Classification of cervical erosion
Cervical erosion is one of the local features of chronic cervicitis, and clinicians have long regarded chronic cervicitis and cervical erosion as synonymous, but cervical erosion is classified into the following types according to their different pathological processes.
1. Pseudo-erosion: The pathological concept of celiac disease is the “shedding of the surface epithelium”, while the common cervical erosion in clinical work is mostly the red area around the external cervical opening. During colposcopy, after applying 3% acetic acid to the surface of the red area, a “grape bunch” change can be seen locally in the red area, which is caused by columnar epithelial edema. If the area is biopsied, the surface is covered with columnar epithelium under the microscope. Therefore, if we strictly follow the pathological definition of celiac disease, this is not celiac disease, so it is suggested that it is called pseudo-erosion. Most of the cervical erosions seen in clinical work are of this kind. Chen Ming, Department of Gynecology, General Hospital of Jinan Military Region
2, true erosion: because the surface of the cervix is often covered with more mucus or purulent secretions, these secretions stimulate and impregnate the squamous epithelium around the ectocervix for a long time, plus the inflammatory infiltration of the deep tissue of the cervix, so that the squamous epithelium covering the surface of the cervix loses its vitality and falls off, forming an ulcer, which is true erosion. However, this erosion surface is soon covered by its surrounding columnar epithelium, forming a red area with a granular, somewhat shiny surface, i.e. pseudo-erosion. Most of the cervical erosions that we find in our daily work are pseudo-erosions, and true erosions are only a brief stage in this lesion process, the regression of which will be the surface covered by columnar epithelium and become pseudo-erosions.
The external features of cervical erosion vary greatly depending on the degree of lesion. In clinical work, the type with slow growth of columnar epithelium on the surface of the cervix, covered only by a more normal single layer of columnar epithelium, with a flat appearance and a flushed, smooth surface, is often referred to as simple celiac disease. If the columnar epithelium grows rapidly and grows towards the interstitium, forming glandular hyperplasia and expansion, with a fine granular surface to the naked eye, it is called granular erosion, or follicular erosion. If interstitial hyperplasia is evident and many small projections or grooves form on the surface of the cervix and the surface is uneven to the naked eye, this type of erosion is called papillary erosion.
The above classification method is based on the pathological concept of celiac disease. As mentioned before, there are many causes of cervical erosion, in addition to trauma causing tearing of the cervical mucosa, secondary bacterial infection leading to epithelial shedding and formation of erosion, and also endocrine changes in the body, so some people also classify this type of erosion as congenital erosion and acquired erosion.
3, congenital celiac disease: during fetal development, the epithelium of the genital tract, except for the vaginal epithelium, originates from the epithelium of the body cavity. When the embryo develops to the 3rd or 4th month, the cylindrical epithelium in the cervical canal and the squamous epithelium on the surface of the vaginal part of the cervix can be clearly distinguished, and at this time the junction of the two types of epithelium is not at the uterine orifice, but is located in the cervical canal. By the time the embryo reaches the 6th – 7th month of development, the columnar epithelium of the cervix has acquired a secretory function.
In late gestation, these columnar epithelia are affected by maternal estrogen and the columnar epithelium of the cervical mucosa proliferates and begins to grow outward and beyond the cervical orifice, so that in newborn female infants about 1/3 of the cervix resembles the appearance of adult cervical erosion. Since there is no laceration, infection and other factors that form cervical erosion at this time, this erosion is called congenital erosion. After birth, the influence of estrogen from the mother gradually subsides, and this erosion in newborn baby girls also subsides on its own.
4, Acquired celiac disease: Acquired celiac disease is the opposite of congenital celiac disease, which occurs in women of childbearing age with strong ovarian function, where the cervical canal columnar epithelium is affected by estrogen produced by the ovaries and becomes overproliferated beyond the cervical ectocervix, thus making the cervical ectocervix celiac-like. The appearance of this type of celiac disease is no different from that of inflammation-induced celiac disease, except that the cause of the celiac disease is different. This type of erosion is most often seen during pregnancy and most of them subside on their own after delivery. The clinical presentation varies more or less due to the different causes. The leucorrhea of these patients also increases, but it is clear and mucus-like in nature, clinging to the surface of the cervix and not easily wiped off. On pathological examination there is no inflammatory cell infiltration under the columnar epithelium, but rather glandular and interstitial hyperplasia. This means that this kind of celiac disease may have some connection with endocrine changes, while it does not seem to be directly related to inflammation. Of course it is easy to develop inflammatory infections secondary to celiac disease, but this inflammatory manifestation is only the result and not the cause of celiac disease.
Causes and treatment of cervical erosion
Celiac disease is not an independent disease, but a manifestation of chronic cervicitis. It is called celiac disease, but in fact, it is not celiac disease, but a phenomenon in which the epidermis of the ectocervix is shed and replaced by another type of epithelial tissue, much like true celiac disease, hence the name.
