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31.10.2019

According to the medical literature, cervical erosion is detected during a gynecological examination in 15% of all women. Some varieties of this pathology are diagnosed in about half of all patients. Such a wide prevalence explains the important medical and social significance of the problem.

Definition and types of erosion

The term erosion is commonly understood as damage or degeneration of the structure of the mucous membrane of the cervix. First of all, the part of the cervix that goes into the vagina suffers. In this place, the neck is covered with a special type of cells that form the surface of the skin and mucous membranes. These cells are called stratified squamous epithelium. The internal or cervical canal of the cervix is normally covered with cylindrical epithelium (cells have the appropriate shape).

The cervix is covered by stratified squamous epithelium

Erosion classification

Depending on the location of the defect and the nature of the changes in the mucosa, it is customary to distinguish the following types of cervical erosion:

True erosion is a pathological condition in which the stratified squamous epithelium is damaged, the integrity of the mucous membrane is violated and a defect is formed in the form of a wound.
False, or pseudo-erosion, is a change in which cylindrical cells appear on the cervix instead of stratified squamous epithelium.
Congenital erosion is a condition when elements of the cylindrical epithelium grow beyond the boundaries of the cervical canal. Such erosion develops in girls at the earliest stages of development.

Erosion looks like a bright red spot on the cervix

True erosion is divided into several types depending on the cause:

inflammatory - caused by infectious pathogens - viruses, chlamydia, etc .;
traumatic - resulting from damage by gynecological instruments, with rough intimate contact or careless introduction of local contraceptives;
chemical - developing when exposed to aggressive chemicals, for example, acidic solutions with improper douching;
burn - arising after surgical treatment (diathermoelectrocoagulation);
trophic - caused by poor blood circulation in the vessels of the cervix;
specific - developing with tuberculosis or syphilis;
cancerous - malignant degeneration of epithelial cells on the cervix.

True erosion - damage to the cells of the epithelium of the cervix

Pseudo-erosion, in turn, is divided into several forms according to its structure. The following forms of pseudo-erosion are described:

Glandular - characterized by a large number of special formations - erosive glands. With this form, cylindrical cells not only line the neck from above, but also grow into the thickness of the tissues.
Papillary - a form in which the entire surface of the cervix is covered with growths in the form of papillae.
Cystic - develops when the layers of the epithelium grow on top of each other.
The glandular-cystic form, characterized by an increase in erosive glands and the formation of cysts between them (cavities filled with mucus).
Epidermis or healing - a variety that occurs at the site of successfully treated diseases of the cervix - true erosion, polyp, etc.
Papillary - characterized by the growth of connective tissue formations (the so-called papillary stroma).

With congenital erosion, the columnar epithelium grows beyond the boundaries of the cervical canal

Why does the disease occur

Doctors have not yet been able to fully figure out the exact cause of the development of this pathology. In practical gynecology, it is customary to single out several possible reasons for such a high prevalence:

Chronic inflammation of the gynecological organs.
Early onset of sexual activity.
Mechanical injuries of the mucous membrane - transferred curettage, ruptures during childbirth, gross mechanical damage during sexual intercourse.
Violations of the normal microflora in the vagina (dysbiosis) - develops with a frequent change of sexual partners, taking antibacterial drugs.
Hormonal disorders against the background of taking corticosteroid drugs (Prednisolone, Hydrocortisone, etc.), chronic diseases, age-related changes (decrease in estrogen levels with).
Decreased immunity due to past diseases, etc.
Features of the anatomical structure of the female genital organs - ectropion (pathological eversion of the uterine mucosa).

Infection with chlamydia can provoke the development of erosion

The factors provoking the development of erosion include:

frequent douching that disrupts the normal microflora in the vagina;
violations of the technique of setting the intrauterine device;
excess body weight;
transferred surgical operations on the uterus - removal of polyps, etc .;
the use of various artificial devices during sexual intercourse.

Main symptoms

In the first days and weeks of the disease, the woman does not feel pain or discomfort and is unaware of the pathology that has arisen. Over time, the following complaints appear:

discomfort and blood smearing during intimacy or when lifting weights;
lack of connection of such secretions with menstruation;
when a secondary infection is attached, the discharge from the genital tract turns greenish-yellow and acquires an unpleasant odor;
drawing pain in the lower back and lower abdomen;
high body temperature;
discomfort in the vagina when going to the toilet or having sexual contact;
when the inflammatory process passes to the uterus and fallopian tubes, the menstrual cycle is disturbed, the discharge becomes abundant and becomes brown.

A woman can independently suspect the appearance of erosion in herself only when the process becomes neglected and is accompanied by severe discomfort.

The nature of the secretions also gradually changes. They may be:

Brown or bloody. Such discharge indicates an inflammatory process in the uterus or mechanical damage to the mucous membrane.
Curdled, white with a sour smell - characteristic of the defeat of the genus Candida ().
Yellow - when affected by staphylococcus aureus or ureaplasma.
Green and thick - with gonorrhea or trichomoniasis.

Thrush is characterized by white cheesy discharge

With postpartum erosion, the patient feels a pulling pain in the vagina, but may not pay attention to it, attributing discomfort to the recovery period after childbirth.

In nulliparous discharges from the genital tract during erosion are meager, the main symptom is pain in the lower abdomen. The discharge is reddish or brown in color and occurs between menstrual periods.

If the pathology develops after cauterization of the cervix, the leading sign will be the appearance of scanty, light, transparent discharge.

Erosion after cauterization accompanied by clear secretions

Erosion and pregnancy

According to most experts, uncomplicated erosion on the cervix does not affect the process of conception and the development of the fetus.

A woman may well become pregnant, but at the same time she will have to be more carefully observed by an obstetrician-gynecologist. The situation is different in those cases when it is accompanied by an infectious inflammation of the genital organs. Such complications can cause intrauterine growth retardation and even fetal death.

If the erosion was cured by cauterization, doctors advise postponing conception for at least a year. During this time, the scars on the cervix will dissolve, and it will regain elasticity. During pregnancy, this pathology most often develops in young women who are about to give birth for the first time. Its appearance is associated with hormonal changes in the body.

Uncomplicated erosion does not affect the course of pregnancy

Symptoms that make it possible to suspect cervical erosion in a pregnant woman can be:

sensation of itching or burning in the area of the external genital tract;
pain in the lower abdomen of a aching or pulling character;
copious discharge mixed with mucus, blood or pus;
bleeding from the genital tract, which appear soon after sexual contact.

Diagnostic methods

For diagnostic purposes, the doctor examines the cervix using a special tool - a gynecological mirror. Examination reveals a red spot. If the erosion is of an inflammatory or traumatic origin, an elevation consisting of squamous epithelium is visible along the edges of the spot.

Speculum is used to examine the cervix

To determine the consistency of tissues in the focus of erosion, its bottom is examined with a metal probe (Krobak's test). If the probe easily enters the tissues, the sample is considered positive. With this test, some individual types of erosion can be distinguished.

