What is uterine erosion and how to treat it. Cervical erosion - what to do, how to treat? Erosion: radio wave treatment method

Quite often, after the next preventive examination by a gynecologist, a woman hears the phrase: “You have cervical erosion!” And this is perhaps the most common diagnosis in women of childbearing age.

However, in fact, it turns out that in our time the concept of “erosion” is absent in professional medicine throughout the world, except for Russia. In our country, for some unknown reason, this term has taken root firmly, although today it has been precisely proven that it is absolutely incorrect and does not reflect the essence of the processes occurring on the mucous membrane of the cervix.

Is there actually erosion?

Translated from Latin, “erosio” means “corrosion.” For many years, it was believed that erosion was a defect in the cervical tissue (ulcer) that could develop into cervical cancer if not treated. And cauterization was carried out on all women in a row. This is how it was in the time of our grandmothers and mothers.

As time passed, gynecology developed progressively, and the following became clear:

There is virtually no cervical cancer without infection with the human papillomavirus;
The presence of erosion in itself does not increase or decrease the likelihood of developing cancer;
Often erosion is not erosion at all, but ectopia;
Ectopia is the migration of cervical epithelial cells from the inner part of the cervix to the outer surface;
Ectopia is not a disease, but a physiological condition of the cervix that does not need to be treated: over time it goes away on its own.

This is what large cervical erosion on the anterior and posterior lips looks like during colposcopy.

On a note

Cervical erosion is not a female disease that needs to be treated. This is the norm. In other words, cells turn from the inside out (in medical parlance, this condition may be called ectropion). No matter how paradoxical it may sound, if you do nothing about such erosion, it will go away on its own.

Therefore, if you are informed that you have been diagnosed with erosion, do not panic, do not rush to remove it and spend money on treatment, the cost of which is often quite high.

We repeat once again that the concept of erosion is outdated, and it would be more correct to say ectopia (false erosion or). But this term has become so firmly established in our everyday life that it continues to be used not only by patients, but, oddly enough, even by doctors. This is probably due to a lack of information among women. If the patient is told that she has “erosion,” then no additional questions arise, because she heard this name from her friends, mother or grandmother. But if you tell a woman that she has ectopia or ectropion, then she is unlikely to immediately understand what the doctor is talking about; she will also decide that something terrible and dangerous has been discovered in her.

This is what a large cervical ectopia looks like during colposcopy.

Therefore, doctors still have a long way to go to eliminate illiteracy among the female population.

On a note

The term “erosion” is currently used exclusively for true erosions that arise as a result of an infectious process, trauma or radiation.

How is the cervix structured?

To clearly understand what we are talking about, you need to have minimal knowledge of anatomy and know how the organ we are talking about works.

So, that part of the cervix that is located in the vagina and which the doctor sees during a gynecological examination in the speculum is quite logically called the vaginal part of the cervix. Inside the cervix is the cervical, or cervical, canal, which opens into the uterine cavity. There are two physiological narrowings in the cervical canal - the external and internal pharynx. The external os opens into the vagina. In nulliparous women, it is round in shape, and after childbirth it takes on the appearance of a transverse slit. The internal os opens into the uterine cavity. The cervical canal contains mucus, the main function of which is to prevent infection from entering the uterine cavity from the vagina.

The structure of the cervix.

The outside of the vaginal part of the cervix is covered by stratified squamous epithelium. The word “multilayered” itself suggests that it consists of several layers of cells. Thus, it has a significant (of course, by microscopic standards) thickness and performs a protective function. The mucous membrane of the cervix, covered with stratified epithelium, has a pale pink color.

Inside the cervical canal there is a cylindrical, or glandular, epithelium. It is thinner and more delicate, consists of a single row of cells, and the blood vessels shining through it give it a red color.

The columnar epithelium has a completely different function - to produce mucus. Columnar epithelium is hormone-dependent: when there are a lot of female sex hormones, it produces liquid mucus, when there is little, thick mucus. This invention was invented by nature for conception: through liquid mucus, sperm very easily penetrate the uterine cavity, meet the egg, and fertilization occurs. This quality of mucus is observed during the period of ovulation. The rest of the time, cervical mucus is thick, viscous, its function is protective - no infectious agent can penetrate the uterine cavity and cause inflammation.

The zone where two types of epithelium meet is called the transition zone, or transformation zone. At different age periods of a woman, this zone is located at different levels, which depends on the stage of development of the female reproductive system.

Thus, in newborn girls and virgins, the junction zone is located on the outer cervical surface. In this case, they talk about congenital erosion.

Histological structure of different types of cervical epithelium (in women of reproductive age and during menopause).

During puberty or during pregnancy, when a high level of sex hormones is noted in the female body, the cylindrical epithelium begins to quickly “crawl” out of the cervical canal and is located around the external pharynx, resulting in the formation of a red spot in this place. The same can happen if a woman takes hormonal contraceptives.

As a girl grows up, the level of sex hormones decreases, the stratified squamous epithelium begins to displace the cylindrical epithelium into its place - into the cervical canal, and the junction zone moves closer to the external pharynx.

With age, the border of the two epithelia completely hides deep into the cervical canal, which is why it becomes invisible. Therefore, ectopia no longer occurs in women of the older age group.

What does erosion (ectopia) look like?

Below in the picture, made based on the photo, you can see what a healthy cervix looks like and a cervix with erosion, or ectopia.

Ectopia of the cervix (schematically).

Let's take a look at the medical history...

So, we have already mentioned that ectopia (we will get used to speaking correctly) is a common condition in which a gynecologist sees a red spot around the external os of the cervix. Previously, due to imperfect research methods, it was believed that this was a defect in the cervical tissue, which could turn into cancer if left untreated. Therefore, in order to prevent cervical cancer, they tried to eliminate this defect by cauterization. Moreover, cauterization was performed on almost all women in 100% of cases.

But science moved forward. It became clear that the doctor’s eye cannot examine the cervix and its defect in detail: after all, it is necessary to evaluate the quality and structure of the cells. But it is almost impossible to do this with the naked eye. And in the daily practice of gynecologists, colposcopes began to appear - microscopes for a detailed study of the condition of the cervix.

The colposcopy procedure, an examination of the cervix in a speculum under microscope magnification, allows you to assess the condition of the epithelium and the presence of pathological changes.

