Pseudoerosion of the cervix is a condition in which the cylindrical epithelium of the cervical canal is located on the vaginal surface of the cervix, normally covered with multilayer epithelial tissue. In most cases, it is asymptomatic and is accidentally detected during a gynecological examination. There may be unusual discharge, soreness during sexual intercourse. Colposcopy, scraping or biopsy of the cervix, cytological studies are used for diagnosis. Treatment for an asymptomatic course is not required, observation and periodic examination are prescribed, in case of complications, cryodestruction, electrocoagulation, laser or chemical moxibustion are performed.
Pseudoerosion of the cervix is also known as epithelial ectopia or endocervicosis. The terms reflect the essence of the process leading to such a condition – the penetration of the cervical single-row epithelium on the vaginal part of the cervix. The actual erosion (destruction or damage to the epithelial cover) does not occur. Experts of the World Health Organization do not consider such a phenomenon a pathological process, it is regarded as a physiologically variable condition. Ectopia is almost always registered in women younger than 35-40 years, more than half of the individuals are aged 20-23 years. Endocervicosis occurs in the vast majority of pregnant women and spontaneously disappears 1-2 years after childbirth. There is a correlation between this process and the use of combined oral contraceptives – the latter contribute to ectopia of the epithelium.
A prerequisite for pseudoerosion of the cervix is an anomaly in the formation of female genital organs during embryonic development. A single-row cylindrical epithelium at the intrauterine stage covers the inner surface of both the uterus and the vagina. Shortly before birth, such a cover is replaced by a multi-layered flat epithelium, normally preserved only in the cervical canal, but in some women it remains on an insignificant part of the vaginal part of the cervix. The size of this zone may change over time under the influence of various factors:
- Hormonal background. The epithelial cells of a woman’s genitals are hormone-sensitive, reacting differently to the work of the endocrine system. This explains the frequent detection of pseudoerosion during puberty, during pregnancy or the use of hormonal contraceptives.
- Infectious factors. Sexually transmitted diseases or nonspecific inflammation of the female genital organs (colpitis, cervicitis) provoke the expansion of the zone of cervical ectopia.
- Chemical factors. Irritation of the cervix with chemical compounds that are part of vaginal suppositories, lubricants, lubricants for condoms can cause the development of this condition.
- Mechanical irritation. The appearance of a cylindrical epithelium is noted when the vaginal part of the cervix is injured – the cause may be frequent sexual intercourse, the use of barrier methods of contraception, childbirth.
The question of the purely acquired nature of this condition and its development without congenital prerequisites in gynecology remains debatable. There is no convincing evidence that environmental factors can cause endocervicosis without a predisposition to it. Proponents of the hypothesis about the acquired nature of pseudoerosion of the cervix believe that inflammatory, immunological and endocrine disorders are involved in its development.
Pseudoerosion of the cervix occurs with a combination of congenital and acquired factors. If at birth there is such a feature of the distribution of epithelial cover in the genitals, then in different periods of a woman’s life the area of the ectopia zone will constantly fluctuate. The expansion occurs under the influence of female sex hormones, since the cervical epithelium is more sensitive to them and reacts to their effects by growth. With a decrease in the concentration of hormones, the multilayer cover is restored due to growth cells.
Therefore, in a woman at different periods of life, ectopia can be either pronounced or not defined at all. Although this condition is not recognized as pathological, it can be potentially dangerous, since the cylindrical epithelium has a lesser barrier function. This increases the risk of penetration of infectious agents. The constant activation of reserve growth cells of the multilayer epithelium creates the risk of their abnormal growth and division, which in the future is fraught with cervical cancer. The formation of various clinical types of the condition is associated with the addition of inflammation or the influence of other factors.
At the moment, there is no generally recognized line separating the physiological feature of the female body from the condition requiring therapeutic intervention. There are several types of ectopia that differ in their histological structure.
- Papillary form. Epithelial tissue forms papillary growths and strands, which are inflammatory infiltrates. It occurs under the influence of infection or another factor that causes inflammation.
- The glandular form. Small follicles and cysts are formed, covered with a multilayer epithelium. The causes of development are unclear, the influence of hormones or cellular changes is suspected.
- Mixed form. The epithelial cover forms both papillae and cystic growths.
