Celiac disease used to be a condition that plagued many women, and when they went for a physical exam, almost nine times out of ten they would be diagnosed with celiac disease. To talk about celiac disease, it may still be necessary to start with the education of doctors. In the unified textbook for Chinese medical students, in Obstetrics and Gynecology until 2008, celiac disease was always present as a standard disease, and even talked about its clinical presentation, diagnosis and treatment. But in reality, that was a misconception. Obstetrics and gynecology in China has been out of step with international practice for many years. In the past, obstetricians and gynecologists treated the cervical epithelial ectropion during the physiological phase of the cervix as a pathological phenomenon and diagnosed it. In 2008, the 7th edition of the textbook of Obstetrics and Gynecology for undergraduate students clearly stated in its preface that it should be in line with international standards and pay attention to the updating of knowledge …… to constantly update clinical diagnostic and therapeutic standards. For example, the name of “cervical erosion” was abolished and replaced by the physiological phenomenon of “cervical columnar epithelial ectasia”. So from that time on, the diagnosis of “cervical erosion” should be abolished in China, but due to the slow updating of knowledge of many physicians, even 5 years after the revision of this diagnosis in undergraduate textbooks, there are still many physicians who are diagnosing “cervical erosion”. Celiac disease, in the end, is actually a misconception of a normal manifestation of the cervix in the past. The pathophysiological mechanism Well, let’s talk about why celiac disease was wrongly considered an abnormal disease in the past. The normal figure 1 is a coronal view of the connection between the human uterus and the vagina. If you do a gynecological examination, the part that the doctor can see from inside the vagina is the yellow part, which is the appearance of the cervix (Figure 3). In the area of the cervix, there are two different types of cells, as shown in Figure 2, the squamous cell near the vagina and the columnar cell near the uterus. The appearance of the two types of epithelium is different, as seen in Figure 3 below, which shows the appearance of the cervix under gynecological examination. In the central part, the part of the cervix that looks a little bit like “erosion” is covered by columnar epithelium, while the outer part of the cervix, which is relatively smooth, is covered by squamous epithelium. This area is medically named as “squamous junction zone”, which is also a good area for cervical cancer (cervical cancer and cervical erosion are not necessarily correlated, as explained below). The squamocolumnar junction zone is susceptible to estrogenic influences. Before puberty, when ovarian function is not perfect and estrogen is low, the columnar epithelium is more medial, after menstruation, the columnar epithelium is influenced by estrogen and develops more laterally, so there is more columnar epithelium like “celiac disease” found at the cervical opening during examination. The woman’s estrogen level drops, the columnar epithelium starts to retreat inward again, so the “vesicles” will be invisible at the time of the examination. So, essentially, what is called cervical ectropion is actually cervical epithelial ectropion. In the past medical textbooks, there was also a so-called graded diagnosis of cervical ectropion, called mild, moderate and severe, see Figure 4, where the size of the extent was considered to be the degree of inflammation, with less than 1/3 of the area being mild, 1/3-2/3 being moderate and more than 2/3 being severe. If you understand the real mechanism of the so-called “cervical erosion” that I mentioned earlier, it is well understood that this is actually a different degree of columnar epithelial ectropion after being affected by estrogen, which is a normal physiological phenomenon. Figure 4 Cervical non-erosion, it is just a different degree of columnar epithelial ectropion Clinical manifestations Normal physiological phenomena, no specific clinical manifestations. Some people may have contact bleeding, but it is only an individual variation of the cervix, just like some people chew something hard and have some blood coming out of their teeth or mouth, which is understandable. Here we need to mention cervicitis, if there is an increase in leucorrhea, yellowing and odor, these are the manifestations of cervical inflammation, which is a symptom that appears after the infection on the cervix. The cervical cyst and hypertrophy are also the result of chronic inflammation of the cervix. If you understand what has been said, it is easy to understand that the so-called “cervical erosion” is actually a normal physiological phenomenon that does not require any treatment, and that the many treatments for cervical erosion that are now available on the Internet are wrong. Also by the way, for symptomatic cervicitis, treatment is needed. The specific treatment method needs to be determined by different hospitals, but usually, acute inflammation can be treated with suppository medication, while chronic inflammation can be treated with physical therapy methods such as laser or freezing. Do you need regular checkups? Regular checkups of the cervix are necessary, this is not to prevent cervical erosion, but to prevent cervical cancer. Can cancer develop without treatment Cervical cancer is related to human papillomavirus (HPV) infection. Some so-called high-risk HPV types of HPV are prone to precancerous lesions and cervical cancer when they persist in the squamocolumnar junction zone of the cervix. Cervical cancer has seen a substantial decrease in mortality since the availability of cervical smears, and the key is early prevention and treatment. Currently, it is recommended that women after the age of 21 should have a cervical smear once a year, and after the age of 30, they can be combined with HPV screening. If three consecutive HPV and cervical smear tests are negative, the interval can be extended to once every three years, and screening can be stopped after the age of 65. Does it have an effect on fertility Understanding that celiac disease is a physiological phenomenon means that it will not have an effect on fertility.