Diagnostics have become more advanced. It was established that “erosion” is not an area devoid of epithelium at all, but a displacement of the intracervical columnar epithelium onto the vaginal part of the cervix. It is the columnar epithelium on the surface of the cervix that looks like a red spot.

Types of erosion

Experts distinguish the following types of cervical erosion:

Ectopia, or pseudo-erosion (sometimes in the scientific literature you can find the name “false erosion”). It occurs when the internal epithelium of the cervical canal shifts to the surface of the cervix (this was discussed above);
True erosion. We can talk about it when a defect appears on the outer part of the cervix and the stratified squamous epithelium is completely absent. The reason for this may be an inflammatory process, trauma to the cervix with gynecological instruments, or constant trauma to it due to uterine prolapse.

On a note

In young women, true erosion is extremely rare, while ectopia is quite common. On the contrary, in women over 40 years of age, ectopia is an extremely rare phenomenon. For this age, true erosions are more typical.

This is what pseudo-erosion and true erosion of the cervix look like during colposcopy.

How is ectopia diagnosed?

There is no diagnosis of cervical erosion worldwide. However, although today most practitioners do not consider cervical erosion a disease and claim that there is no such diagnosis, in the international classification of diseases of the 10th revision (ICD-10) under the heading “Non-inflammatory diseases of the female genital organs” it is assigned code N86. Allow me a small clarification: this section refers only to a case of ectopia with complications, that is, a pathology variant that requires treatment.

Ectopia is a condition that has no symptoms. And only a gynecologist can detect it during an examination. Very rarely (when ectopia reaches a large size) there may be complaints of spotting after intimacy or appear. There is never pain during erosion. And it cannot be seen on an ultrasound.

So, what does a doctor do if he discovers an unclear red spot on the patient’s cervix during a gynecological examination?

Firstly, the doctor will definitely take smears from the cervix for atypical cells. A smear for cancer cells in gynecology is called a PAP test. This is a very important analysis. Even if a woman is gynecologically healthy, she must undergo it without fail once a year.

The process of collecting material for a PAP test.

On a note

Cervical Papanicolaou smear examination (PAP test) is the main method for identifying precancerous conditions of the cervix. Material for cytology is collected from three areas: from the outer part of the cervix, from the junction of stratified squamous and columnar epithelium, and from the lower third of the cervical canal. To take material for examination, special brushes are used.

Interpretation of the results of cytological examination

Secondly, he will take a vaginal smear for flora. The smear may contain elevated leukocytes and pathogenic microflora, which indicates inflammation of the vagina. The inflammatory process in the vagina makes it difficult to identify atypical cells, therefore, if one is detected, then it is necessary to treat it, and then repeat the cytological examination.

For sanitation of vaginal inflammation, topical preparations in suppositories or vaginal tablets are used: Terzhinan, Hexicon and others. In some cases, it may be necessary to prescribe antibiotics, and to treat thrush - antifungal agents. The doctor will select all medications taking into account the causative agent of the disease.

To speed up the healing of erosion, all existing inflammatory diseases in the vagina should be cured, as they can affect the development of the focus of an existing pathological area.

It's important to understand

All of these medications are not used to treat erosion. The purpose of their purpose is to sanitize the vagina so that microbial agents do not provoke the transition of an uncomplicated form of erosion, which does not need to be treated, into a complicated one. Complicated erosion has a less favorable prognosis and always requires therapy.

Thirdly, if a cervical defect is detected, the gynecologist will suggest taking an HPV (human papillomavirus) test. Cervical pathology is usually caused by two oncogenic types of HPV - 16 and 18.

And finally, a colposcopic examination. The doctor will examine the cervix in detail under a microscope and evaluate the structure of the cells of the spot seen, the nature of the surface, color, edges of the affected area, and vascular pattern. Colposcopy complements cytological examination and makes it possible to identify a group of healthy women - those who do not require treatment for ectopia. The purpose of this study is to identify the lesion and substantiate the indications for targeted biopsy of the cervix. There is no need to be afraid of this procedure - it is absolutely painless.

A cytology smear allows you to determine the presence of cervical diseases and identify the risk of neoplasms.

Ectopia – is it dangerous or not?

Today, medicine has firmly established that ectopia, especially small ones, is a natural stage in the development of the female reproductive system. The spot of columnar epithelium at different periods of life against the background of hormonal surges can either appear or disappear, sometimes be very small, sometimes more extensive. And with age, the body completely eliminates this area, moving the transformation zone deeper into the cervical canal.

Often , and is a physiological condition that does not require treatment and does not pose a health hazard.

Need to know

If you have been diagnosed with ectopia of the cervix, but a cytological examination does not reveal pathological cells and there is no human papillomavirus, then your erosion is not dangerous, nothing needs to be done about it, it will go away on its own over time. The only thing that should not be ignored is annual gynecological examinations.

If HPV is still detected, and there are no atypical cells in the PAP test, then nothing needs to be done about your erosion. Just see a gynecologist twice as often (every six months).

When should erosion be treated?

In most cases, erosion does not need to be treated. But for this there are two conditions that should be remembered:

There should be no inflammatory process;
There should be no atypical or cancer cells in the smear for oncocytology.

When we talk about ectopia, we mean that the cylindrical epithelium of the cervical canal is not in its place, that is, not inside the cervix, but outside - on its vaginal part. The columnar epithelium is very thin and easily injured. The vaginal environment is not entirely natural for him. In addition, microbes can enter the vagina during sexual intercourse or from the rectum and harm the delicate epithelium.

Therefore, to prevent ectopia from developing into a complicated form, you need to keep the vagina clean, follow the rules of intimate hygiene and use condoms or spermicides during sex. This is especially true for women who are in sexual search and do not have a permanent sexual partner.

Chronic cervicitis during colposcopy (presence of hyperemia and discharge from the cervical canal).

Who is at risk for complicated erosion?

Complicated erosion can occur in any woman, but most often it occurs in representatives of the following groups:

Women who begin sexual activity early;
Women who often change partners. They are more susceptible to sexually transmitted infections, which adversely affects erosion, and the latter takes a complicated course;
Patients who have had abortions in the past, since mechanical trauma to the cervix can also cause complications of erosion.

What should I do if my Pap test reveals cancer cells?

If cancer cells are found in a cytological study, then this condition will no longer be called erosion. This is dysplasia (precancer) or even cervical cancer. In this case, you need to take a targeted biopsy from the suspicious area under the control of a colposcope.

