Ectopic cervix after childbirth. Ectopia of the cervix (pseudo-erosion)
This is an atypical location of the cylindrical (cuboidal) epithelium lining the cervical canal from the inside, on the vaginal portion of the cervix, normally covered with squamous epithelium. Uncomplicated ectopia of the cervix does not give a clinical picture; with complications, leucorrhoea, contact bleeding, itching in the genital area, and dyspareunia are noted. Cervical ectopia is detected during a gynecological examination; the diagnosis is clarified using extended colposcopy, cytological examination of scrapings, and, if necessary, biopsy. There is no treatment for uncomplicated ectopia; in complicated forms, etiotropic therapy is prescribed, and destruction of the altered lesions is performed.
General information
To refer to cervical ectopia, gynecology often uses the terms pseudo-erosion, false erosion, endocervicosis, and glandular-muscular hyperplasia. Normally, the vaginal part of the cervix, accessible to inspection in speculums, is covered from the outside by stratified squamous epithelium, while from the inside the cervical canal is lined with columnar epithelium. With ectopia of the cervix, the border of the transition of the cylindrical epithelium to the flat epithelium shifts to the area of the external pharynx, located around its circumference or locally.
Cervical ectopia is detected in 40% of women; in 11.3% of patients this feature is congenital. The maximum incidence of cervical ectopia (40-50%) is observed in women under 30 years of age. Ectopia itself never turns into cervical cancer, however, against its background, the likelihood of developing a malignant process increases.
Reasons
In the puberty and early reproductive period, cervical ectopia is regarded as a functional feature based on relative hyperestrogenism. The detection of pseudo-erosion during pregnancy is also considered a physiological condition caused by changes in the hormonal function of the ovaries. Various theories explaining the occurrence of cervical ectopia associate this process with dishormonal, inflammatory, immunological, and traumatic factors.
- The theory of inflammation. The formation of ectopia is explained by recurrent vaginitis and endocervicitis caused by streptococci, Escherichia coli, STI pathogens (mycoplasmosis, gardnerellosis, ureaplasmosis, chlamydia, human papillomavirus infection), etc. Pathological discharge affecting the vaginal part of the cervix causes desquamation of squamous epithelium with the formation in its place true erosion. Within 1-2 weeks, the epithelium of the endocervix spreads to the surface of the erosion, covering it, and in place of the latter, an area of ectopia is formed. Infection of the cervix is facilitated by: birth injuries, cervical injuries during medical abortions, trauma when using barrier contraception and spermicides.
- Immunological theory. Considers a decrease in general protective functions as the leading etiological factor. The formation of acquired ectopia of the cervix is predisposed by early sexual activity, frequent change of sexual partners, the presence of chronic extragenital pathology (diabetes mellitus, etc.), multiple births, and smoking.
- Hormonal concept. Links the development of cervical ectopia with ovarian dysfunction. It has been noted that cervical ectopia often occurs with endometriosis, fibroid, ovarian stromal hyperplasia, menstrual irregularities, early menarche and other conditions caused by hyperestrogenism.
Pathomorphology
Histologically, glandular, papillary ectopia of the cervix and pseudoerosion with squamous metaplasia are distinguished. With glandular ectopia, accumulations of glands with an extensive network of glandular ducts and signs of inflammation are detected. With papillary ectopia, there is a proliferation of stromal components and the formation of papillary structures covered with columnar epithelium.
Healing of cervical ectopia is accompanied by the reverse replacement of the columnar epithelium with cells of mature squamous epithelium, i.e., the formation of a transformation zone. This process involves reserve cells, which, as a result of differentiation, first turn into immature and then mature metaplastic epithelium.
Classification
Based on their origin, they distinguish between congenital and acquired ectopia of the cervix. In case of disruption of the relationship between the epithelial and stromal elements of the cervix, ectopia is interpreted as ectropion. The nature of the course of pseudo-erosion can be recurrent; clinical form - uncomplicated and complicated.
- Uncomplicated. Modern colposcopic nomenclature considers uncomplicated ectopia of the cervix as normal findings and a variant of the physiological condition.
- Complicated. This course of cervical ectopia is usually associated with colpitis and cervicitis caused by infection.
Symptoms of cervical ectopia
Uncomplicated ectopia of the cervix does not cause symptoms and, as a rule, is diagnosed during a routine examination by a gynecologist. In 80% of cases, complicated forms of cervical ectopia are observed, combined with inflammation or precancerous changes (dysplasia, leukoplakia, cervical polyps). In the presence of endocervicitis or colpitis, leucorrhoea, itching, dyspaurenia, and contact bleeding are noted. Primary disorders leading to cervical ectopia can cause menstrual disorders or infertility.
