The cervix is the part of the uterus that is exposed to the vagina and is the place where the vagina must pass to the uterine cavity. The mucus plugs in the cervical canal normally also block pathogens from the outside world and the vagina from entering the uterus. Therefore, the cervix is very important, and it is also vulnerable to attack by vaginal pathogens such as bacteria and viruses. Cervical erosion is not all a true inflammatory disease, nor is it a true erosion. Many patients who usually consult online and in outpatient clinics are often over-treated for cervical erosion, so it is necessary to understand cervical erosion. What is chronic cervicitis? Chronic cervicitis can be caused by acute cervicitis or by persistent pathogenic infection. Chronic cervicitis is mostly asymptomatic. A few patients may have increased vaginal discharge, yellowish or purulent, bleeding after sexual intercourse, bleeding between menstrual periods, and occasional itching or discomfort of the vulva due to discharge irritation. Gynecological examination may reveal cervical erosion-like changes, or yellow discharge covering or flowing from the cervical orifice, or may be manifested as cervical polyps or cervical hypertrophy. Asymptomatic physiological celiac changes do not require treatment. Cervical intraepithelial neoplasia and cervical cancer must be excluded before treatment. Is cervical erosion a disease? The previous view, mentioned in all textbooks, is that cervical erosion is a pathological type of chronic cervicitis. Over the decades, it has become clear that cervical erosion is a “disease”, and it is now clear that “cervical erosion” is not a true erosion due to pathological ulceration and loss of epithelium, nor is it consistent with the definition of chronic cervicitis, which is the presence of chronic inflammatory cells in the interstitium. It is not consistent with the definition of chronic cervicitis as chronic inflammatory cell infiltration in the interstitium. Therefore, the term “cervical erosion” is no longer appropriate as a diagnostic term for chronic cervical inflammation. Cervical erosion is a clinical sign that can be either physiological or pathological. The word “celiac disease” is so powerful that when ordinary people hear the word celiac disease, they already imagine that “my uterus is starting to rot, and if it is not treated, the whole uterus will slowly rot and smell”. In fact, this is a big mistake in the history of medical terminology. The term “cervical erosion” has been replaced by “cervical columnar epithelial ectasia”, which is a normal physiological phenomenon. How does celiac disease develop? Before puberty, the “squamous-columnar junction” is located in the cervical canal. After puberty, under the action of estrogen, the volume of the cervix grows rapidly and greatly exceeds the body of the uterus, followed by ectropion of the cervix. Ectropion exposes the cervical columnar epithelium to the ectocervix, which is red and rough – red because the columnar epithelium is arranged in a single layer with a rich network of blood vessels underneath; rough because the columnar epithelium is fused with each other in a villi or granular shape. Simply put, columnar epithelial ectropion is caused by estrogen, a physiological phenomenon that lasts for decades from puberty onward. However, some people have it and some do not, depending on their body type. What are the conditions that can manifest as cervical erosion? Chronic cervicitis, physiological columnar epithelial ectoplasia of the cervix, cervical intraepithelial neoplasia, and early cervical cancer can also present with cervical erosion-like changes. What is cervical columnar epithelial ectasia? Physiological columnar epithelial ectopic ectopia of the uterine cervix is a finely granular red area in the vaginal part of the uterine cervix at the external cervical os, which appears colposcopically as a wide transformation zone. This condition has been referred to in previous textbooks as “cervical erosion” and is considered to be one of the most common pathological types of chronic cervicitis. Physiological columnar epithelial ectoplasia is seen in adolescents, women of childbearing age with high estrogen secretion, oral contraceptives, or during pregnancy, when the squamocolumnar junction is displaced due to estrogen and the cervix is locally erosion-like in appearance. What should I do if I find cervical erosion-like changes? Since cervical intraepithelial neoplasia and early-stage cervical cancer are also associated with cervical erosion, cervical cytology and/or HPV testing, colposcopy and biopsy if necessary, are needed to rule out cervical intraepithelial neoplasia or cervical cancer. Which cervical erosions need to be treated? Cervical inflammation usually does not require rehydration and anti-inflammatory treatment. Physical therapy can be done in a single session and does not require a course of treatment. Different treatments are used for different lesions. (1) For those who present with celiac-like changes, no treatment is needed if they are asymptomatic physiological columnar epithelial ectoplasia. (2) For vesicular changes with increased discharge, papillary hyperplasia or contact bleeding, local physical therapy, including laser, freezing, microwave, etc., can be given, as well as herbal pessary treatment or as an adjunct before and after physical therapy. If you have already had children you can undergo physical therapy. If you have not yet had children, physical therapy is generally not recommended and active follow-up physical examination is sufficient. (3) If cervical intraepithelial neoplasia or cervical cancer is detected, treatment will be given according to the corresponding lesion. Does it have any effect on fertility? If you understand that cervical erosion is a physiological phenomenon, it does not affect fertility. Precautions for physiotherapy: (1) Before treatment, cervical cancer screening should be routinely performed. (2) Acute inflammation of the reproductive tract is contraindicated. (3) The treatment should be performed within 3-7 days after menstruation. (4) After physical therapy, there is an increase in vaginal discharge or even a large amount of watery discharge, and there may be a little bleeding when the scab is removed 1-2 weeks after surgery. (5) During the period when the trauma is not completely healed (4-8 weeks), tub bathing, sexual intercourse and vaginal douching are prohibited. (6) Physiotherapy may cause post-operative bleeding, cervical stenosis, infertility and infection. After treatment, regular check-ups should be conducted to observe the healing of the wound until it is healed, and to pay attention to the presence of cervical stenosis. Do I need regular checkups and prevention? Regular check-ups of the cervix are necessary, not to prevent cervical erosion, but to prevent cervical cancer. The occurrence of cervical cancer is related to human papillomavirus (HPV) infection. Some patients with high-risk HPV infection are prone to precancerous lesions and cervical cancer when the infection persists in the squamocolumnar junction area 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 have a joint HPV test. 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.