Table: characteristic features of some specific erosions

Type of erosion	Characteristic diagnostic signs
Syphilitic (hard chancre)	diameter up to 1 cm; saucer shape; raised flat edges; shiny surface; red color; compaction at the base; no pain and bleeding when touched; Krobak's test is negative.
tuberculosis	the edges are uneven, as if undermined; multiple formations.
Cancer	edges in the form of uneven rollers; the bottom has the shape of a funnel; at the bottom of a plaque of dead tissue; bleeds easily when touched; Krobak's test is positive; the adjacent tissues of the neck are deformed, have a wooden density.

To diagnose erosion, smears are taken from the cervical canal and from the surface of the ulcer. The material is sent to the laboratory, where the cellular structure of the tissues at the site of the lesion is determined (cytological examination). If an infectious nature of the pathology is suspected, a bacteriological examination is carried out - the type of pathogen and sensitivity to antibacterial agents are determined.

Smears from the cervical canal allow you to determine the nature of the tissues and the possible causative agent of infections

An accurate diagnosis can be established using instrumental and additional research methods. These include:

Colposcopy - examination of the cervix using a sophisticated optical instrument. The method allows you to identify a defect in the epithelial tissue and the connective tissue base under it (stroma). The erosion bottom has a granular bright red surface. In true erosion, it is always below the level of the epithelial cover and has clear contours.
Samples with chemical reagents. If the damaged area is treated with 3% acetic acid, the bottom of the ulcer becomes pale, and when treated with 5% silver nitrate, it turns black.
Biopsy of the cervix - scraping of the mucosa in the damaged area with sending for the study of the cellular structure (histology). Such a study is carried out if cancer is suspected or if altered (atypical) cells are found in a smear. During the examination, it is possible to identify an area of the ulcerated surface, proliferation of connective tissue, a large number of leukocytes and plethora of blood vessels in the lesion. With pseudo-erosion, altered cells of the cylindrical epithelium are found.

Colposcopy - allows you to assess the condition of the cervix

Based on the results of the examinations, the attending obstetrician-gynecologist may prescribe a consultation of narrow specialists:

oncologist - upon detection of atypical cells;
dermatovenereologist - in the detection of sexually transmitted infections;
phthisiatrician - if a tuberculosis infection is suspected.

Principles and methods of treatment

It is necessary to develop a treatment regimen individually, taking into account the following indicators:

forms of the disease;
stages of development;
the size of the lesion;
the intensity of the inflammatory process;
the age of the patient;
obstetric anamnesis (information about pregnancies and childbirth).

Congenital erosion, according to obstetrician-gynecologists, does not need special active treatment, since it usually heals on its own. The woman in this case should be under dispensary supervision. Therapeutic measures are carried out when infectious and inflammatory complications are detected.

Women who do not yet have children and who plan to become pregnant are usually prescribed local and systemic medications. Active therapy of true and false erosion during pregnancy is carried out only in cases where there are concomitant infectious and inflammatory processes. In this case, local funds are assigned.

Do not confuse cervical erosion and the so-called ectopia. The latter is often found in nulliparous women (up to 23–25) years old and looks like erosion (it is what many gynecologists mistakenly try to treat both conservatively and surgically). However, ectopia - a congenital condition in which part of the mucous membrane of the cervical canal goes beyond its position - is not a pathology and, as a rule, goes away on its own. The doctor needs to conduct a cytological examination, which will confirm that this is not an erosion, and simply observe until the patient is 25 years old. If the ectopia increases, it will be necessary to do a biopsy and use the most sparing surgical treatment (for example, radio wave). If it disappears or remains the same size, interventions on the cervix are not recommended.

Professor K. Bakhtiyarov, obstetrician-gynecologist, MD
http://bakhtiyarov.ru/article/6-mifov-ob-erozii-sheyki-matki

Drug therapy

Drug therapy is carried out for nulliparous women, as well as as part of complex treatment along with cauterization procedures or surgical interventions.

Table: medications for the treatment of erosion

Release form and method of application	Group	Titles	Operating principle
Tablets and capsules for oral administration	Antibacterial	Levomycetin; Erythromycin; Metronidazole.	Destroy pathogenic microflora and stop its further growth
	Antifungal	Flucostat; Diflucan; Fluconazole; Terbenafine; Pimafucin.	Destroy pathogenic fungi, eliminate inflammatory processes, help restore the microflora of the vagina.
	Antiviral	Acyclovir; Valtrex.	Suppresses the activity of viruses that cause inflammation
	Immunomodulators	Immunal; Polyoxidonium.	Restore systemic immunity
	Medicines to speed up healing	Methyluracil; Apilak; Actovegin; Folic acid; Vitrum.	Improve metabolic processes in tissues, accelerate regeneration, promote rapid healing of erosion
Candles for topical use	Antibacterial	Betadine; Terzhinan; Depantol.	Destroy the pathogenic microflora of the genital tract, eliminate inflammation.
	Antifungal	Livarol;	Destroy pathogenic fungi in the vagina, including Candida.
	Stimulating healing	sea buckthorn; Depantol; Suporon; Fitorovye; Erotex.	Accelerate healing, promote the restoration of epithelial tissue.
Ointments and creams	Antibacterial and anti-inflammatory	Levomekol; Vulnuzan; Vishnevsky.	Eliminate pathogenic flora, have an anti-inflammatory effect, accelerate regeneration
Ointments and creams	Antifungal	Pimafucin.	Suppress the activity of pathogenic fungi, eliminate inflammation

Photo gallery: preparations for erosion control

Amoxicillin helps cure genital infections Clotrimazole cream effectively fights pathogenic fungi Candles Hexicon - a remedy for the local treatment of gynecological infections

Surgery

Surgical treatment involves surgical excision of the affected area or its cauterization. The indications for surgical excision are:

large area and rapid growth of the lesion;
erosion in women giving birth;
the appearance of pain and bleeding;
malignant degeneration (cancerous erosion).

Such an operation is performed by the method of conization - in this case, a cone-shaped piece of tissue is removed, the top of which goes into the depth of the cervical canal, and the base is located outside. Removal is possible in several ways:

classical surgical (using a scalpel);
laser;
radio wave.

The most effective and least traumatic experts consider radio wave conization of the cervix using a device called "Surgitron". The operation is performed outside the hospital, for its implementation it is enough to use local anesthetics (anesthetics). With this method, it is easy to control the depth of intervention and the amount of tissue removed. At the same time, pathological areas are not destroyed and it is possible to send them for histological examination. Due to the coagulating effect of radio waves, bleeding is minimal.

Radio wave surgical treatment of erosions is carried out using the Surgitron apparatus.

Conventional knife conization is performed in the operating room. Such an intervention is performed under general or local anesthesia in an operating room in a hospital. The operation is highly traumatic and the risk of bleeding.

Conization with a laser beam is reduced to tissue burning. With this method of treatment, it is not possible to conduct a study of the removed tissues. In addition, this method does not allow to determine the exact depth of excision. Laser conization can only be performed with true erosions without the slightest sign of cell degeneration or malignant growth.

The most effective and modern are the methods of cauterization of the affected area. Their comparative characteristics are given in the table.