The biopsy results are sent to the laboratory for histological examination, and only a histologist can make a final verdict, based on which the following actions are taken:

If, according to the results of the biopsy, there is no cervical cancer, but a precancerous process is confirmed, then in this case treatment is indicated (most often by);
If cancer is confirmed, then the method of choice is wide conization - excision of the cervix, in which the focus of the affected tissue is removed in the form of a cone with an apex extending deep into the cervical canal.

Which cauterization method is preferable for cervical dysplasia and cancer?

Often, mild dysplasia detected may simply be a consequence of inflammation. And after anti-inflammatory therapy at the control oncocytology, not a trace will remain of it.

But if dysplasia really needs to be treated, it is important to choose the right cauterization method. When a doctor decides on the method of surgical treatment of dysplasia, the key factors are the following:

Severity of dysplasia;
Woman's age;
Does her plans include motherhood in the future?

Of course, gentle surgical methods are indicated for young women with mild to moderate dysplasia who are planning to give birth after cervical treatment. This can be done using radio waves, argon or freezing with liquid nitrogen. In case of deep lesions of the cervix in women who do not plan to give birth, diathermoelectrocoagulation or electroexcision may be justified.

Extent of spread of cervical cancer.

Frequently asked questions for women with cervical erosion (ectopia)

Is it possible to install a spiral if there is erosion?

Can. But only on the condition that there are no signs of inflammation in microflora smears, and there are no atypical cells in oncocytology smears.

It is important to know

Uncomplicated cervical erosion is not a contraindication for the installation of an intrauterine device.

Is it possible to have sex if there is erosion?

Can. But you need to remember that small erosion does not give any symptoms and does not interfere with sexual activity, but large ectopia (more than 1-1.5 cm) can cause bleeding after sexual intercourse. In this case, you will need to see a doctor for examination.

Is it possible to use tampons for cervical erosion?

Yes, you can.

Can erosion affect the conception of a child and the pregnancy in the future?

By itself, it does not cause obstetric complications. The problem is different. It happens that the tactics for managing and treating erosion are chosen incorrectly. An unjustified desire to cauterize uncomplicated ectopia can lead to narrowing of the cervical canal, which often causes infertility.

Why does menstruation delay due to erosion?

Cervical erosion does not affect the menstrual cycle, and delayed menstruation is associated with concomitant pathology.

What are the psychosomatic causes of erosion?

According to the theory of psychosomatics, erosion occurs in women who do not accept their feminine essence, are dissatisfied with their relationship with their partner, and experience certain difficulties in their sexual life. Official medicine does not focus on psychosomatics, so a practicing gynecologist is unlikely to recommend that his patient accept herself as a woman in terms of treating erosion (although this is exactly the advice that is given on numerous forums).

We think that from the above you understand: it is very important to decide whether your erosion is normal or pathological. The tactics of further management and treatment will depend on this. Knowing in which cases ectopia can be observed and in which it needs to be treated, you will not part with “your blood” in vain, because the cauterization offered in many clinics is paid, and the price for services is far from symbolic.

Useful video about cervical erosion

What is cervical erosion

Cervical erosion is not a clinical diagnosis of the disease. This term is only a statement by the gynecologist of the presence of changes, not always pathological, but requiring certain diagnostic studies to clarify the diagnosis. To understand what is meant by this concept and why cervical erosion is dangerous, you need to have a general understanding of the structure of the organ.

Brief anatomy of the uterus

The uterus is conventionally divided into sections: fundus, body and cervix. In the latter, in turn, there is an upper part (supravaginal), into which the uterus passes, and a lower part, located in the vagina and accessible for examination by a gynecologist. A narrow cervical (cervical) canal runs throughout the entire cervix, opening with an internal os into the uterus and an external os into the vagina.

All departments differ in their functions, histological structure and, accordingly, diseases. The upper layer of the mucous membrane of the cervical canal is represented by columnar epithelium, and the surface of the cervix on the vaginal side is multilayered flat non-keratinizing, which slightly passes into the canal in the area of the external pharynx. The boundary between these types of epithelium is called the transformation zone. This is exactly the area where erosion forms.

What is erosion

Normally, the transformation zone is visible only when examined using significant optical magnification or during histological examination. In diseases and even in some physiological conditions, the border shifts to the vaginal surface of the cervix and is already determined visually without optical magnification. This occurs due to the growth of the columnar epithelium of the cervical canal beyond the border zone.

Currently, such changes are called ectopia (displacement, movement to an unusual place). Despite the change in terminology, the previous name (erosion) remains more familiar to patients when communicating with a doctor. At the same time, the correct understanding by gynecologists of the meaning and differences of these terms influences their targeted determination of the causes of the pathological condition and how to treat cervical erosion - with conservative or radical methods.

But until recently, all visible changes were called erosion, which was divided into true and false (pseudo-erosion). However, there is nothing in common between them. True erosion (corrosion, destruction) can occur as a result of:

burns due to rejection of the scab formed after treatment with chemicals, cryodestruction, electrical destruction;
inflammatory processes that accompany vaginitis (colpitis) or cervicitis - inflammation of the vaginal mucosa or the mucous membrane of the cervical canal;
trophic disorders (impaired blood supply) in postmenopause, with uterine prolapse, after radiation therapy;
disintegration of a cancerous tumor;
primary syphilis during the formation of chancre on the cervix.

In the first two cases, healing of erosion usually occurs on its own within a maximum of two weeks or can turn into pseudo-erosion (ectopia).

1. Cervix without pathology
2. Cervical ectopia

Causes of ectopia

In girls and young women under 18 years of age, erosion can be congenital and detected after the start of sexual relations. Many experts classify ectopia in all nulliparous women as congenital. In girls under 21 years of age and women during pregnancy, as well as during the period of involution, erosion is considered the result of hormonal changes. In these cases, changes often go away on their own and require only examination and observation.

However, ectopia occurs in more than 50% of women with cervical pathology and is dangerous because it can be a background, that is, a nonspecific sign of precancerous diseases and sexually transmitted infections. Therefore, it is classified as a group of “background” pathological conditions. In the structure of the general morbidity of the female genital organs, it is 9%; during preventive examinations, it is detected in various forms on average in 38.8%, of which 17-22% are nulliparous young women.

