Gynecological infectious diseases account for more than 40% of gynecological outpatient visits, of which the so-called “celiac disease” is what makes the majority of female compatriots “talk about celiac disease”. The repeated explanations at the clinic are sometimes difficult to dispel the doubts in the minds of patients. The reason for this is probably related to the lack of knowledge, insufficient knowledge update and excessive propaganda of some hospitals for profit-making purposes, the current cervical erosion treatment is more confusing, irregular treatment and excessive treatment phenomenon is exceptionally serious, this treatment has the trend of further expansion, which is very worrying! In order to help the majority of patients correctly understand celiac disease, the author read a lot of relevant literature at home and abroad, combined with their own clinical experience, I would like to tell you the “truth” about celiac disease and how to correctly standardize the treatment of celiac disease from the following aspects. I hope it will be of some help to you, if you can benefit from it or not, I am glad.
I. What is “celiac disease” all about?
The term “cervical erosion” has been a long-standing term used in textbooks to diagnose “chronic cervicitis” for more than 100 years. It was also once thought to be a precancerous lesion of cervical cancer, and it was believed that if cervical erosion was not treated, it could develop into cervical cancer, leading to long-term overtreatment. However, with the advancement of medical science, especially the in-depth research on the etiology and pathogenesis of cervical cancer and its precancerous lesions in the last decade, a large number of evidence-based medical findings that continue to be obtained worldwide show that cervical erosion is not a real disease! It is a physiological change of the female cervix, and “cervical erosion”, which was once thought to be associated with cervical cancer, is actually not related to the development of cervical cancer. It is closely related to the development of cervical cancer and its pre-cancerous lesions by the persistent infection with high-risk human papillomavirus (HPV). It must be clear that cervical cancer or pre-cancerous lesions can manifest as cervical erosion, but only erosion caused by HPV infection can develop into cervical cancer! Therefore, the term “cervical erosion” has been changed to “cervical columnar epithelial ectropion or displacement”.
There are two types of cervical epithelium: primitive squamous epithelium and columnar epithelium. Before puberty, the primitive squamous-columnar junction is located anywhere inside or outside the cervical canal or vaginal vault. After puberty, in response to estrogen, the columnar epithelium is displaced or ectropioned. The ectropion exposes the cervical columnar epithelium to the ectocervix, and because of the thinness of the columnar epithelium of the cervical canal, there is a rich network of blood vessels beneath it with a reddish area or red granular appearance. It looks like erosion on the surface, hence the name “cervical erosion”. In fact, it is not really celiac disease, but the clinic still needs to pay attention to the cervical columnar epithelium ectropion or displacement is more likely to lead to infection, causing acute inflammation of the cervix and cervical epithelial shedding, ulceration, both the so-called true celiac disease.
The actual cervical erosion is treated correctly
It is absolutely correct that people attach importance to “cervical erosion”. The reason for this is that it is difficult to distinguish between cervical erosion and precancerous lesions of the cervix or cervical cancer on visual examination. For cervical erosion, cervical cancer screening such as TCT is completely necessary to rule out cervical precancer and cervical cancer. It is not possible to distinguish them by the doctor’s naked eye alone, but only through ancillary examinations. The standardized treatment of cervical erosion, also known as “three-step diagnosis”, is currently advocated.
The standardized “three-step” diagnosis: cervical cytology-colposcopy-histopathology.
Step 1: Cervical fluid-based cytology (TCT, etc.)
Step 2, based on TCT results, determine whether colposcopy is needed
Step 3, based on colposcopy results decide whether pathology is needed
Step 4, based on the pathology results, decide whether to perform further treatment.
After ruling out malignant cervical lesions by the above-mentioned auxiliary examinations, cervical erosion can be considered to be treated in this way.
1. If “cervical erosion” causes obvious symptoms of infection, such as significantly increased leucorrhea, leucorrhea with blood, bleeding after intercourse, leucorrhea with odor, or causes infertility, etc., give symptomatic treatment after clarifying the cause of the disease. If you do not have fertility requirements, but have a large area of erosion and severe symptoms, you can consider physical therapy, such as laser, after excluding cervical lesions. If you have fertility requirements, try to medicate and if necessary, choose a physical method of treatment that is less damaging to the cervix, such as the Hepatome.
2. For those who do not have symptoms of co-infection such as increased discharge or contact bleeding, regular follow-up is usually sufficient and no treatment is needed. However, it is emphasized that pathogenic and cytological examination should be performed previously. Women with normal sex life should have an annual gynecological checkup, including cervical cancer prevention cytology. In order to achieve early diagnosis and early treatment as much as possible.
3. If cervical cytology or biopsy reveals abnormal cells or precancerous lesions on the surface of the cervix, further treatment is needed. Such as.
(1) In patients with cervical intraepithelial neoplasia (CIN )I, 65% of the lesions can regress on their own; 20% of the lesions persist and remain unchanged; only 15% of the lesions progress. Physical plus local drug therapy can be given to CIN I patients. Regular examination and close monitoring are also emphasized.
(2) CIN II should be treated with physical therapy, such as freezing, electrocoagulation, laser, LEEP knife, etc. Currently, cervical loop electrosurgery (LEEP) is increasingly used for the treatment of CIN II, because it can preserve tissue specimens for pathological examination to further clarify the diagnosis and understand the condition of the cut edge.
(3) CIN III may develop into cancer and should be treated actively, firstly by cone excision. If you are older, you can also consider a total hysterectomy after conectomy for invasive cancer.
Cervical erosion and fertility
The issue of fertility is a major concern for young infertile women. As many people believe that the treatment of cervical erosion will have an impact on future fertility, so whether or not cervical erosion needs to be treated and when and how to treat it has been a very difficult problem for cervical erosion patients. So, does the treatment of celiac disease affect fertility or not?
For example, acute cervicitis can lead to cervical adhesions due to acute inflammation, inflammatory secretions that can affect sperm passage or sperm fertility, and pelvic infections due to retrograde inflammation, which can certainly affect pregnancy. Celiac disease in the usual sense and its treatment should not affect fertility. Of course, some treatment methods such as LEEP knife, cold knife cone cut, laser, etc. will make the cervix harder after the treatment of cervical erosion due to scar formation, which is not good for cervical dilation during normal delivery, and if more cervical excision is done, it may also lead to cervical insufficiency and greater chance of miscarriage and preterm delivery. However, whether or not to cure it still depends on the relevant test results and other specific circumstances. After all, life is precious, and when necessary, it is still necessary to choose a method of treatment that is less damaging to the cervix.