Table: methods of cauterization of erosions

Name	How is it carried out	Indications	Advantages	disadvantages
diathermocoagulation	Cauterization of affected areas with electric current.	large area of damage; pain and discharge mixed with blood; frequent inflammation; the presence of sexually transmitted diseases; immunodeficiency.	safety and high efficiency of the procedure;	soreness; long healing; the formation of cicatricial changes at the site of cauterization; can only be performed on those who have given birth.
Laser coagulation	Cauterization of tissues with a laser beam	large affected area; associated pain and bleeding.	high accuracy; the possibility of use in nulliparous; there are no scars and scars; painlessness.	requires a lot of practical experience and qualifications of a surgeon or gynecologist; large erosions require several treatments.
Cryodestruction	Freezing the affected area with liquid nitrogen	Superficial defects in the epithelial lining of the cervix	painlessness; affordability; gentle effect; no scars remain.	Very accurate exposure is important, there is a high risk of damaging healthy tissues.
Radio wave treatment	Evaporation of tissues with the help of the thinnest electrode that creates energy waves.	true erosion with inflammation; pseudo-erosion.	fast healing; painlessness; lack of scars; the ability to treat nulliparous.	Do not use in pregnant women and patients with pacemakers.
Chemical coagulation	Mucosal treatment with a special chemical solution (Solkagin, Vagotil)	Erosions of small diameter, especially with signs of inflammation	In parallel with cauterization of erosion eliminates signs of inflammation.	The ability to apply only with a small area of damage (no more than 1 cm)

Video: laser treatment of erosion

The recovery period after surgical removal can last about 10 days. At this time, a woman may notice the appearance of reddish or brownish discharge from the genital tract. During this period, it is extremely important to observe the rules of personal hygiene.

After the surgical treatment received, the patient is strictly prohibited from:

douche;
visit a bath, sauna, solarium, swimming pools, take a hot bath;
sunbathe on the beaches and swim in open water;
play sports or hard physical work;
live sexually until the first menstruation;
use sanitary tampons (pads are allowed).

Folk methods of treatment

Folk remedies for getting rid of cervical erosion are most effective after the end of menstruation, when the recovery processes are faster and easier.

Tampons with therapeutic compounds are considered a popular home recipe:

Sea buckthorn oil is applied to a tampon and inserted into the vagina for 12-15 hours, placing a pad. The full course of treatment is 2 months, although noticeable improvements occur in 2-3 weeks. The oil accelerates the healing of erosion, reduces bleeding, eliminates pain and discomfort.
A tablespoon of linden honey is wrapped in a bandage or a piece of gauze and injected deep into the vagina. It is best to do this before bed. The procedure should be done for 10-15 days. Honey stimulates regeneration processes, increases local immunity.
Fresh aloe leaf juice can be used on its own or mixed with an equal amount of honey. Soak a swab in the liquid and inject overnight. According to patients, recovery occurs after a month of regular use.

Sea buckthorn oil has a wound healing effect

Douching is an effective method:

A teaspoon (about 5 ml) of a pharmacy tincture of calendula (marigold) is dissolved in 300 ml of heated water and douching is done. The procedure is carried out once a day, preferably at night. The douching course lasts 21 days. Calendula relieves inflammatory manifestations well and fights pathogenic microbes.
You can make an infusion of marigold flowers at home. To do this, take a tablespoon of flowers and pour half a glass of boiling water, after which they insist for 10 minutes. Douche with this remedy should be daily for 7 days.
Pharmaceutical chamomile flowers (2 tablespoons) are poured with 1 liter of fresh boiling water and left on low heat for 15 minutes, after which they insist for half an hour. This product should be used within 2 weeks. Chamomile has an antimicrobial and anti-inflammatory effect, promotes the healing of erosion.

Pour 7 yarrow flowers with 1 liter of water and boil for 20 minutes. The decoction is drunk throughout the day instead of regular tea, the course of treatment is 2 weeks. The tool has a pronounced anti-inflammatory and wound-healing effect.
Grind fresh pumpkin seeds in a meat grinder and pour boiling water over it. Take 2 parts of water for 1 part of seeds. Infuse the mixture for 10 hours and take half a glass in the morning. Pumpkin seeds contain a large amount of biologically active substances, accelerate tissue regeneration.

Treatment prognosis, possible consequences

If cervical erosion was detected in a timely manner and the patient received the correct treatment, there is a high probability of a complete recovery. If appropriate assistance has not been provided and the disease progresses, the following complications are possible:

further growth of the lesion;
accession of a secondary bacterial or fungal infection and the development of an inflammatory process;
development of bleeding from the genital tract;
degeneration of erosion into a cancerous tumor of the cervix;
miscarriages at short terms of pregnancy;
development of female infertility.

Cervical cancer can become a formidable complication of untreated erosion

It is also possible the development of some complications after surgery on the cervix (knife conization or diathermoelectrocoagulation). As a result of such interventions, the following complications are possible:

narrowing of the lumen of the cervical canal;
difficulties in pregnancy;
scarring on the neck;
rupture of the cervix in pregnant women or during childbirth;
development of endometriosis - a chronic gynecological disease.

Prevention of erosion development

To prevent the formation of an erosive defect of the mucous membrane of the cervix, doctors recommend:

avoid casual sexual contact;
use personal protective equipment against sexually transmitted infections;
carefully observe the rules of hygiene;
regularly undergo a preventive examination by a gynecologist;
timely treat the arisen diseases of the genital organs.

- defect, damage to the squamous epithelium of the cervix on its vaginal part around the external os. More often occurs due to endocervicitis and other inflammatory diseases of the genital area, hormonal disorders in the female body. The course can be asymptomatic or manifested by pathological discharge of a mucopurulent, sometimes bloody nature, pulling pains in the sacrum. It is a risk factor for the occurrence of neoplasms of the cervix (polyps, cancer). The main methods for diagnosing cervical erosion are examination of the cervix in the mirrors and colposcopy. In the treatment, methods of diathermocoagulation, laser vaporization and cryodestruction, as well as the radio wave method, can be used.

General information

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 pathologies and occurs in 15% of women. The cervix is the lower part of the uterus, protruding into the vagina, inside which passes a narrow cervical (cervical) canal. The upper section of the cervical canal ends with the internal os, the lower section with the external os. The external os 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. Damage to the stratified squamous epithelium around the external os of the vaginal part of the cervix manifests itself in the form of cervical erosion.

Protruding into the vagina, the cervix is exposed to infections, trauma during sexual intercourse and medical procedures. The prolonged existence of cervical erosion can lead to changes in epithelial cells and the appearance of benign neoplasms (cervical polyps) and malignant tumors (cervical cancer).

The causes of cervical erosion can be different. Changes in the cervical mucosa can develop after childbirth, abortion, due to inflammatory diseases of the cervix, hormonal disorders. A common 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. Cervical erosion can occur in adolescence and in nulliparous women.

Types of cervical erosion

Cervical erosions are of the following types:

true;
congenital.