Specialists in various fields of medicine have identified and proven multiple causes of cervical erosion, among which there are factors both exogenous (external) and endogenous (in the body itself). The first include:

Early sexual debut (beginning of sexual intercourse before the age of 16-18).
Early first pregnancy (before 18 years of age).
Sexual contact with several partners or frequent changes of the latter.
Refusal to use barrier methods of contraception.
Dysbacteriosis, infections that are mainly sexually transmitted - gonorrhea, chlamydia, trichomoniasis, human papillomavirus, herpes virus. These infections first cause inflammatory processes and then contribute to the formation of precancerous diseases.
Inflammations caused by conditionally pathogenic microorganisms - Gardnerella vaginalis and candidomycosis.
Frequent abortions and damage to the cervix during abortion or complicated childbirth, as well as chemicals and some medications.
Low social, cultural and economic living standards.

Endogenous causes:

Hormonal dysfunctions during puberty, pregnancy, menopause, and also when using hormonal contraceptives.
Dysfunction of the endocrine glands - the thyroid gland, adrenal glands, ovaries.
Changes in the immune state of the body.
Metabolic disorders.

Symptoms of cervical erosion

Sometimes, in 2-6% of cases, cervical erosion does not manifest itself in any way and is diagnosed during preventive gynecological examinations or examinations not related to cervical pathology. Most often women complain about:

The discharge is yellowish or white (on average 80%).
Contact bleeding (in 6-10%). They consist in the fact that bloody discharge due to erosion of the cervix occurs during sexual intercourse or after physical exertion on the abdominal muscles.
Dyspareunia is difficulty in sexual intercourse due to the occurrence of psychological disorders or pain before, after or during sexual intercourse.
Menstrual irregularities.
Unexpressed and intermittent pain or heaviness in the lower abdomen.

Diagnostics

Examination using a speculum

When examined by a gynecologist using mirrors, a bright red area with uneven contours is visually identified in the area of the external pharynx, which may bleed slightly with a light touch.

Colposcopy

A highly informative, accessible and painless diagnostic method is a simple colposcopy for cervical erosion, which allows, using a 10-fold magnification, to roughly examine and get an idea of the condition of the mucous membrane, its epithelium and underlying vessels. The surface of a healthy mucous membrane is shiny and pink in color. The vessels underneath are not visible.

Ectopic areas, depending on the severity of the process, have the appearance of cluster-shaped bright red clusters of elongated shape or spherical papillae. In the transformation zone, you can see ectopic fragments and open glands in the form of dark dots around the external pharynx, areas of immature epithelial cells in the form of “tongues,” vesicles with yellowish contents (retention cysts).

A clearer picture is presented during extended colposcopy using simple additional tests - acetoacetic and Schiller. The first is that unchanged areas of the cervical mucosa become pale after treating them with acetic acid (3% solution). In this case, clusters of papillae become glassy and resemble grape bunches in shape, and the vessels are sharply narrowed.

When performing the Schiller test (lubrication with Lugol's solution), unchanged areas of the surface of the cervix become uniformly dark brown as a result of the combination of iodine contained in the solution with epithelial glycogen. The intensity of the color depends on the amount of the latter in the cells. The transformation zone takes the form of a clear, even line. Ectopic zones do not stain as a result of treatment with Lugol's solution.

Required laboratory tests

When diagnosing ectopia, mandatory tests will also include:

smear for bacteriological examination (for flora);
tests for urogenital infections, HIV, RW, hepatitis HBS and HCV;
scraping for cytological examination;
if necessary, cervical biopsy.

Treatment of cervical erosion

The decision on the need for dynamic observation or treatment, and the choice of conservative or surgical treatment methods, is made only after examining the woman by a gynecologist using laboratory and instrumental methods, as well as consulting an endocrinologist (if necessary).

Conservative therapy

Conservative treatment of cervical erosion consists of:

carrying out nonspecific anti-inflammatory therapy;
treatment with drugs that suppress the growth and development of fungal bacteria and sexually transmitted viral infections (if detected);
correction of hormonal and immune disorders;
the use of physiotherapeutic techniques (rarely) - vaginal tampons with therapeutic mud, irrigation with mineral waters, iontophoresis with drugs, ultraviolet and short-wave ultraviolet therapy, microcurrent and ozone therapy, helium-neon laser.

In some cases, removal of cervical erosion is carried out using chemicals that lead to a chemical burn (chemical destruction). One such remedy is Solkovagin. It is an aqueous solution of zinc citrate, nitric, oxalic and acetic acids. The solution is characterized by a selective coagulating effect on the columnar epithelium of the cervical canal without involving the stratified squamous non-keratinizing epithelium. As a result of treating the mucous membrane, it penetrates to a depth of 2.5 mm and has an effect after a single, or in extreme cases, a double procedure.

Another drug is an aqueous 36% solution of Polycresulene, which has cauterizing, antiseptic and astringent effects.

Surgical methods

Cryodestruction

A safe, easy-to-use and easily tolerated surgical procedure that does not require hospitalization is freezing cervical erosion with liquid nitrogen, or cryodestruction. It is based on the formation of tissue necrosis under the influence of very low temperatures that occurs during the rapid evaporation of liquid nitrogen. However, the effect of exposure is poorly controlled and can extend to a tissue depth of up to 5 mm or more, and therefore the formation of a narrowing of the external pharynx of the cervical canal is possible. In addition, the cryodestruction procedure often requires repetition.

Laser vaporization

Sometimes laser destruction (vaporization) is used - removal of cervical erosion with a laser, for which high-energy laser radiation devices are used. This includes ruby, argon, carbon dioxide and neon lasers. The advantages of this method are the ability to control the area and depth of tissue necrosis, and the absence of bleeding and inflammatory processes after the procedure. Disadvantages include pain and high cost of laser treatment.

Radio wave surgery

Currently, the Surgitron device is widely used in medical centers, antenatal clinics and hospitals. The method is a controlled, limited incision of tissue without contact with it. This is possible due to the high thermal energy generated when the radio waves emitted by the device are exposed to the pathological area of the mucous membrane. As a result of the influence of concentrated energy, cell destruction and evaporation occurs.

The advantage of removing ectopia using the radiosurgical method is the speed of the almost painless (due to the coagulating effect of the nerve endings) procedure, the absence of pain after surgery, the accuracy of the effect, the absence of bleeding, the bactericidal effect and the rapid healing of the wound without the formation of scars, leading to cervical rigidity and the possibility of its rupture during childbirth This method is successfully used for.