Diagnostics
The presence of congenital ectopia of the cervix is usually established during the initial visit to the gynecologist. In the case of diagnosing acquired pseudo-erosion, its formation on the previously unchanged surface of the cervix is taken into account.
- Gynecological examination. Upon visual examination, a bright red focus of ectopia with irregular outlines is visible on the chair in the area of the external pharynx. Touching the area of pseudo-erosion with an instrument may cause slight bleeding.
- Colposcopy. If cervical ectopia is detected, extended colposcopy is indicated. During the study, an atypical area is identified, represented by columnar epithelium and transformation zones. In 40% of cases, when performing the Schiller test, an abnormal colposcopic picture is determined: leukoplakia, mosaic, puncture, iodine-negative zones. The detection of these signs dictates the need for an in-depth examination of the patient.
- Analyzes. During diagnosis, microscopy, bacteriological culture, and PCR examination of cervical discharge are performed. Mandatory for cervical ectopia is a cytological examination of the scraping, which reveals the presence of squamous and columnar epithelial cells and signs of inflammation.
- Biopsy. If an abnormal colposcopic and cytological picture is detected, a cervical biopsy or separate diagnostic curettage (SDC) with histological examination is required.
To study ovarian function, functional tests are performed and hormonal status is examined. If hormonal disorders are detected, a gynecologist-endocrinologist is consulted. Differential diagnosis of ectopia is carried out with true erosion and cervical cancer.
Treatment of cervical ectopia
For uncomplicated congenital ectopia of the cervix, treatment is not carried out; The patient is monitored dynamically, allowing timely detection of deviations in the development of pseudo-erosion. Treatment of complicated forms of cervical ectopia is carried out taking into account existing changes. Etiotropic antiviral and anti-inflammatory therapy is prescribed, a competent selection of contraception is made, and immune and hormonal disorders are corrected.
After stopping the infectious process, destruction of foci of cervical ectopia is performed using cryogenic exposure, radiosurgery, laser coagulation, diathermocoagulation, and chemical coagulation. When identifying ov. Nabothi performs the opening of cervical cysts. If leukoplakia, dysplasia, polyps, or endometriosis of the cervix are detected, appropriate treatment of these conditions is indicated.
Prognosis and prevention
When pseudo-erosion is detected, regular colpocytological monitoring is indicated to exclude the development of pathological precancerous processes. With cervical ectopia, the prognosis is favorable. The development of cervical ectopia can be prevented by carrying out preventive medical examinations, correcting disorders of immune and hormonal homeostasis, timely treatment of sexually transmitted infections and inflammations, improving the culture of sexual relations, and gentle gynecological manipulations.
Causes and treatment of cervical ectopia
Cervical ectopia is the same gynecological pathology that most of us know as “erosion”. This diagnosis is given to women of different ages, those who have given birth and those who have not, those who have had an abortion and those who have never had one, those who have other gynecological diseases and those who do not. What is cervical ectopia, and what is more dangerous - its non-treatment, or vice versa - treatment?
To understand the issue, you need to remember the anatomy of the female genital organs. The cervix is the lower part of the uterus that partially extends into the vagina. And doctors can examine this part using a gynecological speculum. Pathologies are often detected - cervical erosion, cervical inversion (in women who have recently given birth), scar changes, leukoplakia, dysplasia, cancer, etc. Not all of these conditions require treatment due to the fact that they are a normal phenomenon and not a disease. Thus, cervical ectopia has causes that have nothing to do with gynecological diseases. This area, which has a brighter color, represents the boundary between two types of epithelium lining the cervix - ectopia of the cervical epithelium in a different way. But this is one of the normal options. Normally, this zone is located on the vaginal part of the cervix, and not inside the cervical canal, in girls and young women during puberty. Cervical ectopia is often diagnosed during pregnancy when taking oral contraceptives. That is, it is simply a peculiar reaction to hormonal changes.
Is it dangerous? The “erosion” itself, in most cases, is not dangerous, but this does not mean that a woman should not regularly visit a gynecologist for an examination at least once a year. The fact is that not only symptoms of cervical ectopia, but also severe cancer may be absent. And the woman herself has no way of knowing what is happening inside her. The doctor can not only visually examine the cervix, but also take a smear, which will answer whether the woman has precancerous conditions. To clarify the diagnosis, colposcopy may be prescribed - examination of the cervix under high magnification using a colposcope and a biopsy. Dysplasia is a precancerous condition.
