What is celiac disease]
Celiac disease used to be a disease that plagued many women, and when they went for a physical exam, almost nine times out of ten they would be diagnosed with celiac disease.
To talk about celiac disease, it may still be necessary to start with the education of doctors. In the unified textbook for Chinese medical students, in Obstetrics and Gynecology until 2008, celiac disease was always present as a standard disease, and even talked about its clinical presentation, diagnosis and treatment. But in reality, that was a misconception. Obstetrics and gynecology in China has been out of step with international practice for many years. In the past, obstetricians and gynecologists treated the cervical epithelial ectropion during the physiological phase of the cervix as a pathological phenomenon and diagnosed it.
In 2008, the 7th edition of the textbook of Obstetrics and Gynecology for undergraduate students clearly stated in its preface that it should be in line with international standards and pay attention to the updating of knowledge …… to constantly update clinical diagnostic and therapeutic standards. For example, the name of “cervical erosion” was abolished and replaced by the physiological phenomenon of “cervical columnar epithelial ectasia”. So from that time on, the diagnosis of “cervical erosion” should be abolished in China, but due to the slow updating of knowledge of many physicians, even 5 years after the revision of this diagnosis in undergraduate textbooks, there are still many physicians who are diagnosing “cervical erosion”.
Celiac disease, in the end, is actually a misconception of a normal manifestation of the cervix in the past.
Pathophysiological mechanism
So, let’s talk about why celiac disease was wrongly considered an abnormal disease in the past.
Take a look at the following diagram.
Figure 1: Diagram of the cervix
The normal Figure 1 is a coronal view of the area where the human uterus and vagina are connected. If you do a gynecological examination, the part that the doctor can see from inside the vagina is the yellow part, which is the appearance of the cervix (Figure 3). On the part of the cervix, there are two different types of cells, as shown in Figure 2, the squamous cell near the vagina and the columnar cell near the uterus. The appearance of the two types of epithelium is different, as seen in Figure 3 below, which shows the appearance of the cervix under gynecological examination. In the central part, the part of the cervix that looks a bit like “vesicles” is covered by columnar epithelium, while the outer part of the cervix, which is relatively smooth, is covered by squamous epithelium. This area is medically named as “squamous junction zone”, which is also a good area for cervical cancer (cervical cancer and cervical erosion are not necessarily related, as explained below). The squamocolumnar junction zone is susceptible to estrogenic effects. Before puberty, when ovarian function is not perfect and estrogen is low, the columnar epithelium is more medial, after menstruation, the columnar epithelium is influenced by estrogen and develops more laterally, so there are more columnar epithelium like “celiac disease” found at the cervical opening during examination. The woman’s estrogen level drops, the columnar epithelium starts to retreat inward again, so the “vesicles” will be invisible at the time of the examination. So, essentially, what is called cervical ectropion is actually cervical epithelial ectropion.
Figure 2: Histological structure of the cervix
Figure 3, appearance of the normal cervix
In the past medical textbooks, there was also a so-called graded diagnosis of cervical erosion, called mild, moderate and severe, see Figure 4, which considers the size of the extent as the degree of inflammation, with an area of less than 1/3 being mild, 1/3-2/3 being moderate and more than 2/3 being severe. If you understand the real mechanism of the so-called “cervical erosion” that I mentioned earlier, it is well understood that this is actually a different degree of columnar epithelial ectropion after being affected by estrogen, which is a normal physiological phenomenon.
Fig. 4 Cervical non-erosion, it is just a different degree of columnar epithelial ectropion
Clinical manifestations]
It is a normal physiological phenomenon with no specific clinical manifestations.
Some people may have contact bleeding, but it is only an individual difference in the cervix, just like some people chew something hard and have some blood coming out of their teeth or mouth, which is understandable.
Here we need to mention cervicitis, if there is an increase in leucorrhea, yellowing and odor, these are the manifestations of cervical inflammation, which is a symptom that appears after the infection on the cervix. The cervical cyst and hypertrophy are also the result of chronic inflammation of the cervix.
Do you need treatment?
If you understand what has been proposed, it is easy to understand that the so-called “cervical erosion” is actually a normal physiological phenomenon that does not require any treatment, and that the many treatments for cervical erosion that are now available on the Internet are wrong.
Also by the way, for symptomatic cervicitis, treatment is needed. The specific treatment method needs to be determined by different hospitals, but usually, acute inflammation can be treated with suppository medication, while chronic inflammation can be treated with physical treatment methods such as laser or freezing.
Do you need regular checkups?
Regular cervical checkups are necessary, this is not to prevent cervical erosion, but to prevent cervical cancer.
Will it develop into cancer if left untreated?
The occurrence of cervical cancer is related to human papillomavirus (HPV) infection. Some so-called high-risk HPV types of HPV are prone to precancerous lesions and cervical cancer when they are persistently infected 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 undergo cervical smear once a year, and after the age of 30, they can be combined with HPV. 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.
[Does it have any effect on fertility].
Understanding that cervical erosion is a physiological phenomenon means that it will not affect fertility.
Why are so many hospitals still treating celiac disease?
As mentioned before, the change in the concept of celiac disease in China was officially written into the textbook after 2008, but many doctors still do not understand and learn this new concept and are still diagnosing and treating celiac disease.
Nowadays, it is outrageous that many unscrupulous hospitals use celiac disease as a sign to attract patients to their gynecological clinics, allowing healthy people to go for a celiac disease check, followed by medication, infusion, and even LEEP and laser, with thousands and thousands of dollars in treatment fees, becoming a typical means of over-treatment. We hope that more of the public will become aware of this problem and avoid being over-treated.