Recently, a friend who is planning to get pregnant asked me: I am planning to have a baby and went to the hospital for a preconception test, but the doctor told me that I have severe celiac disease, I am worried, I am 33 years old, I want to ask, should I treat the celiac disease first or get pregnant first? This user’s question is actually quite common. Simple celiac disease is not terrible and does not affect pregnancy, but severe celiac disease is indeed one of the causes of infertility. Here, let’s start with the concept of celiac disease. First, let’s talk about what is celiac disease? Let’s take a picture and compare it to get a visual understanding of celiac disease. The picture below shows the normal cervix as seen under the vaginal speculum (with a little bit of bloody discharge from the uterine cavity on the surface): the normal surface of the cervix is smooth, pink or a little bit whitish in color, with no redness. In contrast, cervical erosion is characterized by redness of the surface of the cervix, and sometimes the red areas show raised fine particles, as can be seen in the two pictures below, the one on the left has a smaller erosion surface, while the one on the right has an erosion surface that occupies the entire surface of the cervix, indicating that the degree of erosion is a bit heavier. After having a visual understanding of celiac disease, let’s take a look at how it is caused, what the dangers are, how to treat it, whether you can get pregnant and so on. Celiac disease is actually a manifestation of chronic cervicitis. The current belief is that celiac disease is still related to sexual life, especially frequent and unclean sexual life. The normal surface of the cervix is smooth and slightly white compared to flesh colored. When men and women have sex, the tip of the penis, the glans, hits the surface of the cervix, causing a transient break in the epithelium of the surface of the cervix, and at this time, if you suspend sex for a few days, the broken epithelium of the surface of the cervix will quickly proliferate and repair itself. However, if you have frequent sex every day, every day, which causes the cervical surface epithelium to be too late to repair, if there happens to be some pathogenic bacteria in the vagina or glans circumcision at this time, the pathogenic bacteria can infect the damaged cervical surface epithelium, resulting in acute inflammation of the cervical surface epithelium, and over time, it becomes a fine granular red area. Therefore, in China, cervical erosion is often considered to be a manifestation of chronic cervicitis. Currently, the term cervical erosion has been discarded in Western countries in favor of the term cervical columnar epithelial ectasia, and is considered not a pathological change but one of the physiological changes of the cervix. However, for many years in our country, it is still considered as pathological inflammatory erosion of the cervix, and only in some physiological situations such as adolescent and pregnant women, when the columnar epithelium of the cervical canal proliferates and moves out due to increased estrogen levels, it is considered as cervical pseudo-erosion, while the majority of cervical erosions are still considered as inflammatory erosions of the cervix. Cervical erosion can be divided into 3 degrees according to the size of the erosion area: mild erosion (degree I) means that the erosion surface is less than 1/3 of the entire cervical area; moderate erosion (degree II) is 1/3 to 2/3; and severe erosion (degree III) means that the erosion surface is greater than 2/3 of the entire cervical area. as shown in the figure below: So, some friends are asking, the diagnosis of cervical erosion requires professional gynecological examination equipment such as a vaginal speculum or colposcope. Is there an easy way to make a preliminary judgment if we usually do not go to the hospital for examination? In fact, since cervical erosion belongs to chronic cervicitis, the various manifestations of chronic cervicitis, such as: increased vaginal discharge, discharge in the form of milky white mucus, sometimes yellowish pus, or bloody leucorrhea, or bleeding after intercourse, or even frequent and urgent urination, lumbosacral soreness, lower abdominal cramping, and weakness of the lower limbs are all manifestations of different degrees of cervical erosion (chronic cervicitis). Let’s go back to the question at the beginning of this article, can I have a successful pregnancy with celiac disease? In fact, as long as couples have sex, they all have some degree of celiac disease. Here is a little common knowledge that condom use should reduce the occurrence of celiac disease, probably because condoms prevent the contamination of the epithelium on the surface of the cervix by the foreskin in the coronal groove of the glans penis. Going back to the previous question, since celiac disease is so common in married women, and the vast majority of married women are able to conceive and have children without any problems, does that mean that celiac disease does not affect pregnancy? The answer is no. If celiac disease is very mild, of course, it will not affect pregnancy, but if it is heavy, there is a sticky purulent discharge in the vagina, on the surface of the cervix, and in the cervical canal, which is very unfavorable for sperm to pass through and can certainly cause infertility. Even the purulent leucorrhea can kill the sperm in the semen, which is very harmful. I have a very profound example to tell you about this point. It was 15 years ago, I had just joined the workforce, and one of my sister’s close friends was in a hurry to get pregnant, but after more than 1 year of marriage, she couldn’t get pregnant. When I heard that my best friend’s brother was working in a hospital in Beijing, I rushed to Beijing from Heilongjiang to see infertility. Infertility is not easy to treat, especially because the cause is not easy to find, which I knew when I was in college. For this reason, I found our director. After the director’s examination, he said: smelly leukorrhea, bad cleanliness, and severe cervical erosion. It was considered that purulent leukorrhea due to severe cervical erosion was the main cause of infertility. So, the patient was prescribed metronidazole tablets for oral use and metronidazole suppositories for vaginal use. Soon, the sister who returned to Heilongjiang got pregnant successfully, and the problem that had plagued her couple for more than a year was solved so simply. This incident is also a deep touch for me, the sister in the local hospital to see a number of fertility specialist, but who would have thought that it is a small celiac disease in the trouble. In fact, the above example, we can already know that celiac disease is actually not terrible, you can treat the celiac disease first before getting pregnant, here the treatment, recommended vaginal or oral medication, at the same time, during the treatment period, forbidden to have intercourse, after the treatment, if you want to get pregnant, it is also recommended to have intercourse around the ovulation period. The number and frequency of intercourse should be reduced and condoms should be used. Cervical physiotherapy is not recommended. If there is no intention to get pregnant in the near future and the cervical erosion is severe, you can consider cervical physiotherapy, such as laser, freezing, infrared coagulation, microwave, etc. The principle is to destroy the epithelium of the cervical erosion surface by various physical methods, so that it will be covered by new epithelium after necrosis and shedding, and it will take 1 month for the wound to heal. I suggest that if you want to have physical treatment for celiac disease, you must choose a public hospital obstetrics and gynecology department for treatment. This is because I know from the mouths of my patients who consult me that too many private hospitals, in order to generate revenue, give infrared spectrum treatment for mild cervical erosion, and individual patients have chronic pelvic inflammation, contracture of the ectocervix, adhesion of the cervical canal, and eventually infertility in young patients due to the irregularity of cervical physical therapy, and such things are really alarming. Last but not least, it is very important to mention that it is difficult to distinguish cervical erosion from cervical intraepithelial neoplasia (i.e. cervical precancerous lesions, CIN grade I, II, III) or early cervical cancer from its appearance, so every woman of childbearing age, or women with cervical erosion, is recommended to have regular cervical TCT and, if necessary, colposcopy and biopsy for a clear diagnosis. Especially for women who are planning to get pregnant, TCT is an indispensable part of the preconception examination.
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