Does cervical ectopia of the cervix need treatment if no dysplasia is detected? In quite rare situations. Only if the erosion occupies a large area, extends beyond the boundaries of the external pharynx, and spreads to the walls of the vagina. If there are signs of constant inflammation in this area. This issue must be resolved individually. But we must remember that cervical ectopia in nulliparous women will most likely bring fewer problems than the possible result of its treatment - scarring. In addition, in many women, laser and electric current treatments subsequently lead to cervical endometriosis.
Before agreeing to treatment, weigh the pros and cons.
Ectopia is a pathological condition of the cervix, which is characterized by the release of columnar epithelium beyond the organ canal. This disease is also called pseudo-erosion, since its external signs are similar to erosion.
Many pregnant women are faced with a diagnosis. The appearance of the latter is associated with hormonal changes in the female body (in particular, an increase in the level of estrogen hormones) against the background of the following provoking factors:
- weakened immune system;
- rough sexual acts;
- mechanical damage to the cervix;
- medical abortion in the patient's history.
How does ectopia affect the course of pregnancy?
A woman with this diagnosis begins to worry about the process of bearing a child. Doctors are convinced that cervical ectopia does not affect conception, the course of pregnancy, intrauterine development of the fetus and the course of delivery.
The main symptom of the disease is after sexual intercourse. However, this fact should not cause concern among women. Danger arises when a sexually transmitted infection (herpes, gonorrhea or chlamydia) is simultaneously diagnosed. It is the addition of infection that can cause the development of cervicitis or the threat of termination of pregnancy.
Clinical picture
Visually, the pathology has an irregular shape, the diameter of which ranges from 2-20 mm. The red color highlights the ectopia against the background of healthy pink epithelium. During pregnancy, pseudo-erosion becomes bright red. This occurs due to increased blood circulation in the cervical area. This is why the pathological area bleeds when touched. Hence the main symptom - bloody discharge, for example, after sexual intercourse or a gynecological examination.
The presence of ectopia increases mucus secretion, so a pregnant woman may be bothered by copious white discharge.
Diagnosis and treatment
The gynecologist must conduct an examination, because only after identifying the cause can the further course of treatment be predicted. The attending physician proceeds from the individual situation of each patient, taking into account her age, the size of the pathology, the presence of concomitant infections and inflammations, as well as the likelihood of a threat to the fetus.
- Waiting tactics
If the pathology is small in size and there are no concomitant infectious diseases, then gynecologists prefer to monitor the development of the disease with a control examination of smears. In most cases, ectopia disappears on its own after childbirth and, accordingly, does not require treatment.
- Treatment after childbirth
If there is a possibility of developing cervicitis, then treatment of the disease begins immediately after delivery. Treatment during pregnancy is resorted to in exceptional cases, so as not to disrupt its normal course.
Cervical ectopia and sexually transmitted infection
The protective properties of the organ epithelium are significantly reduced in the presence of ectopia. This creates a danger of various sexually transmitted infections entering the pregnant woman’s genital tract. When an infection occurs, conservative treatment is prescribed, in particular, taking anti-inflammatory drugs and antibacterial agents.
Destructive methods of treating cervical ectopia (chemical coagulation, cryotherapy or) are not used during pregnancy. Any manipulation of the tissues of the organ can cause a miscarriage.
The cervix is a very vulnerable place due to its location. Therefore, most gynecological ailments are associated with or have an impact on her condition. A combination of diseases is also possible, such as cervical ectopia of the cervix with chronic cervicitis. One of the ailments, if left untreated, can cause symptoms of the other.
Read in this article
About cervicitis
The interior of the cervix is called the cervical canal. This is the transitional part of the reproductive system, leading from the vagina to the main female organ. It is covered with a mucous membrane that differs in composition and appearance from those that line both the uterine cavity and its cervical part from the outside.
The cervical canal is susceptible to inflammation under certain conditions. After all, his task is to prevent further infection. Under the influence of many factors, the protective properties of the organ membrane are weakened. Then the infection settles in it, causing.
If it takes an acute form, it is quite easy to notice the malaise by contacting a specialist and based on purely external signs. But many women suffer from poor health caused by cervicitis, attribute it to a cold, and treat themselves. And the disease becomes chronic.