Once celiac disease occurs, there is often increased and thicker leucorrhea, sometimes with an abnormal odor, and occasionally purulent or bloody leucorrhea. Low back pain, abdominal pain, and a feeling of abdominal swelling are also common. Also, contact bleeding may occur during sexual intercourse.
Causes of celiac disease formation
There is a relationship between celiac disease and sexual life, and it is very important to remind you that although celiac disease is more common in married women. However, it does not mean that unmarried women are free from the possibility of celiac disease. In addition to childbirth, miscarriage, infection, and surgical operations that can cause celiac disease, having sex can also damage the cervix to some degree, which can cause symptoms to appear.
Some women are very hygienic, but lack the necessary knowledge and often douche their vagina with a larger concentration of cleaning solution, which often backfires. This not only affects the growth of the normal vaginal flora and reduces its ability to inhibit pathogenic bacteria, but can also cause various degrees of damage to the epithelium of the cervix, leading to erosion.
Disease Profile
The erosion surface of the cervix is well defined from the surrounding normal squamous epithelium. It is often clinically classified as light (Ⅰ°), medium (Ⅱ°) and heavy (Ⅲ°) according to the area of erosion. The cervical mucous membrane at the cervix has a slow growth of columnar epithelium with flat epithelium and a smooth appearance due to different degrees of inflammatory stimulation, which is simple erosion; columnar epithelium grows fast and forms glandular hyperplasia when it is adenoidal erosion. If the glandular expansion can be follicular erosion, with interstitial hyperplasia, forming small protrusions, covered with columnar epithelium is uneven, then the formation of papillary erosion. These types can often occur in combination. Cervical erosion is the most common type of gynecological disease.
Causes
The causes include mechanical irritation or injury, such as sexual intercourse, abortion and childbirth lacerations and bacterial attack causing cervicitis;
Pathogenic attack, commonly septic bacteria such as Staphylococcus, Streptococcus, Neisseria gonorrhoeae, Mycobacterium tuberculosis, viruses, actinomycetes, trichomonas, and amoebae can cause cervicitis.
Symptoms
The main symptom is increased leucorrhea, often purulent. There may be lower abdominal and lumbosacral cramping and bladder irritation symptoms; patients with heavy erosion surface may be accompanied by varying degrees of light bloody discharge, typically after sexual intercourse with bloody discharge, cervical sticky purulent discharge, unfavorable sperm passage, resulting in infertility.
Examination
The diagnosis is not difficult according to clinical manifestations, but it should be noted that cervical erosion and cervical intraepithelial neoplasia or early cervical cancer are difficult to distinguish from each other in terms of appearance, so cervical scraping; cervical canal aspiration, colposcopy and biopsy should be routinely performed to clarify the diagnosis.
The erosion surface of the cervix has clear boundaries with the surrounding normal squamous epithelium. It is often clinically classified as light (Ⅰ°), moderate (Ⅱ°) and severe (Ⅲ°) according to the area of erosion. Where the area of erosion accounts for 1/3 of the total area of the cervix is mild cervical erosion. Those who have 1/2 of the total area of the cervix are considered to have moderate cervical erosion. Those with more than 1/2 of the total area of the cervix are considered to have severe cervical erosion.
Treatment
(1) medication: for small erosion surface, inflammation infiltration is relatively shallow can be used the following drug treatment methods: can use a combination of Chinese and Western medicine drugs – the United Kingdom’s Ximeiyan gynecological antibacterial gel to carry out treatment.
①10-20% silver nitrate: topical application, once a week, 2-4 times for a course of treatment.
②Potassium permanganate: localized after menstruation and repeated once after 1 to 2 months. When using the above drugs, be careful to prevent burns on the surrounding vaginal wall, and pay attention to disinfection when using the drugs to prevent repeated infections.
(2) Physiotherapy: for cervical erosion with larger erosion area and deeper inflammatory infiltration.
1, radiofrequency treatment: with special instruments, the erosion surface tissue will be cauterized after the necrosis to fall off, and to a certain depth, so that the treatment effect is good.
2, LEEP treatment: also called cervical circumferential electrosurgery, for the erosion area is large and the cervical cytology examination has abnormalities, this procedure is feasible, outpatient can be operated.
3.Surgical treatment: For those who are invalidated by drugs and physical therapy, have deeper or larger cervical erosion, or have cervical hypertrophy or suspected cancer, conical hysterectomy or total hysterectomy can be considered.
Hazards of cervical erosion
I. Causes infertility.
When cervical erosion occurs, especially moderate and severe cervical erosion, the cervical secretion will increase significantly, with a sticky texture and a large number of white blood cells, which can phagocytose sperm and adversely affect sperm motility, preventing sperm from entering the uterine cavity and affecting conception.