True erosion of the cervix

It is customary to call true erosion of the cervix, which is formed as a result of damage and desquamation of the squamous epithelium around the external pharynx of the vaginal part of the cervix. For true erosion of the cervix, the formation of a wound surface with signs of inflammation is characteristic. The most common cause of the development of true erosion of the cervix is irritation of the mucosa with pathological secretions of the cervical canal during endocervicitis. True erosion is usually bright red, irregularly rounded, and bleeds easily on contact. Colposcopic examination and microscopy of the eroded surface show dilated vessels, swelling, infiltration, traces of fibrin, blood, and mucopurulent secretions. After 1-2 weeks, true erosion passes into the healing stage - pseudo-erosion.

pseudo-erosion

In the process of healing, the defect of the squamous epithelium is replaced by a cylindrical one, extending to the erosive surface from the cervical canal. The cells of the columnar epithelium have a brighter color compared to the cells of the stratified squamous epithelium, and the erosive surface remains bright red.

The stage of replacement of squamous epithelial cells with cylindrical ones is the first stage of healing of true erosion of the cervix. Usually at this stage, cervical erosion is diagnosed by a gynecologist.

The growth of the cylindrical epithelium occurs not only along the surface of erosion, but also in depth with the formation of branching glandular passages. In the erosive glands, a secret is released and accumulates, with difficulty in the outflow of which cysts are formed - from the smallest - to those visible during visual examination and colposcopy. Sometimes large cysts located near the external os look like cervical polyps. Multiple cysts lead to thickening - hypertrophy of the cervix.

There are pseudo-erosion:

follicular (glandular) - having pronounced glandular passages and cysts;
papillary - having papillary growths on the surface with signs of inflammation;
glandular-papillary or mixed - combining the signs of the first two types.

Pseudo-erosion without treatment can persist for several months and years until the causes of its development and existence are eliminated. Pseudo-erosion itself is a source of inflammation in the cervix due to the presence of infection in the erosive glands.

When the inflammation subsides on its own or as a result of treatment, the process of reverse replacement of the cylindrical epithelium by 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 healed erosion, small cysts (nabotovy cysts) often remain, which are formed as a result of blockage of the ducts of the erosive glands.

Prolonged course of pseudo-erosion and concomitant inflammatory process can lead to pathological changes in epithelial cells - atypia and dysplasia. Erosion of the cervix with the presence of epithelial dysplasia is considered as a precancerous disease.

Pseudo-erosion can be small (from 3 to 5 mm) or capture a significant part of the vaginal segment of the cervix. The predominant localization is around the external os or along the posterior edge (lip) of the cervix. Pseudo-erosion is a modified area of the mucous membrane of irregular shape, with a bright red color, velvety or uneven surface, covered with mucous or pus-like secretions. Along the edges of the healing pseudo-erosion, areas of pale pink squamous epithelium and naboth cysts are visible.

Pseudo-erosion, especially papillary, bleed easily during sexual intercourse and instrumental studies. Also, increased bleeding is noted with pseudo-erosion dysplasia and during pregnancy. The healing of pseudo-erosion is considered complete if the erosive glands and columnar epithelium are rejected and the squamous 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. The displacement (ectopia) of the epithelium occurs even in the prenatal 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 os, has a bright red color, and a flat surface. An objective examination (in the mirrors or colposcopy) shows no pathological secretion from the cervical canal and no symptoms of inflammation.

Congenital erosions of the cervix are detected in childhood and adolescence, often self-healing. If congenital erosion persists until the sexually mature period, 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 observed.

Causes and mechanism of development of cervical erosion

In the question of the causes and mechanism of development of cervical erosion, the leading role belongs to the inflammatory theory of the origin of the disease. 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 inhabited by the microflora of the vagina and cervix.

Dishormonal theory puts forward a change in the level of sex hormones-steroids as the cause of the development of cervical erosion. Clinical observations show the appearance of cervical erosion during pregnancy and regression in the postpartum period with the stabilization of the hormonal background.

Erosions are also formed during ectropion (eversion) of the mucous membrane of the cervical canal during birth injuries. Erosions of the cervix (pseudo-erosion - 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.

Diagnosis of erosion and pseudo-erosion of the cervix

Diagnosis of cervical erosion is often difficult due to the absence of characteristic complaints of the patient or the asymptomatic course of the disease. Changes in the subjective state are usually caused by a disease that causes erosion. Therefore, the main diagnostic methods are visual examination of the cervix in the mirrors and colposcopy, which allows you to examine the pathological focus in detail under multiple magnification.

The method of extended colposcopy is used for 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. If areas of erosion are found that are doubtful in terms of dysplasia, a targeted biopsy of the cervix is \u200b\u200bperformed with a histological analysis of the tissue obtained.

Treatment of erosion and pseudo-erosion of the cervix

In the treatment of cervical erosion, practical gynecology adheres to the following rules:

observation of congenital erosions, no need for their treatment;
true erosions and pseudo-erosions are treated simultaneously with the background diseases that caused or support them;
if there are signs of inflammation, the therapy should be directed to infectious agents (trichoionads, chlamydia, gonococci, etc.);
erosion in the active stage of inflammation is treated with sparing methods (vaginal tampons with sea buckthorn oil, fish oil, synthomycin emulsion, aerosols containing antibiotics - chloramphenicol, etc.).

Modern approaches to the treatment of cervical erosion are based on the use of the mechanism of destruction of cells of the cylindrical epithelium, their rejection and subsequent restoration of the squamous epithelium on the surface of pseudo-erosion. For this purpose, the methods of diathermocoagulation, laser vaporization, cryodestruction, and the radio wave method are used.

Diathermocoagulation is a method of cauterization of altered tissue by the action of a high-frequency alternating electric current, which causes significant tissue heating. Coagulation is not used in nulliparous patients because of 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.

Laser vaporization or "cauterization" of cervical erosion with a laser beam is carried out on the 5-7th day of the menstrual cycle. Before laser vaporization, 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 births. Laser destruction of altered tissues causes rapid rejection of the necrosis zone, early epithelialization and complete regeneration of the wound surface already 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 epithelialization of the wound surface after rejection of necrosis. The first day after cryodestruction, there are abundant liquid secretions, swelling of the cervix. Complete epithelialization of the defect occurs after 1-1.5 months.

Radio wave treatment Cervical erosion by the Surgitron apparatus consists in exposing the pathological focus to ultra-high frequency electromagnetic oscillations - 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 nulliparous women, since it does not lead to the formation of burns and scars that make childbirth difficult.

Diathermocoagulation, laser vaporization, cryodestruction, radio wave treatment is carried out after extended colposcopy and targeted biopsy to exclude the oncological process. If malignant degeneration of cervical erosion is suspected, radical surgical treatment is indicated. Even after curing cervical erosion by one of these methods, a woman should be registered with a dispensary and observed by a gynecologist.

Erosion of the cervix is manifested by impaired functioning and destruction of the upper layer of the epithelium, which can only be seen during a gynecological examination

A defect in the epithelium of the cervix is detected during a routine examination or after a woman contacts a gynecological consultation with complaints of other disorders. The doctor sees the changes by examining the patient with the help of mirrors.