The isolated use of conservative or surgical methods sometimes does not allow achieving lasting results. Only comprehensive treatment taking into account endogenous and exogenous factors, prevention and adherence to a culture of sexual relationships, and the use of modern contraceptive methods make it possible to prevent the formation of new cervical erosion.

The most common causes of erosion include mechanical damage to the cervix, decreased immunity, sexually transmitted infections (genital herpes, human papillomavirus and others).

True cervical erosion may occur after difficult childbirth, abortion and other gynecological intrauterine interventions. And also due to the resulting gaps. The cervix can, as it were, turn out, the cylindrical epithelium of the cervical canal appears on the vaginal part of the cervix and ectopia is formed.

Symptoms of cervical erosion

Symptoms are few. As a rule, cervical erosion does not lead to significant changes in a woman’s well-being.

Women with this disease do not have discomfort in the lower abdomen. And it does not appear during sexual intercourse, because... There are no sensory receptors on the cervix. However, after intimacy, some women experience slight bloody or bloody discharge, which is a good reason to visit a gynecologist.

In most cases, cervical erosion is an incidental finding during examination by a gynecologist. The doctor sees it as a small bright red area on the cervix. However, to clarify the diagnosis, it is important to do an additional examination - the so-called colposcopy.

Colposcopy is an examination of the cervix using a special optical device with a magnification of 25-30 times. The device helps the doctor to better see the changed areas. After colposcopy, the gynecologist makes a more accurate diagnosis. The fact is that the term “cervical erosion” refers to several diseases that differ in their origin and prognosis. The examination lasts at least 20 minutes, but it is practically painless for the patient.

During colposcopy, the gynecologist has the opportunity to perform a biopsy of the changed area of the cervix. This study is not carried out if the patient complains of any symptoms, but only if the doctor sees a suspicious area during colposcopy.

A biopsy is usually performed on days 5-7 of the cycle, immediately after the cessation of menstruation. It is also important that at the time of taking the material there is no inflammation in the vagina. Therefore, if you are bothered by itching or discharge, it is advisable to see a gynecologist in advance and get treatment. And then go for a cervical examination.

The doctor excises a small area of cervical tissue to then send it for histological examination. A detailed study of the cells in the area of cervical erosion and the depth of the lesion allows the doctor to develop the correct treatment tactics for the patient.

If erosion exists for a long time, and there is no proper treatment, the cells of the cervix can change irreversibly. As a result, the risk of cervical cancer increases. Therefore, a medical examination by a gynecologist twice a year is mandatory for every woman.

Despite the fact that the symptoms of erosion are not always pronounced, this disease must be treated. Pseudo-erosion of the cervix is characterized by the presence of epithelium around the cervical canal that does not have a protective function and cannot prevent the penetration of infection (if any) from the vagina into the uterine cavity.

In addition, in some cases, a process of spontaneous epithelization of erosion occurs, which can lead to the formation of defective epithelium.

Diagnosis of cervical erosion

Erosion of the cervix may show virtually no symptoms. Only occasionally is minor bleeding possible during sexual intercourse. Therefore, for early detection and timely treatment of erosion, even a healthy woman should visit a gynecologist at least twice a year.

If the doctor sees that there are any defects on the cervix, it is necessary to conduct a colposcopy - an examination using a special device with an optical system. This procedure is painless and does not require special preparation.

If during the examination the doctor sees an area that requires a more careful examination, he will take a small piece from it with special tweezers. This is called a biopsy. It is necessary to then examine the cells of the cervix in detail under a microscope.

In addition to colposcopy and biopsy, a number of additional examinations must be completed before treating erosion. This is a smear for flora, cytological examination, blood tests for HIV, syphilis, viral hepatitis. Tests for the presence of sexually transmitted infections will also be required: chlamydia, gardnerella, myco- and ureaplasmas, trichomonas, herpes, human papillomavirus.

Complications

A patient with cervical erosion must be under the supervision of a gynecologist. Only with erosions that occur in adolescence can one not rush into treatment. Such erosions most often do not cause much harm and disappear on their own. But even in this situation, you need to regularly see a doctor.

In other cases, in the absence of proper treatment, cervical erosion can lead to complications. Due to prolonged inflammation, the structure of cells in the area of erosion may change. The appearance of so-called atypical cells, precancer and even cervical cancer is possible. Sexual infections, especially papillomaviruses and their combination with genital herpes viruses, can play a negative role in this process.

Treatment of cervical erosion

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The treatment method is determined after a complete examination. The issue of choosing a specialist and the method of influence should be approached with caution, especially if a woman plans to have children in the future.

Cauterization with electric current (diathermoelectrocoagulation - DEC) has been used for quite a long time. But this procedure is not without its drawbacks. Healing after it takes a long time, and sometimes cauterization leads to complications, and rough scars may occur. It is possible, for example, a narrowing of the external opening (or pharynx) of the cervical canal. This can lead to problems during your next pregnancy and birth. Therefore, diathermoelectrocoagulation is now used much less frequently. Currently, preference is given to other methods, in particular, freezing with liquid nitrogen - cryodestruction, radio wave method and laser coagulation.

However, with cryodestruction, there is a shortening of the cervix and, just like with DEC, a narrowing of the external os is possible. Therefore, radio wave using the Surgitron apparatus or laser coagulation have become the methods of choice in recent years.

Surgical laser treatment used in our clinic is the most preferred treatment method. It simultaneously affects the affected area and stops bleeding. After laser coagulation, complications are rare; a scar does not form, because The operation is carried out under close supervision and under the direction of a doctor. The depth of exposure can be minimal (up to 1-2 mm) and can be adjusted during the coagulation process. The recovery process takes less time than using other methods.

Sometimes, with cervical erosion, a minor operation is necessary - conization of the cervix. It is carried out if, based on the results of a biopsy, doctors find significantly changed, that is, atypical cells. If erosion occurs after a difficult birth, cervical plastic surgery is sometimes required. Remember that cervical erosion is a disease for which consultation with a doctor is required. Self-medication using traditional recipes can do more harm than good.

Cervical erosion, ectropion, leukoplakia

Article outline

Every woman should monitor her intimate health and regularly visit a gynecologist. Unfortunately, most people neglect this rule and end up facing unpleasant consequences. Cervical erosion is a common disease that occurs in every second girl.