Additionally, epidermizing or healing forms are isolated, in which there is a normal restoration of the multilayer cover of the vaginal part of the neck. Some experts criticize this classification, referring the above types to pathological complications of ectopia.
In most cases, ectopia is asymptomatic, noticeable manifestations occur only with the addition of infection or abnormal growth of multilayer epithelial tissue. For example, when cervicitis occurs, the appearance of transparent or whitish discharge from the vagina is recorded, sometimes with an unpleasant odor. Some women note soreness during sexual intercourse, sometimes after it there are small spotting. Rare symptoms are also pain in the lower abdomen, itching of the vagina, burning sensation. The duration of manifestations can be months or even years without a tendency to progress, their disappearance or, on the contrary, the addition of complications is possible.
Due to the reduced resistance of the cylindrical epithelium in this condition, inflammation occurs more easily under the influence of infectious agents, chemical and mechanical stimuli. A change in the consistency and volume of cervical mucus leads to reversible infertility – the secret forms a barrier to the penetration of sperm. Promiscuous sex life, non-compliance with the rules of personal hygiene can cause the destruction of the covers of the cervix and the development of true erosion. Ectopia is not attributed to precancerous diseases of the cervix, but chronic inflammation against its background can cause cell dysplasia, which is the first step towards their malignant degeneration.
Diagnosis of pseudoerosion of the cervix is important for differentiating the condition from precancerous conditions, inflammatory lesions and other pathologies requiring treatment. It includes a consultation with a gynecologist who develops a scheme for further research and analysis:
- Examination on the chair. Signs of ectopia can be detected with a simple visual examination of the cervix in mirrors. To confirm the diagnosis, the doctor asks the patient and prescribes a list of additional procedures.
- Extended colposcopy. A targeted study of the altered part of the neck under multiple magnification is necessary to determine the structure of the epithelial cover. During the study, a Shiller test is performed.
- Cervical scraping. Examination of tissue samples allows us to determine the nature of cells in the abnormal area. It is also necessary to exclude dysplasia and inflammatory changes. Cytology of cervical scraping is used (PAP test).
- Determination of the level of sex hormones. The study of a woman’s hormonal background will help determine the causes of ectopia and clarify the prognosis of the condition. For example, during pregnancy, this phenomenon is considered absolutely normal.
Additionally, the doctor may prescribe immunological studies to detect sexual infections, allergies and other conditions that can affect the appearance of pseudoerosion of the cervix.
Treatment of pseudoerosion of the cervix
In the absence of complaints and pronounced symptoms, treatment is not required, regular observation by an obstetrician-gynecologist is sufficient to prevent complications. In case of infection, etiotropic therapy is carried out according to indications. A woman should limit the use of hormonal and some barrier contraceptives (caps). If ectopia is manifested by secretions, abdominal pain, characterized by abnormal growth of multilayer epithelium, pseudoerosion coagulation is performed using various methods:
- Diathermocoagulation. Cauterization of the site with a cylindrical epithelium is carried out by thermal action of an electric current. It is characterized by mediocre performance (75-90%) and a number of complications – bleeding, stenosis of the cervical canal with the development of infertility. It is prohibited for the treatment of ectopia in unborn women.
- Laser destruction. Carbon dioxide or helium-neon lasers are used, the efficiency is very high – 98-100%.
- Cryodestruction. Freezing with liquid nitrogen of the abnormal area, followed by healing and epithelization. The method is widely used due to its simplicity, the efficiency is 87-95%.
- Chemical coagulation. It is based on the traumatic effects of various compounds and pharmacological agents. It can be used in combination with other methods of treating pseudoerosion of the cervix to increase their effectiveness.
Given the wide prevalence of ectopia and its characterization as a variant of the development of the female reproductive system, the prognosis of the condition is favorable. A relative threat may be complications of pseudoerosion – inflammation, pathological overgrowth of the integumentary tissues. But with regular monitoring and timely correction of changes, the risk of severe consequences is very small. To prevent ectopia, one should adhere to the rules of personal hygiene, avoid accidental and unprotected sexual contacts, and fully treat inflammatory pathologies of the genitals and endocrine disorders. Women who are seen by a gynecologist for this reason should be careful in choosing contraception – hormonal and some barrier methods can lead to complications.