Cervix

The vagina and the uterus hidden inside the small pelvis of a woman are interconnected by means of a neck. From the vagina, its external pharynx is visible, which is normally covered with pink epithelium. There is a canal inside the cervix, and the wall of the organ consists of three layers:

external;
muscular, consisting of fibers arranged in a circle;
inner, epithelial layer.

Each of them has its own purpose. The muscular layer provides compression and sealing of the cervix, protecting the uterus and its contents from infection and fluids.

The inner layer lining the uterine canal consists of a single layer of cells that have a specific, cylindrical shape. They are painted in a specific red color and form a velvety surface, the purpose of such cells is to secrete mucus, which tightly clogs the neck. The epithelium covering the cervix from the side of the vagina has a different structure. Its cells:

flat, with dense walls, the core inside;
arranged in several layers;
tightly closed.

In the lowest, basic row of cells, located on the border of the muscle and epithelial layers, there is a continuous process of division of existing and the birth of new cells. Layers of "fresh" cells rise, squeezing out the aging ones, providing a complete renewal of the mucosa over a short period of time. This process ensures the healing of large and small injuries that occur on the mucosa in the process of life.

The period of such renewal for each woman is individual and depends on the state of her body.

In some cases, there is a violation in the functioning of the layer of cells, they cannot recover as quickly as necessary to maintain their integrity, and ulcerations appear on the cervix. The base layer of the epithelium becomes too thin and weak for infection. Such destruction is defined as cervical erosion.

Types of erosion

Patients in whom the doctor has identified the disease are interested in what cervical erosion will look like (photo), erosion, what is it?

Externally, the lesions are in the form of scratches or rounded wounds covering the cervical mucosa, and defects found on the mucous membranes are usually red.

true erosion

Wounds occur in varying depths and sizes. If defeat:

observed on the upper epithelial layer;
do not penetrate deep;
leave the basal layer intact;
no infection was found on the mucous membranes and there is no pronounced inflammation;
with a fairly strong body, they will be able to overgrow themselves, the upper layer of the epithelium will recover.

When pressing on the wound with an instrument, the doctor may observe a slight bleeding - this condition is called true erosion. A doctor can rarely see such a lesion - usually defects of this kind are overgrown for 10-14 days.

If the damage is deep, reaching the basal layer of cells or penetrating below, healing can go in two ways:

a scar will form at the site of injury, which will make the neck more rigid and prevent it from stretching during childbirth, the consequence may be its ruptures;
the defect will not overgrow with a flat epithelium characteristic of the cervix, but with a cylindrical, “velvet” epithelium, which normally should not leave the limits of the internal cervical canal. This epithelium is located in one layer and produces thick mucus, which is not typical for the cervix.

Pure "erosion" is quite rare. In the photo, erosion of the uterus, which in most cases is accompanied by inflammatory processes or occurs against their background.

Causes of the condition

Erosion is a complex condition, the exact mechanism of which is unknown.

Clinical observations made it possible to determine the causes that can provoke a defect in the cervical mucosa. These include:

damage to the body by sexual infections that weaken the body of a woman (gonococci, HPV, trichomonas, staphylococci, yeast fungi);
lowering the body's immune threshold;
traumatic damage to the cervix due to birth trauma, curettage of the uterus, surgical treatment or mechanical trauma;
damage to the epithelium in the process of too early or too late childbirth - during early childbirth, the mucosa is still immature, which leads to its destruction;
inflammatory diseases of the vagina or cervical canal, in which there is a massive secretion of mucus and mechanical irritation of the cervical epithelium;
hormonal imbalance due to thyroid disease, adrenal function, age-related changes, ovarian tumors;
violation of the microflora of the vagina, which is caused by violations of hygiene, unreasonable change of sexual partners;
leakage from the uterus caused by the destruction of fibroids or endometritis, which leads to chemical damage to the cervix and the appearance of wounds.

The resulting condition provokes inflammation of the internal genital organs, weakening the body and can cause infertility.

External signs of the disease

It is believed that erosion has no symptoms and does not manifest itself. But an infection usually joins the process, which gives cause for concern and a visit to the doctor. The woman begins to worry:

pain and heaviness in the lower abdomen;
the appearance of bloody discharge after intercourse;
pain during sex;
the appearance of whites of a brown hue (indicates a mechanical injury of the mucous membrane of the cervix);
with a long course of the process, mucous whites with a purulent smell appear;
the appearance of whiter yellowish tint indicates the accession of a conditionally pathogenic infection;
milky whites speak of candidiasis (thrush).

All these conditions, if treated in a timely manner, are curable and require correction, as they can become a background for malignant changes.

false erosion

False erosion or ectopia is understood as the overgrowth of a defect on the mucosa with a single-row cylindrical epithelium. When you click on the affected area, no blood will be released. The mechanism of replacement of the true epithelium of the cervix with a cylindrical one is not fully known. It is believed that the main provoking factor is a hormonal failure, which had an impact on the body at the time of formation or in the process of life.

Speaking of uterine erosion, most gynecologists mean precisely pseudo-erosion. Women under the age of 30 are most susceptible to this disorder. False erosion can be acquired or congenital.

The doctor can observe in the mirrors what congenital cervical erosion looks like - this is a displacement of the natural pink squamous epithelium, on which a layer of red velvet cylindrical cells creeps.

Depending on the type of growth, there are several types of pseudo-erosion that differ in appearance.

glandular

With this lesion, erosion is characterized by strongly overgrown glands - the red epithelium penetrates into the deep layers of the cervical epithelium and "slips" covering vast surfaces. Such a lesion can develop in a woman's body for a long time (over several years). Clinically, it is the most common type of false erosion.

papillary

This view is externally designed as symmetrical, clear-cut growths resembling miniature papillae, on which a layer of “velvet” epithelium is formed on top. Some doctors attribute this false erosion not to a disease, but to the pathology of the development of the tissues of the internal genital organs of a woman.

With the development of such a violation, a woman may complain of:

weak pulling pains in the lower abdomen;
itching and burning in the vagina;
light spotting after sexual intercourse;
copious leucorrhoea without a strong odor, white or translucent.

If the whites acquire a pungent odor or their color changes, this will indicate the addition of an infection.

Cystic false erosion

Such erosion on the cervix (you can see in the photo) is characterized by the appearance of small cystic growths that form between the layers of the cylindrical epithelium. Cysts are dense and elastic when pressed. This form of change in the integumentary epithelium of the cervix is the most common.

Combined false erosion

A pure, "classic" type of erosion is not so common. In clinical practice, gynecologists most often encounter cervical erosion, which looks like a combination of two types of false erosions - glandular and cystic.

On visual inspection, it looks like a combination of enlarged glands and cysts between them. This combination leads to a delay in the secretion secreted by the glands and the attachment of infection. The appearance of such an inflammatory process leads to an increase in painful symptoms and will be the reason for a woman to see a doctor.

After the correct definition of the underlying disease, its effective treatment, a process called healing false erosion can be observed. The process occurs in a mirror order to the process of the occurrence of false erosion - squamous epithelial cells begin to displace the red cylindrical epithelium, eventually completely replacing it. But if a woman is diagnosed with changes in the epithelium with the appearance of cysts, then they will remain in most cases. Cystic formations increase the cervix, change its natural shape.

