Terminology: Someone once translated this as “cervical erosion”, but unfortunately, you can’t find a diagnosis of “cervical erosion” in any authoritative foreign textbook on obstetrics and gynecology. Then you look for wikipedia and it automatically goes to the term “cervical ectropion”. It seems that wikipedia is quite smart and knows what the chinenglish translation is trying to say. What is celiac disease? Celiac disease used to be a disease that plagued a lot of women, and when they went for a medical checkup, almost nine times out of ten, they would be diagnosed with celiac disease. To talk about celiac disease, we need to start from the education of doctors. In the unified textbook for Chinese medical students, Obstetrics and Gynecology, before 2008, celiac disease has always existed as a standard disease, and even talked about its clinical manifestations, diagnosis and treatment. But in fact, that was a misconception. Chinese obstetrics and gynecology has been out of step with international standards for many years. In the past, obstetricians and gynecologists regarded the columnar epithelial ectropion of the cervix, which occurs during the physiological period of the cervix, as a pathological phenomenon, and so diagnosed it. In 2008, the 7th edition of the textbook of Obstetrics and Gynecology for undergraduates clearly stated in its preface that it should be in line with international standards and emphasize the updating of knowledge……. clinical diagnostic and therapeutic standards are constantly updated. For example, the name of the disease “cervical erosion” was canceled and replaced by the physiological phenomenon “cervical columnar epithelial ectasia”. So from that time onwards, the domestic should be canceled “cervical erosion” diagnosis, but due to the slow updating of the knowledge of many physicians, even in the undergraduate textbook revision of this diagnosis after five years, there are still many physicians in the diagnosis of “cervical erosion”. Celiac disease, in the end, is actually a misperception of what used to be a normal manifestation of the cervix. Pathophysiologic Mechanisms: So, let’s talk about why celiac disease has been misperceived as an abnormal disease in the past. Look at the diagram below. The normal one is a coronal view of the area where the human uterus meets the vagina, and if you do a gynecological exam, the part of the body that the doctor can see from inside the vagina is the yellow part, which is the appearance of the cervix. There are two different types of cells in the cervix, squamous cells near the vagina and columnar cells near the uterus. The two types of epithelium are different in appearance, as seen in the cervix during a gynecological examination. The central part of the cervix, the part that looks a bit like “erosion”, is covered by columnar epithelium, while the outer part of the cervix, which is relatively smooth, is covered by squamous epithelial cells. Columnar epithelial cells and squamous epithelial cells are in a dynamic equilibrium, somewhat similar to the stalemate zone in a war, this area is medically named “squamous-columnar junction area”, this area is also a good area for cervical cancer (cervical cancer and cervical celiac disease do not necessarily correlate, the following breakdown). The squamocolumnar junction is susceptible to estrogen. Before puberty, when ovarian function is not perfect and estrogen is low, the columnar epithelium is more medial, but after menstruation, the columnar epithelium is influenced by estrogen and develops more towards the outer side, so there are more “celiac” like columnar epithelium in the cervical os at the time of examination, and after menopause, the estrogen level decreases, and the columnar epithelium is more lateral. After menopause, the estrogen level decreases, and the columnar epithelium starts to return to the inner side, so the “celiac disease” will not be visible at that time. Therefore, in essence, the so-called celiac disease is actually cervical ectropion. In the past medical textbooks, there is also the so-called graded diagnosis of cervical ectropion, called mild, moderate and severe, see Figure 4, that the size of the range of the degree of inflammation is the degree of severity, the area of less than 1/3 is mild, 1/3-2/3 is moderate, more than 2/3 is severe, if you understand the so-called “celiac disease” that I mentioned earlier, the real mechanism, it is possible to understand the so-called “celiac disease”. If you understand the so-called “cervical erosion” that I mentioned earlier, the real mechanism, it is very good to understand, this is in fact affected by estrogen columnar epithelial ectropion of different degrees, are normal physiological phenomena. Clinical manifestations: normal physiological phenomenon, there is no special clinical manifestations. Some people may have contact bleeding performance, but only individual differences in the cervix, just like some people chew something hard, teeth or mouth blood, is understandable. Here we need to mention cervicitis, if there is an increase in leukorrhea, yellowish, odor, these are the manifestations of cervical inflammation, is in the cervix after the infection appeared after the symptoms. Cervical cysts and hypertrophy are also the result of chronic inflammation of the cervix. Does it need to be treated? If you understand the content of the previous paragraph, it is not difficult to understand the so-called “celiac disease”, in fact, is a normal physiological phenomenon, do not need to carry out any treatment, and now if a query to the Internet to the many methods of treatment of celiac disease, are all wrong. At the same time, by the way, for symptomatic cervicitis, need to be treated. The specific treatment method depends on different hospitals, but usually, the acute inflammation can be treated with suppository medication, and the chronic inflammation can be treated with physical therapy methods such as laser or freezing. Do I need regular checkups? Regular checkups of the cervix are necessary. This is not to prevent celiac disease, but to prevent cervical cancer. Will it develop into cancer if left untreated? Cervical cancer is related to human papillomavirus (HPV) infection. Some of the so-called high-risk types of HPV are susceptible to precancerous changes and cervical cancer when they persist in the squamous-columnar junction area of the cervix. Cervical cancer has seen a dramatic decrease in mortality since the availability of pap smears, and the key is early prevention and treatment. It is currently recommended that women after the age of 21 should have an annual cervical scraping test. After the age of 30, the test can be combined with HPV, and if 3 consecutive HPV and cervical scraping tests are negative, the interval can be extended to 3-yearly tests, and screening can be stopped after the age of 65. Does it affect fertility? Understanding that celiac disease is a physical phenomenon means that it doesn’t affect fertility. Why do so many hospitals still treat celiac disease? As I said before, the concept of celiac disease was officially written into the textbooks after 2008, but many doctors have not understood and learned this new concept, and are still diagnosing and treating celiac disease. What is infuriating in society now is that many unscrupulous hospitals use celiac disease as a signboard to attract patients to gynecological outpatient clinics, allowing healthy people to go to a celiac disease checkup, followed by medication, infusion, and even LEEP and laser, with thousands of thousands of dollars in treatment fees, making it a typical over-treatment method. We hope that more members of the public will realize this problem and avoid being over-treated.