The physical and chemical properties of the cervical mucus are significantly changed, containing more white blood cells and the PH value of the mucus is alkaline. When sperm pass through the cervix, not only the inflammatory microenvironment of the cervix decreases the vitality of sperm, the sticky secretion makes it difficult for sperm to pass, the toxic effect of inflammatory secretion on sperm makes sperm consume too much energy and have a shorter life span, but also a large number of sperm are engulfed by inflammatory cells and destroyed by bacteria and their toxins, among which E. coli also has a strong agglutinating effect on sperm, causing sperm to lose vitality. In addition, some of the patients with celiac disease often have a combination of endocrine dysfunction. These increase their difficulty in conceiving. Thus, it is important to actively treat celiac disease in order to avoid getting infertility.
II. Causes complications.
When you have cervical erosion, it can cause inflammation in other organs, such as: the pathogen of cervical erosion can cause endometritis upstream; it can cause chronic pelvic inflammation by spreading through the parametrial ligament and lymphatic vessels; when the inflammation spreads to the bladder triangle, it can cause urinary system diseases and irritating symptoms such as painful urination, frequent urination or difficulty in urination.
Third, it can lead to more in-depth lesions.
Due to the long-term stimulation of chronic inflammation, it can cause polyps, fissures, ectopia and cysts and other deeper pathologies.
IV. Carcinogenesis.
The incidence of cervical cancer in women with cervical erosion is nearly ten times higher than that of the general population. Under the stimulation of long-term chronic inflammation, atypical hyperplasia can occur in the columnar epithelium of cervical canal hyperplasia, which will gradually develop in the direction of cervical precancerous lesions if not treated in time and correctly, because cervical erosion is often combined with HPV infection, which is one of the suspicious signals causing cervical cancer, and this development process usually takes 5 This process usually takes 5 -10 years.
Prevention methods of cervical erosion
1.Keep your spirit happy and strengthen your ability to resist diseases.
2, good contraceptive birth control: from the pain and trauma of abortion and scraping.
3, keep the vulva clean: no infection, do not use a variety of douches, so as not to destroy the natural protective barrier of the vagina, so that the more you wash, the more annoying.
4. Keeping a happy mood is also a good way to boost your immunity. In addition, your normal routine should be normal so that your immune system can function properly.
What is the examination of cervical erosion?
1. Gynecological examination: focus on the size, shape, texture, thickness of the cervical canal, whether there is contact bleeding, followed by examination of the vulva, vagina, uterus and parametrial tissues such as ovaries, fallopian tubes, pelvic lymph nodes, etc.
2.Cervical scraping cytological examination is a routine gynecological examination, which is easy to perform and economical, and is the most important auxiliary examination and the first screening method for cancer screening.
Colposcopy can quickly detect lesions invisible to the naked eye, and taking biopsy of suspicious parts during colposcopy can significantly increase the accuracy rate of biopsy.
4. The iodine test and visual observation methods are simple and inexpensive and can detect at least 2/3 of lesions. Currently, the World Health Organization (WHO) recommends the use of visual observation in developing countries. As a primary screening method for cervical cancer, the cervical epithelium is smear with 3%-5% acetic acid solution. The reaction of cervical epithelium to acetic acid is observed, and then biopsy is taken in the white lesion area.
5. Pathological examination of cervical biopsy is the basis to confirm the diagnosis of cervical cancer.
Why cervical erosion does not heal repeatedly
1, older age: According to statistics, women under 30 years old have a lower recurrence rate after treatment of cervical erosion; women over 30 years old have a higher recurrence rate.
2, heavier lesions: the larger the area of cervical erosion, the higher the recurrence rate after treatment. Women with mild and moderate cervical erosion have a higher cure rate and a low recurrence rate; women with severe cervical erosion have a lower cure rate and a subsequent higher recurrence rate.
3, cervical erosion treatment is not complete: in the laser, electric scalding or microwave physical therapy, if the treatment is too superficial or too limited in scope, failure to completely destroy the lesion tissue at the erosion, so that the lesion tissue residue, can cause recurrence.
4. Repeated abortions: The cervix is damaged during abortions. If you have repeated abortions, the cervix is damaged many times, which is one of the reasons for recurrence of cervical erosion after treatment.
5, suffer from sexually transmitted diseases: our patients with sexually transmitted diseases are increasing year by year, such as gonorrhea, reproductive tract chlamydia infection, condyloma acuminata, etc. These pathogens can invade the epithelial cells of the cervix, causing cervical inflammation and leading to cervical erosion.
6, local immunity abnormal: It is believed that the sperm of each sexual partner and the bacteria brought in during sexual intercourse will play a specific immune invasive role. The ability of the local immune response of the cervix increases in proportion to the increase in the number of sexual partners. In other words, women who have sex outside of marriage or too many sexual partners can also contribute to the recurrence of cervical erosion after treatment.