The papillary growths shown in the photo of erosion on the cervix are covered with a layer of cylindrical epithelium from above. They contain infiltrated and inflamed areas. The cause of the growth is the human papillomavirus.

Such a violation can exist for a long time on the cervix without significantly disturbing the woman. In this case, dysplasia, which is considered a precancerous condition, can develop. Overgrowth of the cervix does not allow sperm to enter the organ cavity, which threatens the development of infertility.

Condition of the cervix after treatment

During conservative treatment, the condition of the mucosa can change - its layer is restored or a scar is formed. After the removal of inflammatory processes, cauterization of the affected area is used to accelerate the restoration of the squamous epithelium layer.

After the procedure, epithelial recovery processes are activated - leukocytes and other cells are pulled into the burn area, enhancing regeneration.

A crust forms at the site of erosion, which falls off within 10-15 days, revealing a part of the mucosa, which will fully recover within 45-60 days. When using the radio wave method, not a scab appears on the surface of the treated area, but a thin film.

To accurately diagnose the condition of the cells of the cervix, it is necessary to examine them under magnification. For this, colposcopy is used, a method that involves examining an organ under a microscope (with the possibility of additional lighting) and a mirror.

In order for the examination to be of high quality, the doctor cleans the cervix. To do this, the vagina is treated with a cotton swab moistened with a solution of vinegar or Lugol.

This treatment makes the lesions more contrast and allows you to better see the erosion of the uterus, what the lesion looks like.

If, when stained with Lugol, light-colored spots appear on the neck, this raises suspicions of malignant cell degeneration, which requires taking material for research.

Condition prevention
For the timely detection of cervical erosion, women over 25 years of age should contact a gynecologist for an examination at least once every 6 months for examination by a doctor and taking a smear.

Important for the prevention of defects in the mucosa is the need to choose high-quality underwear that meets the requirements of personal hygiene.

Constancy in choosing a sexual partner will allow you to protect yourself from sexually transmitted diseases and subsequent erosion with a high probability, it is advisable to practice protected sex even with a regular partner.

In order for the immune system to be strong, you should adhere to a healthy diet, proper lifestyle, treat infectious diseases in time.

Cervical erosion is a cervical pathology caused by an active inflammatory process. The erosive area is externally represented by a defect in the wall of the mucous membrane of the uterine cervix at the site of its transition to the vagina.

This defect can be characterized as a wound surface devoid of epithelial cells.

Erosion can become the entrance gate of infection to the higher reproductive organs and cause the development of infectious and inflammatory diseases of the pelvic organs.

About what cervical erosion is, how this pathology manifests itself, and how to deal with it, will be discussed in more depth later.

Causes of cervical erosion

The causes of cervical erosion are quite diverse. The following come to the fore:

acute and chronic infectious diseases of the reproductive system. The causative agents of these diseases can be: staphylococci, enterococci , streptococci, Escherichia coli,. Fungal infections (candidiasis), especially in the chronic form, can also cause the development of an erosive process;
previous exposure to certain chemicals: intimate hygiene products, lubricants;
traumatic damage to the uterine neck with:
- performing gynecological diagnostic, therapeutic and other manipulations - curettage, abortion, childbirth;
- aggressive sexual intercourse.

Causing factors for the development of the disease

The role of factors that are not direct etiological causes, but significantly increase the risk of developing pathology, are:

early intimacy, when the full formation of all cellular structures did not occur (incomplete maturation of the mucous membrane), and the hormonal balance was not established;
primary and secondary immunodeficiencies;
diseases accompanied by an imbalance of hormones;
improper hygiene of the genitals.

Erosion of the cervix, the causes of which can be both external (trauma) and internal (infection), is most common in those women who are most exposed to the above predisposing factors.

Symptoms of cervical erosion

In this photo you can see what erosion looks like.

Signs of cervical erosion can have varying degrees of severity. Some women, regardless of age, do not even suspect that they have this pathology, since clinical symptoms are absent or very poor.

Others highlight vivid symptoms characteristic of diseases of the reproductive system.

The clinical symptoms of the disease are based on such phenomena as:

discharge from the genital tract with impurities of a characteristic brown or yellowish tint, not associated with a certain phase of the cycle (see photo above);
discomfort, varying degrees of intensity itching, burning, accompanying the process of urination;
dryness of the vagina;
pain and discomfort during intercourse;
liquid, rather abundant discharge of green, yellow color with a sharp rather unpleasant odor, as well as pain over the womb of a pulling nature, appear when the cause of erosion is an acute inflammatory process;
smearing brown discharge outside the menstruation itself, which was not previously there, is observed when inflammation spreads to the area of \u200b\u200bthe uterine wall and appendages.

Even if the patient has no symptoms of cervical erosion, but the doctor, upon examination, detects a brightly colored spot that is largely distinguished from the surrounding tissues, then the need for a detailed examination increases significantly.

Classification

Having an idea of what an erosive lesion is, attention should also be paid to the types of the pathological process. So, depending on the causes and nature of all damage to the mucous membrane of the uterine neck can be divided into 2 large groups:

true erosion- violation of the integrity of normal epithelium;
pseudo-erosion or ectopia- characterized by abnormal (not necessarily pathological) development of the mucosal epithelium. That is, there is some shift in the border zone between the cells of the epithelium lining the uterine canal (here it is single-layered) and the epithelium, which is located on the surface of the vaginal part of the cervix (multilayered). In many cases, ectopia is not a danger, but is a normal physiological state of women in different age periods of life.

Sometimes you can find the concept of congenital erosion of the cervix. In this case, we are also talking about ectopia, which does not adversely affect the health of a woman.

Among all true erosions, several groups of pathological processes can also be distinguished, the causes of which can also vary from hormonal disruptions to mechanical damage. These should include:

endometriosis- displacement with overlapping of cytologically different cells of the uterus and cervical canal;
ectropion- displacement of the epithelial zone, which lines the mucous membrane of the cervical canal into the vaginal cavity. It is a consequence of intense mechanical impact (late abortions, severe complicated labor activity);
leukoplakia- hardening of the epithelium in any of the sections of the mucosa;
polyps and condylomas of viral origin located in the region of the cervical canal.

As for pseudo-erosion, they are classified according to their appearance depending on the type of growth:

glandular;
papillary;
cystic;
papillary;
combined.

Signs of cervical erosion may vary depending on its specific subspecies and the nature of the location.

Diagnostics

Erosion of the vagina or that part of the cervix that is closest to it - diagnoses that the doctor can first make after a manual examination in the mirrors.

However, in order to make a final diagnosis, the gynecologist should not rely only on the external signs of cervical erosion and the patient's complaints.