Often the pathology is diagnosed by chance, as it proceeds calmly. It is important to understand the symptoms and treatment of this disease in order to correctly approach the problem and solve it much faster. What is cervical erosion, is it dangerous, and how to treat it, you will learn in the article.

Erosion - what is it?

Erosion is a purely female disease, manifesting itself as ulcerative damage to the wall of the mucous membrane of the cervix or the epithelium of the cervical canal. The disease affects 70% of women, but few people know what kind of disease it is and how to cope with it. The pathology is a bright red area, easily identified when examined with a gynecological speculum. There is a true type of erosion and pseudo-erosion ().

Often in gynecology, erosion refers to any damaged area of the uterine wall. The reasoning is correct, since a disease often develops into another disease. Pathological processes of erosion are provoked by the replacement of the normal uterine epithelium with a cylindrical one. In simple terms, small wounds appear on the cervix, that is, on its mucous membranes, which do not cause discomfort or unpleasant sensations.

The disease develops in both mature women and girls. Typically, a malignant neoplasm occurs extremely rarely, since the course of the pathology is benign. Despite this, cervical erosion must be treated. It is impossible to independently determine the course and type of pathology, so therapy is prescribed only by gynecologists.

Having understood what erosion is, we can move on to the next, important question: what kind of pathology exists and whether an oncological process is possible if a cancer cell begins to replace a healthy one.

Varieties

If we talk about varieties, experts distinguish three types of erosion. Each of them manifests itself differently and requires an individual approach.

Types of cervical erosion:

Congenital - the type is caused by a displacement of the boundaries of the epithelium lining the cervical canal and its limits. Pathology appears in the womb, during the period of active development of the fetus.
True cervical erosion is an acquired type that occurs as a result of some negative factors. Often, true erosion develops on the lower lip of the cervix, causing its deformation and bright red coloration.
False erosion - the process is accompanied by the replacement of epithelial cells with cylindrical ones. The pathology is detected at about 40 years of age, there are no symptoms, but with concomitant infections, leucorrhoea, bleeding after sex, and pain in the lower abdomen may appear.

In turn, true and pseudo-erosion are divided into several types.

True:

Traumatic, occurring after surgery, childbirth, abortion, etc.
Cancerous – malignant course;
Inflammatory – developing after infection;
Trophic – caused by insufficient blood supply;
Specific - appears after suffering from syphilis, tuberculosis of the pelvic organs and gonorrhea;
Chemical - develops as a result of the use of chemicals during douching, etc.;
Burn – caused by cauterization procedures performed incorrectly.

A true ulcerative defect lasts a relatively short time, then ectopia develops. There are several types of false flow:

Papillary – papillary erosions grow on the surface of the mucous membrane;
Glandular – has glandular cysts and ducts;
Mixed - combines both of the above types.

Most often, doctors diagnose minor erosion (false). It is easily cured and is clearly visible when examined with a mirror. Major erosion of the cervix is observed less frequently. It looks like a red spot located on the light mucous membrane.

If the cervix is severely eroded, laser therapy is used, which gives good results. Small erosion often goes away on its own, in cases where a gynecologist diagnoses pseudo-erosion.

Stages of disease development

Pathology develops in several stages. Since the congenital type is formed in the womb, we will consider the process of development of cervical erosion of the true and false types. At the very beginning of ectopia, erosive glands are formed, which slowly progress over several years.

Sometimes papillary growths appear on the affected areas. After the inflammation subsides, the cells are replaced by epithelium. In cases where the pathology progresses, the secretion blocks the erosive glands and cysts appear. The danger lies in their infection, which increases inflammation.

Stages of true cervical erosion:

The inflammatory process lasts about two weeks. The cervix is attacked by pathogenic microorganisms, as a result of which leukocytes are activated, swelling, purulent or serous fluid appears.
The appearance of a wound surface. At this stage, wounds are formed that do not heal for a long time.
Ectopia - lack of therapy leads to improper healing of ulcers. They are covered with cells of the cervical canal.

If you “close your eyes” and do not treat, ectopia and the accompanying inflammatory process will lead to dysplasia, which develops and develops into oncology.

Causes

Erosion occurs under the influence of internal and external factors. Doctors have different opinions on this matter.

What causes the pathology will be discussed below. the following:

Hormonal imbalance;
Heredity;
Decreased immunity;
Sexual infection, especially papillomavirus (HPV);
Too early birth and onset of sexual activity;
Injuries;
Diseases of the genitourinary system;
Diseases caused by viruses and bacteria;
Improper hygiene;
Frequent change of partners;
Inflammation in the uterus.

Sometimes erosion appears in young girls without any reason and disappears on its own. Some types of pathology arise due to infectious inflammation.

Diagnostics

Since erosion is asymptomatic, diagnosis usually occurs by chance. A gynecologist can easily determine the disease during examination using a mirror. To finally confirm the diagnosis and determine the type, the specialist prescribes additional studies:

Microflora smear.
Extended colposcopy.
Tests to detect infections.
Cell research.
Chromium for syphilis, HIV, hepatitis.
Bac sowing.
If cancer is suspected, a biopsy is taken.

True erosion looks like a bright red spot that bleeds a little when touched. The false one is less colored, often looks different and can be localized not only around the external pharynx, but also close to it.

Symptoms

The clinical picture rarely manifests itself, but some women go to the doctor with complaints such as bleeding, not related to the menstrual cycle. The patient may be bothered by purulent discharge and pain during sex. This is due to the addition of an infectious disease.

Advanced erosion can cause vaginal bleeding, indicating multiple gynecological problems. Often a woman is tormented by intense mucous discharge, which bothers her with true erosion of the uterus. Some symptoms can be confused with thrush, threatened miscarriage, etc.

Treatment methods

Therapy is determined depending on the stage of the pathology, its type and size, as well as the presence of concomitant diseases. requires lifelong monitoring; as a rule, it soon disappears on its own.

The true form must be treated with surgery; the operation is performed after conservative therapy. How to treat the pathology and what to do first is determined by the doctor individually for each patient.

Conservative therapy

Drug treatment is prescribed for concomitant inflammatory or infectious diseases. First of all, the doctor must eliminate the cause of the pathology. Antibiotics, anti-inflammatory drugs, traditional recipes and immunomodulators are prescribed.

The cervix is treated with special drugs that cause coagulation of the affected areas. Medicines contain acetic or nitric acid intended for the treatment of benign tumors. The drugs are mainly prescribed to nulliparous girls, since no scars remain after treatment. The main disadvantage of therapy is a possible relapse, but the advantage is that it is used for any type of erosion.

