I often get patients with colposcopy pictures asking me, “Doctor, I have cervical erosion, is it very serious? Nowadays, it is said that “celiac disease” is not a disease, so does it mean that all celiac disease does not need to be treated? What is celiac disease? Celiac disease was once a disease that plagued many women, and nine out of ten patients who visited the clinic were diagnosed with celiac disease. There is now a consensus in China and abroad that most of what used to be called “cervical erosion” is actually caused by ectopic cervical columnar epithelium. The ectopic cervical columnar epithelium refers to the outward migration of the columnar epithelium of the cervical canal to the vaginal part of the cervix due to estrogen in women during their childbearing years and pregnancy. What really needs to be treated? In addition to physiological columnar epithelial ectopia, some gynecological diseases such as cervicitis, cervical intraepithelial lesions, and even early cervical cancer can also manifest as cervical erosion-like changes. 1, cervicitis Cervicitis is one of the common diseases in gynecology. Clinically, it mainly manifests as increased leucorrhea, yellowish or purulent, and bleeding after sexual intercourse. Gynecological examination may show cervical congestion, edema, or cervical erosion-like changes. Routine leucorrhea examination, cervical Chlamydia trachomatis, cervical gonococcus and other inflammatory tests, liquid-based cytology, HPV testing and, if necessary, colposcopic biopsy are recommended to exclude cervical intraepithelial lesions or cervical cancer. Treatment is mainly with antibiotic drugs. Empirical antibiotic therapy can be used until the pathogen test results are available, and then antibiotic therapy can be selected for the pathogen. If the pathogens are Chlamydia trachomatis and Neisseria gonorrhoeae, the sexual partners should be examined and treated accordingly. Cervical intraepithelial lesions are divided into low-grade squamous intraepithelial lesions, high-grade intraepithelial lesions and carcinoma in situ. Intraepithelial lesions usually occur in women aged 25 to 35 years. Occasionally, there is increased vaginal discharge with or without foul odor, and there may be contact bleeding, which occurs after sexual intercourse or gynecological examination. Gynecological examination of the cervix may show celiac-like changes. The diagnosis should follow a “three-step” diagnostic procedure: cytology (HPV test), colposcopy and histopathological examination. (1) Cervical cytology: regular cervical cytology is the most economical, quick and easy diagnostic method to detect intraepithelial lesions of the cervix. Pap smear or liquid-based cytology smear can be used. Any cytological examination suggesting cervical intraepithelial lesions should be further examined and treated. (2) Colposcopy: For patients with suspicious intraepithelial lesions classified by the TBS reporting system, colposcopy is feasible to observe microscopically the cervical surface epithelium and capillaries for abnormalities and to select the lesion for biopsy in order to improve the accuracy of diagnosis. (3) Cervical biopsy: 4 points at 3, 6, 9 and 12 points of the squamous-columnar epithelial junction of the cervix are selected for biopsy. Biopsies can be taken for pathological examination of the suspected lesions under the guidance of iodine test and colposcopy. Both epithelial and interstitial tissues should be present. Cervical biopsy is the most reliable and indispensable diagnostic method to confirm the diagnosis of cervical intraepithelial lesions. Treatment options 1. Patients with CIN grade 1 can be temporarily treated as cervical inflammation, followed up every 3 to 6 months with cervical cytogram and biopsy if necessary. 2. For patients with CIN2 level, cervical conization or LEEP treatment is feasible, and physical therapy such as freezing, laser and microwave can also be used. Postoperative follow-up should be conducted once every 3-6 months. In elderly patients with cervical atrophy and cervical canal adhesions, physiotherapy is not recommended and hysterectomy is feasible. 3. Patients at CIN3 level: therapeutic hysterectomy is feasible for young patients who wish to preserve their reproductive function; total hysterectomy is feasible for older women and those who have completed their reproductive tasks. Follow-up: Cervical smear and colposcopy should be done every 3-6 months after treatment for patients with CIN grade 1~2. After 1 year of stable follow-up, annual check-ups can be done; after treatment for patients with CIN grade 3, cervical smear and colposcopy should be done every 3 months for the first 2 years, and every 6 months for the third 4 years. Thereafter, the examination should be done once a year. Cervical cancer is the most common gynecological malignant tumor. There are about 150,000 new cases of cervical cancer in China every year, accounting for about 1/3 of the total number of patients worldwide, and nearly 80,000 women die every year because of it. The high incidence of cervical cancer is between 50 and 55 years old, but in recent years, the incidence of cervical cancer has a tendency to be younger. Cervical cancer may present with symptoms such as contact bleeding and increased vaginal discharge. Early gynecological examination may show smooth or mild erosion-like changes of the cervix. Different signs may appear as the disease progresses. Diagnosis is also made through a “three-step” diagnostic procedure or direct biopsy of the cervical mass. Treatment for cervical cancer is mainly surgery in the early stage and radiotherapy in the middle and late stages, supplemented by chemotherapy. Prevention Cervical cancer screening allows early detection of cervical lesions and early treatment to reduce the incidence and mortality of cervical cancer. When to start screening Cervical cancer screening should begin at age 21. Regardless of the age of sexual debut or other behavior-related risk factors, women younger than 21 years of age do not need to be screened unless they are infected with HIV or have an immune deficiency. What kind of testing should be done? Women between the ages of 21 and 29 should be screened with a separate cytology test every three years. Combined cytology and HPV screening is recommended every 5 years or every 3 years for women younger than 30 years of age. At what age should cervical cancer screening be stopped? Screening of any kind should be discontinued after age 65 for women with a previous definitive negative screening result and no CIN2 or higher lesions, defined as 3 consecutive negative cytology or 2 consecutive negative co-test results within the last 10 years, with the most recent screening performed within the last 5 years. Conclusion What is now referred to as celiac disease is no longer a disease, but as a clinical sign. A distinction needs to be made between physiologic and pathologic, most of which do not require treatment if physiologic; if inflammatory, the inflammation needs to be addressed; and if cervical squamous intraepithelial lesion or even cervical cancer requires further management.