The diagnostic algorithm of this disease consists in carrying out such laboratory and instrumental research methods as:

examination of a smear taken from the vagina to determine its qualitative and quantitative composition. Not only the type of pathogenic microflora (if any) is determined, but also an approximate quantitative value. In addition, this method allows you to count the number of leukocytes in a smear and roughly determine the degree of inflammation and neglect of the pathological process;
cytological analysis of material taken from the vagina - analysis of cells taken by scraping from different parts of the mucous membrane. In this study, altered cells can be detected;
full (extensive) colposcopy - used to identify cells changed by the erosive process, as well as the boundaries of the pathological focus. This method uses special dyes that change color depending on which medium they fall into. This is what prompts the doctor to assume a particular diagnosis. In colposcopy, a solution of iodine and 3% acetic acid is widely used. Discomfort and a burning sensation bring these solutions only if they fall on areas with a wound surface or abscesses. Colposcopy is a mandatory diagnostic study in determining tumor or inflammatory processes. Erosion of the uterus is determined by hysteroscopy;
sowing of the taken material to identify the causative agent of infection and determine its antibiotic resistance. It is carried out with the aim of prescribing the most rational therapy with a narrow-spectrum antibacterial drug;
, ELISA and RIF to identify the causative agent of infection;
biopsy - taking a biopsy (section of the affected tissue) to determine its cellular composition, identify atypical (cancerous) cells;
histology - allows you to evaluate the structure of cells, and when it changes - to determine the possible causes of their degeneration, as well as to predict the further development of the pathological process.

An additional examination is mandatory, since the symptoms of cervical erosion cannot be the basis for making a final diagnosis.

Treatment of cervical erosion

Treatment of cervical erosion is determined exclusively by a qualified specialist. Methods of influence are individual for each particular patient.

Before prescribing one or another method of exposure, the doctor finds out the causes of the disease. And only after that he decides whether surgery is required in this case or whether conservative methods can be dispensed with.

In addition, in most cases, the defective area, the appearance of which is provoked by traumatic damage to the mucous membrane, which has a small penetration depth, passes on its own and does not require aggressive medication.

Symptoms and treatment of erosion are 2 interrelated concepts. After all, the clinical picture often determines the direction of pathogenetic and symptomatic therapy.

Medical therapy

Conservative treatment of true erosion is based on the use of antibacterial drugs that have a detrimental effect on the isolated microorganism in the presence of infection.

Parallel intake of drugs that restore the natural microflora is considered mandatory. These include products containing lacto- and bifidobacteria.

Surgical

Surgical treatment of the erosive process is prescribed in the period of time corresponding to the first week after the end of menstruation. This is because any operation must be carried out in the cleanest possible conditions.

Before carrying out any surgical intervention on the cervix (as well as on any other organ of the reproductive system), the following are mandatory for clarification: the good quality of the altered area, the presence of concomitant diseases.

The main methods of radical treatment of the disease are:

diathermocoagulation- the most effective method that guarantees the complete removal of erosion (sometimes after repeated procedures). Its essence is to cauterize the affected area of the mucous membrane with an electric current. The disadvantages of diathermocoagulation are considered to be an aggressive effect on the mucous membrane, leaving behind cicatricial changes, which in the future can prevent pregnancy and complicate childbirth. The uterine neck loses physiological elasticity, the risk of ruptures increases;
chemical coagulation- with this method, the eroded area is cauterized with a chemically aggressive substance. Solkovagin is most often used. This type of coagulation is used for small erosions and mainly in nulliparous young women. The disadvantages of the technique are: the lack of a 100% guarantee of complete recovery, as well as a long course of treatment, consisting of several procedures;
laser therapy- one of the most popular methods of treatment, which is a priority in young women who are planning a pregnancy in the future. The big advantage is the absence of changes (cicatricial or adhesive) at the site of exposure;
cryotherapy- removal of erosion by its cauterization with liquid nitrogen. Manipulation is practically painless and can cause only mild discomfort. The rehabilitation period lasts 1 month. At this time, the patient should completely exclude sexual contact and physical activity;
radio wave radiation- the most sparing method of exposure that does not require direct contact with the body. In this case, a radio wave is directed to the altered area, which completely evaporates the damaged layer of epithelial cells. The rehabilitation period lasts about 1 month;
electroexcision- complete excision of the cervix with a special electric knife. It is used only if the disease acquires a malignant course.

Treatment of cervical erosion by surgery in nulliparous women of reproductive age, if possible, should be delayed until pregnancy and childbirth.

This is due to the fact that after a radical method of influencing the defect, the risk of developing secondary tubal dysfunction, functional inferiority of the cervix and, as a result, infertility increases.

Also, to a large extent, the formation of scars and deformities on the uterine neck at the site of erosion removal can prevent pregnancy.

In addition, the operated erosion of the vagina and cervix can cause premature birth even with the onset of pregnancy.

Non-traditional (folk remedies)

Regardless of the cause of cervical erosion, each patient should be given complex treatment. The use of traditional medicine recipes is also possible after prior consultation with a qualified specialist.

Currently, the most widely used tools are:

sea buckthorn oil, which is moistened with gauze swabs and inserted deep into the vagina at bedtime. Sea buckthorn oil has a pronounced anti-inflammatory and antibacterial effect, and also prevents further growth of the damaged area. Apply the remedy for 1-1.5 weeks;
mumiyo, which is also impregnated with tampons and introduced into the genital tract. The course of treatment is 7-10 days;
a mixture of herbs - in equal proportions mix oak bark, mugwort grass, birch leaves, chamomile flowers, eucalyptus leaves. 2 tbsp. spoons of the crushed mixture pour 500 ml of boiling water, let it brew for 2 hours under the lid, strain thoroughly. The resulting infusion is used twice a day. The course of treatment is 1-2 weeks.

Diet

As for dietary nutrition during erosion, it is recommended to exclude sweets, flour products, gluten-containing products, marinades and citrus fruits.

It is necessary to enrich the daily diet with products containing fiber, biokefir, yoghurts with live lactic acid cultures.

Prevention

All preventive measures aimed at preventing diseases of the genital area are based on:

regular examination by a gynecologist - at least once a year;
the presence of a permanent sexual partner;
treatment of acute and chronic diseases not only of the reproductive system;
carrying out immunoprophylaxis in the autumn-spring periods;
use of protective contraceptives.

Cervical erosion is not a sentence, but, like any other disease, it is better to prevent than to treat.

Prognosis for patients

The prognosis for identifying erosion is favorable if it is diagnosed at the early stages of its development and treated in a timely manner.

Erosion is dangerous in women of any age in that it is a favorable (provoking) factor for the development of a malignant formation in this place.

In addition, cystic cavities, scars, polyps form very quickly at the site of damage, which further makes it much more difficult for the desired pregnancy to occur.

The cervix is one of the most significant organs of the female reproductive system. She participates in the process of fertilization, selecting the most viable sperm, plays an important role in carrying a child, being responsible for ensuring that the internal os is closed and the fetus is kept in the mother's womb.

But at the same time, the affected cervix has the most favorable conditions for the development of infectious diseases that can lead to infertility and inflammation of the body of the uterus and ovaries.

A doctor can visually assess the condition of the mucous membrane located in the area of the external pharynx of the cervical canal during a gynecological examination. It is in this way that erosion (or ectopia) of the cervix is usually detected - displacement of the cylindrical epithelium, which can lead to many negative consequences.

Until now, the opinions of scientists about this pathology differ in the world. Some doctors consider it harmless and does not require treatment, even with a large area of pathologically altered epithelium.