Radio wave method

The process uses high energy radio waves to treat the affected area without putting any pressure on the tissue, which prevents damage. painless, does not cause burns, since water molecules are “evaporated” from the cells, without thermal effect.

The radio wave method is not traumatic, the occurrence of burns, abrasions, crusts, pus, scars, etc. is excluded. This allows the treated surface to heal faster, and thanks to the use of a conizer (a special gynecological instrument), the structure of the uterus is preserved.

During the procedure, patients do not feel pain or discomfort. Radio waves do not damage neighboring tissues, so healing occurs quickly - 3-5 weeks.

The method involves cauterization of cervical erosion with high-frequency current using electrode touches. After the electrode cauterizes all areas one by one, a scab (large crust) appears on these areas. Under the scab there is a wound surface that is covered with healthy tissue.

This therapy is used more often than others.

Burning out erosion in women is quite painful, and scars also remain, so electric current is indicated for women who have given birth and who are no longer planning a pregnancy.

The treated surface heals in 8-10 weeks.

Cryodestruction

Freezing with liquid nitrogen allows the water contained in the cells to crystallize, which leads to the destruction of the cellular structure of the affected area. The method is prescribed to nulliparous girls, since scars do not form after the procedure.

Therapy requires careful monitoring; in some cases, the surface layer of cells is destroyed. The treated area heals within 8-10 weeks.

You can read more about the treatment methods described above, as well as about , in the article by clicking on the previous link.

At the initial stage, cervical erosion can be treated using traditional recipes. Most often, sea buckthorn oil, propolis, and copper sulfate are used for this purpose.

It has been used for a long time, the woman independently performs treatment without discomfort or pain. The oil is used to moisten tampons, which are placed overnight every day and removed in the morning. Treatment lasts up to 2 months in the first half of the menstrual cycle, immediately after menstruation stops. Therapy is carried out every two weeks of the month.

Copper sulfate has also proven itself well, with the help of which a solution for douching is prepared. To prepare, you need to take 1 tablespoon of burnt alum and copper sulfate, ground into powder. The mixture is mixed well and boiled for 5 minutes over low heat. After the broth has cooled, it is filtered, poured into a dark bottle, closed with a lid and sent to the refrigerator.

Lasts 10 days. 1 tbsp. the liquid is diluted in a liter of boiled water, cooled and inserted into the vagina at night, after menstruation ends.

Propolis helps well with erosion. An ointment is prepared from it for wetting tampons.

Preparation:

You need to take 100 grams of Vaseline (medical), bring it to a boil, cool a little and add 10 g of propolis. The resulting mixture is heated again (to about 80 degrees), stirred constantly for several minutes. The resulting ointment is passed through cheesecloth, cooled, transferred to a dark jar, and closed with a lid. A tampon is soaked in the ointment and inserted into the vagina, then removed after 10 hours. The procedure must be repeated every day for 2 weeks.
Grind 10 g of propolis, melt in a water bath, add 100 g of butter and grind well. A tampon is soaked in the mixture and injected overnight. During the day, it is advisable to douche with chamomile infusion. The course of therapy is 10-12 days.

It is important to understand that folk recipes do not provide a 100% guarantee. They can be used as an adjuvant treatment, especially if a hormonal disorder or infectious disease is present.

Consequences

If cervical erosion is treated in time, there will be no negative consequences in the future.

Mild forms of pathology are rare, so therapy is necessary in any case.

The presence of erosion supports inflammation, which soon spreads to nearby structures. Often there is fibroid, which is more difficult to remove, dysplasia or endometriosis.

The most considered pathology is with atypical changes. Usually ulcers do not cause cancer, but if they are not treated, parallel diseases occur that provoke cervical cancer.

What is prohibited

Some factors cause relapse or contribute to the progression of the disease. If you exclude them, recovery occurs much faster, preventing future relapses.

Contraindications for cervical erosion:

Drinking alcohol, fast food and smoking;
Visiting the sauna and steam bath if there is bleeding;
Twisting the hoop during bleeding;
Strength training and bodybuilding;
Professional sports.

The above restrictions will help to avoid erosion or its re-development after successful treatment.

Prevention of cervical erosion is simple; nothing extraordinary needs to be done. Make it a rule to regularly visit a gynecologist and maintain personal hygiene. Every woman should take a hygienic shower 2 times a day, especially during menstruation.

It is important to change your attitude towards your lifestyle; it is recommended:

Have regular sex life;
Use condoms if your partner is not permanent;
Use protection if pregnancy is not planned. Abortions injure the genitals, which can cause erosion.
Avoid casual relationships.

Preventing erosion is not easy, since the exact cause is unknown. If gynecological diseases are neglected, the risk increases significantly.

It is important to visit a gynecologist on time, then the disease will be quickly diagnosed and it will be much easier to treat.

Can a virgin have erosion?

As in adult women, virgins may also have erosion, but not the true form, since it occurs when the epithelium is injured during exposure to a mechanical factor, for example, during childbirth.

In virgins, erosion occurs:

Congenital - present at a very young age, but often not detected due to too rare gynecological examinations. Most often, it can be detected after the start of active sexual life.
Pseudoerosion (ectopia) is a condition that does not require treatment until the age of 25-27 years, and is considered completely normal. Occurs due to hormonal changes in the body due to an increase in the hormone progesterone. It is this type of pathology that accounts for the largest percentage of young girls.

Treatment of virgins is carried out using exactly the same surgical methods, but always in the absence of inflammatory and infectious lesions. If the latter are present, their drug therapy with antibacterial and anti-inflammatory drugs is required.

After a woman has heard the sad diagnosis, the question arises: is erosion transmitted to a man? The answer is clear - no, it is impossible to infect a partner.

Cervical erosion is a purely female problem, and occurs only in the fair half. The only point is that you can only pass on to your partner the infection that provoked the pathology.

Women do not always realize that they have cervical diseases. Mild discomfort, minor changes in the nature of discharge usually do not cause much concern. The cause is suspected to be hypothermia or an infection that can be treated with douching. A woman most often learns about the occurrence of cervical erosion during a routine examination or when she consults a doctor with more serious gynecological problems. In fact, the first symptoms of this disease can be noticed on your own.

