Methods of diathermocoagulation, laser vaporization and cryodestruction, as well as the radio wave method can be used in the treatment
N86 Erosion and ectropion of the cervix
The term “cervical erosion” refers to a defect, a violation of the integrity of the epithelium of the vaginal segment of the cervix. Cervical erosion is one of the most common gynecological pathology and occurs in 15% of women. Cervical erosion can occur in adolescence and in women who have not given birth. Cervical erosions (pseudoerosions – follicular, papillary, mixed), characterized by a long, persistent, recurrent course, not amenable to conservative therapy, having microscopic signs of dysplasia, prone to contact bleeding, are regarded as precancerous diseases.
The causes of cervical erosion may be different. Changes in the mucous membrane of the cervix may develop due to mechanical damage, inflammatory diseases of the cervix, hormonal disorders.
- Inflammatory theory. A frequent cause of cervical erosion is sexual infections – chlamydia, gardnerellosis, ureaplasmosis, trichomoniasis, etc., the pathogens of which, penetrating into the damaged mucosa, cause inflammation in it. Endocervicitis and cervicitis, accompanied by pathological secretion from the cervical canal and uterus, lead to irritation of the epithelial cover in the area of the external pharynx and subsequent rejection of the epithelium. True erosion is formed, which is populated by the microflora of the vagina and cervix.
- Dishormonal theory. Puts forward as a reason for the development of cervical erosion a change in the level of sex hormones-steroids. Clinical observations show the appearance of cervical erosions during pregnancy and regression in the postpartum period with the stabilization of the hormonal background.
- Traumatic theory. Erosions are also formed during ectropion (inversion) of the mucous membrane of the cervical canal during birth trauma, due to pregnancy interruptions.
The cervix is the lower part of the uterus protruding into the vagina, inside of which there is a narrow cervical canal. The upper part of the cervical canal ends with an internal pharynx, the lower part ends with an external pharynx. The external pharynx opens on the vaginal part of the cervix and has the shape of a transverse slit in women who have given birth and a rounded shape in those who have not given birth.
Protruding into the vagina, the cervix is exposed to infections, injury during sexual intercourse and medical manipulations. Damage to the multilayer flat epithelium around the external pharynx of the vaginal part of the cervix manifests itself in the form of cervical erosion. The prolonged existence of cervical erosion can lead to changes in the epithelial cells and the appearance of benign neoplasms (cervical polyps) and malignant tumors (cervical cancer).
Types of cervical erosions
Cervical erosions are of the following types:
- pseudo – erosions;
True cervical erosion
True erosion of the cervix is usually called, which is formed as a result of damage and peeling of the flat epithelium around the external pharynx of the vaginal part of the cervix. True cervical erosion is characterized by the formation of a wound surface with signs of inflammation. The most common cause of the development of true cervical erosion is irritation of the mucous membrane by pathological secretions of the cervical canal in endocervicitis.
True erosion is usually bright red in color, irregular rounded shape, easily bleeding on contact. During colposcopic examination and microscopy of the eroded surface, dilated vessels, swelling, infiltration, traces of fibrin, blood, mucopurulent secretions are visible. After 1-2 weeks, the true erosion passes into the healing stage – pseudo-erosion.
Pseudo – erosion
During the healing process, the defect of the squamous epithelium is replaced by a cylindrical one that spreads to the erosive surface from the cervical canal. The cells of the cylindrical epithelium have a brighter color compared to the cells of the multilayer flat epithelium, and the erosive surface remains bright red.
The stage of replacement of flat epithelial cells with cylindrical ones is the first stage of healing of true cervical erosion. Usually at this stage, cervical erosion is diagnosed by a gynecologist.
The growth of the cylindrical epithelium occurs not only on the surface of erosion, but also in depth with the formation of branching glandular passages. A secret is secreted and accumulates in the erosive glands, with difficulty outflow of which cysts form – from the smallest to visible during visual examination and colposcopy. Sometimes large cysts located near the external pharynx look like cervical polyps. Multiple cysts lead to thickening – hypertrophy of the cervix.
There are pseudoerosions:
- follicular (glandular) – having pronounced glandular passages and cysts;
- papillary – having papillary growths on the surface with signs of inflammation;
- glandular-papillary or mixed – combining signs of the first two types.
Pseudoerosion without treatment can persist for several months and years until the causes of its development and existence are eliminated. Pseudoerosion itself is a source of inflammation in the cervix due to the presence of infection in the erosive glands.
When the inflammation subsides independently or as a result of treatment, the process of reverse replacement of the cylindrical epithelium with a flat one occurs, i.e. the restoration of the normal integumentary epithelium of the cervix is the second stage of erosion healing. In place of the healed erosion, small cysts (nabothian cysts) often remain, formed as a result of blockage of the ducts of the erosive glands.
Prolonged course of pseudoerosions and concomitant inflammatory process can lead to pathological changes in epithelial cells – atypia and dysplasia. Cervical erosion with the presence of epithelial dysplasia is considered as a precancerous disease.
Pseudoerosions can be small in size (from 3 to 5 mm) or capture a significant part of the vaginal segment of the cervix. The predominant localization is around the external pharynx or along the posterior edge (lip) of the cervix. Pseudoerosions are a modified portion of the mucosa of irregular shape, with a bright red color, velvety or uneven surface covered with mucous or pus-like secretions. On the edges of the healing pseudoerosion, areas of flat epithelium of pale pink color and nabotovye cysts are visible.