Development and signs of cervicitis in women
Signs of cervicitis and its effect on the cervix
Symptoms of cervicitis in a chronic course are mild, but when monitoring your well-being, they are still noticeable:
- Intensified from the vagina in addition to. If cervicitis is caused by a bacterial infection, they will be purulent. When a virus is to blame for the disease, the discharge is clear. If the cause of inflammation of the mucous membrane is a fungal infection, they acquire a lumpy consistency and a white color;
- Pulling, weakly perceptible. Women may not associate them with gynecological ailments;
- Changes in the characteristics of menstruation. The waste products of pathogenic microflora located in the cervical canal are added to the secretions during the death of the former functional layer of the endometrium. This gives them a different color, perhaps a diluted red. Menstruation can cause exacerbation of cervicitis, which leads to increased abdominal pain, general weakness, and increased temperature.
What happens in the cervical canal, especially a long-lasting process, cannot leave the outer part of the cervix aside. After all, all of these are composite and closely located departments of one section of the organ.
Constant inflammation of the canal mucosa leads to its hypertrophy. The shell becomes larger and thicker, so that it does not have enough space in it. The mucosa, consisting of cylindrical cells, covers a large area. This is cervical ectopia of the cervix, combined with chronic cervicitis.
The epithelium of the canal outgrows its usual internal space, covering the vaginal area of the organ.
The simultaneous presence of these pathologies also gives symptoms that can be noticed independently:
- Painful sensations during intimate contact. The area of inflammation comes into contact with the male genital organ, which causes irritation of the nerve roots;
- The appearance of bloody mucus from the vagina after sex. The cylindrical cells located on the outer part of the neck are easily damaged with vascular ruptures.
More about ectopia
Normally, the cervix, which protrudes into the vagina, is covered with a fairly wide layer of squamous epithelium. It appears as a pink, shiny and smooth surface when examined with a speculum.
The presence in this area of unusual cylindrical epithelial cells of the cervical canal gives the mucous membrane of the outer part of the cervix redness, swelling, and a type of inflammation.
This is what it is if cervical ectopia is not congenital, which also happens. But more often this pathology is acquired and rarely exists alone. The most common accompaniment, or rather, the cause of its occurrence, is inflammation of the cervical canal mucosa.
Causes of combined pathology
Cervical ectopia of the cervix together with chronic cervicitis can have a different nature, arising due to:
- Viral infection. The most dangerous among all is the papillomavirus, because it easily invades epithelial cells and causes dangerous changes leading to precancerous conditions, primarily;
- Bacterial infections, most often transmitted from a sexual partner. The most common cause of cervicitis with ectopic lesions of the cervix is;
- Inflammation of the external genitalia and vagina. , colpitis, easily turns into cervicitis and subsequent ectopia;
- Changes in vaginal microflora due to lack of cleanliness. The proliferation of pathogenic bacteria and a decrease in the activity of the protective biocenosis leads to a weakening of the mucous membrane not only of this organ, but also of the cervical canal, and consequently, its external part;
- Incorrect antibiotic therapy. These drugs can also negatively affect the vaginal microflora. The disturbed balance of beneficial and conditionally pathogenic bacteria reduces the protection of tissues and their proper development;
- . Excessive growth of cervical canal epithelial cells is caused by high concentrations of estrogen. The reason for this may also be an incorrectly chosen contraceptive;
- Associated pathologies. These are mainly diseases of the urinary system. Located close to the reproductive organs, it easily transmits bacteria to them. Other systemic diseases that affect metabolic processes and hormonal levels also weaken the epithelium.
Cervical ectopia can cause chronic cervicitis itself if it is congenital. Columnar cells are more susceptible to destruction than squamous epithelium. Their presence on the cervix makes it more vulnerable even to bacteria present in the vagina. The onset of sexual activity can also be marked by mechanical damage to the epithelium. As a result, inflammation spreads from the outer part of the cervix and passes into the cervical canal.
How dangerous is the prolonged presence of cervicitis and ectopia?
The simultaneous presence of both pathologies means the replacement of each other by the processes of destruction of epithelial cells and their regeneration. The first will predominate, and the second will take on such a character that it can lead to the appearance of other neoplasms, not necessarily benign. Polyps of the cervical canal and cervix, dysplasia, cancerous tumors are the likely consequences of cervical ectopia and chronic cervicitis if they are not seriously addressed.
When this line of defense of the reproductive system against infections is damaged, the uterus also becomes more susceptible to disease. Negative processes can affect it, leading to infertility and a threat to life.
Cervicitis and cervical ectopia require treatment. But it’s better to prevent diseases by keeping an eye on them, avoiding casual relationships, and regularly visiting a gynecologist.
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