What is cervical erosion and is it really a “rotten” cervix? Cervical erosion is called erosion, but in fact, it is not erosion, but rather a phenomenon where the squamous epithelium of the ectocervix is shed and replaced by columnar epithelial tissue and appears “erosion and roughness” to the naked eye, much like true erosion, but not a pathological change. The reason for this is that the colposcopic observation of the erosion surface shows intact columnar epithelium, which is a single layer with red interstitium underneath, so it is not true erosion although it is red erosion-like to the naked eye; secondly, this change is related to the displacement of the junction of cervical squamous and columnar epithelium, and the cervical erosion observed under colposcopy is the transformation zone of the squamous-columnar junction. Cervical erosion used to have the English name “cervical erosion”, but in the 1980s, the term “cervical erosion” was removed from American obstetrics and gynecology monographs and textbooks and was replaced by “cervical columnar erosion”. However, in the 1980s, the term “cervical erosion” was removed from American obstetrics and gynecology monographs and textbooks and was replaced by “cervical ectopia”. In China, it has also been abandoned in recent revisions of obstetrics and gynecology textbooks. So, why this misnomer? It starts with the composition and physiological changes of the normal cervical epithelial tissue. The cervix is divided into the cervical canal and the vaginal part of the cervix, so the cervical epithelium is composed of both the columnar epithelium of the cervical canal and the squamous epithelium of the vaginal part of the cervix. The intersection of the two is at the ectocervix, which is called the primitive squamous junction. This junction shifts with the level of estrogen in the body, so it is called the physiological squamous-columnar junction. When estrogen levels are high, such as in newborn girls, puberty, childbirth, and pregnancy, the columnar epithelium moves out to the vaginal part of the cervix. When estrogen levels are low, such as after menopause, the columnar epithelium moves inward to the cervical canal. As a result, when the cervicovaginal area is covered by columnar epithelium, it 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 form. This is what we see with the naked eye as “celiac disease”, but it is in fact a “celiac disease”, which is the actual condition of the normal endocervical changes, not a chronic inflammation of the cervix. This is the part of women who are accidentally found to have cervical erosion during a normal physical examination when there were no previous symptoms. This is because when there is no pathogenic microbial infection, that is, when there is no combined inflammation, patients with celiac disease may have no clinical symptoms or may only show an increase in vaginal discharge. When there is an increase in leucorrhea, yellow and sticky in texture, or blood in the leucorrhea, accompanied by discomfort during sexual intercourse and pain in the lower back and abdomen, then and only then can the endocervical lining be considered to be ectopic with infection, but this is not due to cervical erosion itself, but to inflammatory infection. Pathological “cervical erosion” is usually associated with infection caused by bacterial invasion of the cervix through childbirth, miscarriage, or surgical operations. The common pathogens are staphylococcus, streptococcus, anaerobic bacteria, Escherichia coli, Chlamydia trachomatis, and gonococcus naive. At present, what are the main methods of treatment for celiac disease? What are the common treatment misconceptions? What are other considerations? How to understand the “cure” of cervical erosion? Based on these new concepts, there should be a new perspective on the treatment of celiac disease. When there is no pathogenic microbial infection, cervical erosion may have no clinical symptoms or may only show an increase in discharge and does not require treatment. In case of increased leucorrhea, blood in the leucorrhea and other symptoms of combined inflammatory infections, a “three-step” screening of cervical lesions (cervical cytology, colposcopy and histopathology) should be performed, and after excluding cervical lesions and cervical cancer, physiotherapy and medication can be considered to relieve symptoms. The basic principle of physiotherapy is to cause necrosis and shedding of inflammatory tissues through physical factors, followed by regrowth of squamous epithelial tissues in the cervix. Commonly used physical treatments include laser therapy, cryotherapy, etc. During the treatment period, attention should also be paid to keep the vulva clean. Sexual intercourse, bathing, swimming and vaginal douching should be prohibited until the wound is completely healed. Regular review after treatment. During the treatment period, if you find any foul-smelling discharge, you should seek medical attention promptly. After physical therapy, if there is a small amount of bleeding, it is normal. If the bleeding increases, exceeds the amount of menstruation or takes too long, you should go to the hospital to find the cause and stop the bleeding as soon as possible. Common misconceptions about treatment are: (a) Cervical erosion can be cured. At present, it is commonly believed in China that physical therapy can cure cervical erosion at once. In fact, in the absence of a clear etiology, it is impossible to permanently cure cervical erosion regardless of the conservative treatment method. Clinically, it is often encountered that patients with cervical erosion become smooth (columnar epithelium replaced by squamous epithelium) after the application of physiotherapy, but after a period of time cervical erosion may reappear. Therefore, it is important to distinguish between physiological changes or combined inflammatory infections, and if the real cause is not removed, cervical erosion may reoccur. (b) Celiac disease treatment requires vaginal douching. The surface of the vaginal mucosa is squamous epithelium, which is affected by female sex hormones and undergoes periodic shedding, which has a protective effect on the vagina. At the same time, the squamous epithelium secretes glycogen, which is broken down into lactic acid by the lactobacilli that live in the vagina, thus maintaining an acidic environment in the vagina and inhibiting the growth and reproduction of bacteria. Celiac disease is not caused by bacterial infection, and the application of disinfectant, antiseptic, antipruritic and anti-inflammatory lotions to douche the vagina may destroy the protective barrier of the vagina itself, which is not only not beneficial to the treatment of celiac disease, but may also cause changes in the local microenvironment of the vagina, resulting in secondary infections. Therefore, local vaginal douches should not be abused when suffering from cervical erosion. (3) Active treatment of cervical erosion once diagnosed Cervical erosion must be treated immediately once diagnosed, otherwise it can lead to cervical cancer. In underdeveloped countries and regions, cervical cancer is the most common gynecological malignancy. The main reason why many women are so afraid of cervical erosion is that they fear that untreated cervical erosion will develop into cervical cancer. In fact, there is no necessary link between celiac disease and cervical cancer. It is now clear that cervical cancer is caused by persistent infection with the human papillomavirus, while most co-infections in celiac disease are combined with bacterial infections. The vast majority of cervical cytology findings in cervical erosion are normal. On the other hand, it is not uncommon for early cervical cancer and precancerous cervical lesions to manifest as a smooth cervix. Only those with abnormal cervical cytology results need further diagnosis and treatment, and it has nothing to do with smooth or erosive cervix. In most areas of China, due to limited medical conditions, many clinicians are still accustomed to determine the presence or absence of cervical disease by visual observation only. However, only a small number of cervical invasive carcinomas are identified by the naked eye, often at a later stage. It is very difficult to determine and distinguish early cervical cancer from cervical erosion by visual observation alone. Treatment without cervical cytology screening may overtreat but may also miss cervical invasive carcinoma or high-grade precancerous lesions, which can be dangerous for the affected woman. Therefore, it is important not to over-treat and even more importantly, not to treat blindly. We urge women to undergo regular cytological examination of the cervix, commonly known as “cancer screening of the cervix”. In summary, the misconceptions about cervical erosion have existed for a long time, but now with the correction of these old views, new treatment concepts are gradually gaining popularity. It is hoped that women will no longer consider “celiac disease” to be a beast, and will avoid being misled by some unscrupulous medical clinics to undergo incorrect treatment, which will bring physical and mental burdens and economic losses.