Pseudoerosions, especially papillary ones, bleed easily during sexual intercourse and instrumental studies. Also, increased bleeding is noted with pseudoerosion dysplasia and during pregnancy. The healing of pseudoerosion is considered complete if the erosive glands and cylindrical epithelium are rejected and the flat epithelium is restored over the entire surface of the defect.
Congenital erosion of the cervix
The formation of congenital erosions of the cervix occurs as a result of the displacement of the boundaries of the cylindrical epithelium lining the cervical canal beyond its limits. Displacement (ectopia) of the epithelium occurs even in the intrauterine period of fetal development, therefore such erosions are considered congenital.
Congenital erosion of the cervix usually occupies a small area along the line of the external pharynx, has a bright red color, a flat surface. With an objective examination (in mirrors or colposcopy), pathological secretion from the cervical canal and symptoms of inflammation are absent.
Congenital cervical erosions are detected in childhood and adolescence, often cured independently. If congenital erosion persists until puberty, its infection, inflammation and subsequent changes are possible. Occasionally, against the background of congenital erosions of the cervix, flat warts develop, malignancy of congenital erosions is not noted.
Diagnosis of cervical erosion is often difficult due to the absence of characteristic complaints of the patient or an asymptomatic course of the disease. Changes in the subjective state are usually caused by a disease that causes the development of erosion. Therefore, the main diagnostic methods are visual examination of the cervix in mirrors and colposcopy, which allows to examine the pathological focus in detail under multiple magnification.
The method of extended colposcopy is used in cases of suspected malignancy of cervical erosion. The erosion zone is treated with a 5% alcohol solution of iodine and examined under a colposcope. True erosion (pseudo-erosion) has a light pink color, the dysplasia zone is yellow, atypical foci are white. When detecting areas of erosion that are questionable in terms of dysplasia, a targeted biopsy of the cervix is performed with a histological analysis of the resulting tissue.
Treatment of cervical erosion
In the treatment of cervical erosions , practical gynecology adheres to the following rules:
- monitoring of congenital erosions, no need for their treatment;
- true erosions and pseudo-erosions are treated simultaneously with the background diseases that caused or supported them;
- if there are signs of inflammation, the therapy should be directed at pathogens of infection (trichoionads, chlamydia, gonococci, etc.);
- erosion in the active stage of inflammation is treated with gentle methods (vaginal tampons with sea buckthorn oil, fish oil, syntomycin emulsion, aerosols containing antibiotics – chloramphenicol, etc.).
Methods of erosion destruction
Modern approaches to the treatment of cervical erosion are based on the use of the mechanism of destruction of cylindrical epithelial cells, their rejection and subsequent restoration of the flat epithelium on the surface of pseudoerosion. For this purpose, methods of diathermocoagulation, laser vaporization, cryodestruction, radio wave method are used.
- Diathermocoagulation is a method of cauterization of altered tissue by exposure to alternating high-frequency electric current, causing significant heating of tissues. Coagulation is not used in nulliparous patients due to the risk of scarring that prevents the opening of the cervix during childbirth. The method is traumatic, rejection of necrosis of the coagulated surface may be accompanied by bleeding. Complete healing after diathermocoagulation occurs after 1.5-3 months. After diathermocoagulation, endometriosis often develops, so it is advisable to plan the procedure for the second phase of the menstrual cycle.
- Laserporization or “cauterization” of cervical erosion with a laser beam is carried out on the 5-7 day of the menstrual cycle. Before laser perforation, the patient undergoes a course of thorough sanitation of the vagina and cervix. The procedure is painless, does not leave a scar on the cervix, and, therefore, does not complicate the course of subsequent childbirth. Laser destruction of altered tissues causes rapid rejection of the necrosis zone, early epithelialization and complete regeneration of the wound surface a month later.
- Cryodestruction (cryocoagulation) is based on freezing, cold destruction of cervical erosion tissues with liquid nitrogen or nitrous oxide. In comparison with diathermocoagulation, cryocoagulation is painless, bloodless, does not entail the consequences of cicatricial narrowing of the cervical canal, is characterized by relatively rapid epithelization of the wound surface after rejection of necrosis. The first day after cryodestruction, there is abundant liquid discharge, swelling of the cervix. Complete epithelialization of the defect occurs after 1-1.5 months.
- Radiowave treatment of cervical erosion by the Surgitron apparatus consists in influencing the pathological focus with electromagnetic vibrations of ultrahigh frequency – radio waves that a person does not physically feel. The procedure takes less than a minute, does not require anesthesia and further postoperative treatment. The radio wave method in the treatment of cervical erosion is recommended for previously unborn women, because it does not lead to the formation of burns and scars that make childbirth difficult.
Diathermocoagulation, laser vaporization, cryodestruction, and radiowave treatment are performed after extended colposcopy and targeted biopsy to exclude the oncoprocess. If a malignant degeneration of cervical erosion is suspected, radical surgical treatment is indicated. Even after the cervical erosion has been cured by one of these methods, a woman should be registered at a dispensary and monitored by a gynecologist.