Another part of doctors (including Russians) consider this disease a source of not only infectious, but also oncological diseases of the cervical canal. They believe that cervical erosion is a time bomb that can be present for years and eventually turn into a cancerous tumor.

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Dangers of cervical erosion

Cervical erosion photo

Small in size ectopia has a good chance of self-healing. Gynecologists in this case prescribe to the patient only regular observation by a doctor, without raising the issue of minimally invasive intervention. But if the erosion is large, then the lack of timely treatment can lead to a lot of problems.

Inflammatory diseases uterus and cervix. They become a consequence of the fact that the mucous membrane of the external pharynx of the cervical canal becomes fragile and vulnerable, and therefore prone to frequent cases of STDs.
Cervical ruptures that happened during childbirth. They can occur due to damaged epithelium, which has lost elasticity and has become thin due to the presence of a constant inflammatory process.
Cervical cancer. Often this disease is a direct consequence of a large and chronic erosion, which over the years turns into dysplasia (precancer), and then into a malignant tumor.

You can avoid all these problems if you follow the doctor's instructions and do not start a large ectopia, leaving it without treatment.

Types of disease and features

The displacement of the cylindrical epithelium is divided into several types, depending on the location of the pathologically altered area, and also depending on the circumstances under which it was formed.

true erosion- a formation characterized by a rich red color, often bleeding. It is localized in the region of the pharynx of the cervix and has a pronounced rounded shape.
congenital erosion- a section of the epithelium of a red color, without bleeding and the presence of inflammatory processes. Such erosion does not lend itself to staining with Lugol's solution during colposcopy, does not tend to transform into a malignant tumor, and, therefore, is not dangerous for a woman.
pseudo-erosion- the formation of a red or dark red color, which has a tendency to inflammation and frequent relapses. It needs treatment, as it can transform over the years into an oncological disease.

Based on the varieties of ectopia, it becomes clear that only true erosion and pseudo-erosion deserve close observation and treatment, and patients with identified congenital ectopia may not be afraid for their health.

The essence of ectopia is the displacement of the cylindrical epithelium from the inside of the cervical canal to its surface. However, the reasons for this shift may be different.

Cervical injury. Often occur due to mechanical damage during sexual contact. Especially if the girl began to live sexually too early. But even more often there is a true erosion of the cervix after childbirth, when the entire cervical canal is injured.
Genital tract infections. Ectopia occurs only in cases where STDs remain untreated for a long time. The mucous membrane of the vaginal walls and the surface of the cervix are constantly exposed to inflammatory processes, the result of which is the gradual replacement of the squamous epithelium with a cylindrical one. Such erosions are most often bleeding and cause discomfort during sexual contact.
Inflammatory process in the pelvis. They can cause ectopia only if they affect the cervix. As a rule, this happens when the inflammation of the uterus, ovaries or fallopian tubes has not been eliminated in time.

To start treatment, the doctor needs to find out what exactly caused the occurrence of the pathologically altered cervical mucosa.

Signs and changes in discharge

Ectopia tends to exist completely asymptomatically and for years not to make itself felt. A woman may not be aware of the presence of the disease, especially if she does not have the habit of regularly visiting the gynecologist's office. But in some cases, erosion has two main symptoms:

Pain during sexual contact. Occur in situations where the sexual partner has a long penis, which easily reaches the external pharynx of the cervix, where erosion is located.
Small spotting that happen after sex. They can occur even if the length of the partner's penis is medium or small, and the cervix does not come into contact with it. The cause of bleeding lies in the change in the consistency of the intravaginal secretion of a woman during sex, which corrodes the inflamed surface of the pharynx of the cervical canal.

Other symptoms of erosion are very indirect and occur quite rarely. As a rule, a woman begins to plan a trip to the doctor exactly when she feels pain or sees a bloody spot after each sexual intercourse.

In some cases, discharge during cervical erosion is profuse and watery.

Treatment of cervical erosion - methods and preparations

Depending on the complexity, erosion can be treated in several ways. Some of them involve minimally invasive surgery. Others are based on drug therapy. As a rule, neither one nor the other can be combined.

Treatment with drugs and suppositories

Only very small ectopias are subjected to such treatment. As the main preparations, suppositories, tampons soaked in special wound healing oils are used.

Doctors also seek to resort to drug therapy in cases where the pathologically altered area of the epithelium is located too close to the entrance to the cervical canal and the scar formed after minimally invasive surgery can become an obstacle to pregnancy.

Candles for cervical erosion are made on the basis of sea buckthorn oil, therapeutic mud or cocoa, or they contain substances that accelerate skin regeneration.

Elimination by radio wave method

This technique involves the use of the Surgitron apparatus, which, using radio waves, removes a pathologically altered area of the epithelium.

The main advantage of this method of treatment is the complete absence of scars after the procedure. All manipulations last from a few seconds to 3-4 minutes (depending on the size of the ectopia focus).

If the lesion is large, then the patient feels a slight pulling pain in the lower abdomen until the doctor completes the procedure.

Radio wave treatment of cervical erosion is suitable for both women who have given birth and those who have not yet given birth.

Elimination with a laser

In terms of time, the treatment is as fast as when using the Surgitron apparatus. True, laser removal can leave a slight scar, but the intervention itself is almost bloodless.

The probability of recurrence is small, but after the erosion of the cervix has been removed with a laser, it is necessary to observe a certain regimen of physical activity for some time, because strong physical stress can provoke bleeding.

Elimination by cauterization

The procedure is quite old and is now used less and less. Leaves a scar, so it is not recommended for nulliparous girls. During the manipulation, the patient experiences a short-term acute pain in the lower abdomen, and then, within 3-4 hours, there are unpleasant pulling sensations in the same area.

Erosion of the cervix after cauterization is prone to relapse, especially if the woman has given birth again.

Liquid nitrogen treatment

A common procedure with a high percentage of complete cure. After cryotherapy, a small scar remains, which, as a rule, does not interfere with either conception or childbearing.

All manipulations are carried out quickly and almost painlessly.

After treatment, slight brown discharge may occur for several days (not bleeding, but a few drops on a daily pad).

There is an opinion among women that ectopia can become a serious obstacle to pregnancy. In fact, there is no direct connection between infertility and displacement of the cylindrical epithelium.

The presence of the disease can affect the change in the consistency of intravaginal secretion, which will become more impermeable to sperm. However, a man with normal sperm counts will be quite capable of conceiving a child in such a situation.

In gynecology, there are indeed cases when problems with the onset of pregnancy and erosion are associated. But then conception does not occur due to the scar after the treatment of ectopia, which blocks the entrance to the cervical canal, and a significant part of the ejaculate cannot enter the fallopian tubes.

This problem arises due to the wrong approach to the treatment of erosion, when the doctor imprudently chose the technique by which minimally invasive surgery was performed.

The presence of untreated erosion does not affect the bearing of a child. The only difficulty is that during childbirth, the thinned mucous membrane of the external os of the cervix will be subject to severe ruptures.

However, it is impossible to live with the presence of ectopia - this can adversely affect the state of health and cause serious problems.

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