The cervical os (the area that opens into the vagina) is covered with a different type of epithelium, with flat cells. Erosion occurs precisely in this area and represents a violation of the structure of the mucous membranes.

Depending on the nature of the changes, two types of cervical erosion are distinguished

Pseudo-erosion, or ectopia

Caused by displacement of the columnar epithelium into the vaginal area of the cervix. The mucous membrane is not damaged. Pseudoerosion, as a rule, does not require treatment. This condition is congenital; the defect disappears on its own by about 20 years of age. Often, in this case, eversion of the cervical canal is observed, when its mucous membrane is on the outside. This is called "ectropion". It can also exist from birth, but it can also be acquired.

Pseudo-erosion is detected visually during a gynecological examination. A sign of ectopia is a red ring (may have an irregular shape) around the opening of the cervical canal. The width of the rim reaches several centimeters. The area of ectopia is clearly visible against the background of the surrounding pale pink surface of the vagina.

Usually, in order to make sure that this is pseudo-erosion, the pharynx area and surrounding tissues are covered with Lugol's solution (a mixture of iodine, potassium iodide and water). In this case, the surrounding tissues darken, and the ectopic area remains red.

Note: Pseudo-erosion often turns into true erosion when the cervix is exposed to factors that contribute to damage to the mucous membrane. This can even happen to a little girl if, due to poor care or infection, an inflammatory process occurs in the vagina.

Video: Detection of pseudo-erosion

True cervical erosion

If pseudo-erosion is mainly hormonal in nature, then true erosion, in addition, occurs as a result of mechanical damage to the mucous membrane of the cervix (during childbirth, surgery, sexual intercourse), as well as due to inflammatory processes in the vagina. In this case, the mucous membrane is damaged, ulcers, areas of inflammation, and crusts appear on it.

Signs of true uterine erosion are more pronounced than pseudo-erosions. When examined on the mirrors around the entrance to the cervical canal, you can see a red ring of regular shape, with a non-uniform surface. Lugol's solution does not color it.

Video: Ectopia and erosion of the cervix. What is the danger

Why is erosion dangerous?

The cervix acts as an obstacle to the penetration of pathogenic microorganisms into the uterine cavity. Thick mucus is produced here, which has an acidic environment that is detrimental to them.

As a result of cervical erosion, the glands that produce this mucus are damaged. The vaginal microflora contains opportunistic microbes, which under normal conditions do not cause harm to the body. But when the immune system is weakened and the acidity of the vagina is impaired, the infection easily penetrates into the internal organs. In this case, inflammatory processes occur in the endometrium, tubes, ovaries, which even results in infertility.

Damaged mucosa sometimes blocks the entrance to the cervical canal and makes it impossible for sperm to enter the uterus. As a result, conception becomes impossible.

Cervical erosion does not turn into cancer, but it prepares the ground for tissue degeneration. Chronic inflammatory processes lead to the appearance of scars, the formation of cystic cavities, and polyps. This makes it difficult to achieve pregnancy and increases the risk of miscarriage or premature birth. In addition, at the site of benign neoplasms, atypical and then cancer cells can appear. The risk of cancer is especially high when infected with the human papillomavirus.

Therefore, erosion must be treated to avoid such complications. First of all, it is necessary to get rid of the causes of its occurrence: infectious and inflammatory diseases.

Video: Symptoms of erosion. Treatment methods

Symptoms of true erosion

The first symptom indicating the presence of true erosion is the appearance of pain in a woman during sexual intercourse and bleeding after it. Minor blood impurities can also appear during physical stress, after lifting something heavy. Such discharge has nothing to do with menstruation; it occurs at any time between menstruation.

If the manifestation of signs of cervical erosion is associated with inflammatory diseases of the vagina and cervix (colpitis, cervicitis), then their manifestations force the woman to immediately go to the doctor, as the following symptoms appear:

abundant liquid discharge, colored green, yellow, which, as a rule, has an unpleasant odor;
aching pain in the lower abdomen, lower back;
feeling of pain during urination, sexual intercourse.

When the inflammatory process spreads to the uterus and appendages, the symptoms will be even more pronounced. A woman experiences menstrual irregularities, spotting brown discharge appears before and after menstruation, and a possible increase in temperature.

Erosion can occur against the background of sexually transmitted infectious diseases. Each of them has its own characteristic symptoms (foamy or curdled discharge with a characteristic odor, color, purulent impurities).

Signs of cervical erosion appear with vaginal dysbiosis (occurs due to taking antibiotics, frequent douching using bactericidal substances that kill beneficial microflora, in other cases).

Symptoms of such ailments can appear in both women who have not given birth and those who have children. The difference lies in the approach to treatment. For nulliparous patients, the ulcerated area is not cauterized, since scarring is highly undesirable if the woman intends to subsequently have children. During childbirth, the cervix will not be able to stretch normally.

Erosion during pregnancy

If, while planning a pregnancy, a woman undergoes a gynecological examination and cervical erosion is detected, then the doctor determines the need for treatment individually. In the absence of a threat of infertility and symptoms of inflammatory and infectious diseases, the condition is simply controlled.

If erosion is detected in a pregnant woman, then treatment is also carried out after childbirth, since the disease does not affect the course of pregnancy and the condition of the fetus. Symptoms of erosion in a pregnant woman may include blood in the discharge, as well as burning and itching during sexual intercourse. Damage and thinning of the cervical mucosa causes rupture during childbirth. In some cases, after the birth of the child, signs of erosion disappear. If this does not happen, the symptoms of erosion intensify, then it is usually cauterized to prevent complications.

Erosion during menopause

One of the most important factors influencing the condition of the mucous membranes of the genital organs, including the uterus, is the ratio of sex hormones. In women of reproductive age, hormonal processes in the body occur with maximum activity, which is why disruption of the epithelium occurs most often.

With the onset of menopause, the production of estrogen and progesterone in the body gradually decreases, so erosion does not occur. Chronic erosion that existed before disappears with the onset of menopause.

Diagnosis of erosion

If, upon examination, a woman is found to have redness of the vaginal mucosa, then additional methods are used to confirm the diagnosis. First of all, a smear is taken. It is examined for the presence of infectious agents. A culture is done to check for the presence of opportunistic bacteria.

To detect signs of erosion, the area of the uterus that extends into the vagina is examined using a colposcope. A blood test is carried out to detect pathogens of syphilis, HIV and other hidden infections. If erosion recurs, the affected tissue is examined by biopsy.