Epidemic ectopia of the cervix. Cervical ectopia: treatment, causes, symptoms, signs. Modern methods included in diagnostics

Ectopic cervix - displacement of the boundaries of the columnar epithelium to the vaginal part of the cervix.

SYNONYMS

False erosion, pseudo-erosion, endocervicosis, glandular erosion, glandular muscle hyperplasia.

ICD-10 CODE In ICD-10, ectopia of the cervix is ​​not included.

EPIDEMIOLOGY

Cervical ectopia is detected in 38.8% of the female population and 49% of gynecological patients. The congenital form of cervical ectopia (including ectropion) is observed in 11.3% of women with this pathology. The maximum incidence (more than 50%) of the incidence of cervical ectopia is observed in nulliparous women under 25 years of age.

PREVENTION

To prevent the development of cervical ectopia, the following is necessary:

prevention, timely diagnosis and treatment of inflammatory processes of the genital organs;

timely correction of hormonal and immune homeostasis disorders;

promoting the culture of sexual relations;

prevention of abortions (rational contraception).

SCREENING

They don't.

CLASSIFICATION

In the modern colposcopic nomenclature adopted at the VII International Congress in Rome (1990), ectopia (cylindrical epithelium) is classified as point I: “normal findings of colposcopic examination.” The absence of cervical ectopia as a pathology in ICD-10 and its classification as normal data in colposcopic nomenclature implies uncomplicated forms of cervical ectopia, which are a physiological condition.

ETIOLOGY

In adolescents and patients of early reproductive age, cervical ectopia is considered as a physiological condition associated with relative hyperestrogenism. The appearance of cervical ectopia during pregnancy is also considered a physiological condition associated with changes in ovarian function.

Acquired ectopia of the cervix is ​​considered as a polyetiological disease caused by the influence of a number of factors.

There are exogenous and endogenous factors that contribute to the development of cervical ectopia. Exogenous factors include: infectious, viral (early onset of sexual activity, a large number of sexual partners, a history of inflammatory processes in the genital organs) and traumatic (cervical injuries during childbirth and abortion, the use of barrier methods of contraception).

Endogenous factors include: disruption of hormonal homeostasis (menarche before 12 years, menstrual cycle and reproductive function disorders), changes in immune status (presence of chronic extragenital and gynecological diseases, occupational hazards).

The factor of hereditary predisposition, the possible influence of COCs and smoking on the development of cervical ectopia are still being discussed.

PATHOGENESIS

The pathogenesis of cervical ectopia has not been sufficiently studied.

In the prenatal period, the process of displacement of the columnar epithelium beyond the internal os is considered a normal stage of development of the cervix. As a rule, when a woman reaches reproductive age, the border between columnar and stratified squamous epithelium is not visible during a gynecological examination. However, ectopia can persist in early reproductive age, especially in women with menstrual irregularities (against the background of relative hyperestrogenism).

Cervical ectopia is considered a congenital, usually temporary, physiological condition; they are not dangerous in relation to malignancy and do not require treatment.

The formation of acquired ectopia of the cervix occurs under the influence of endogenous and exogenous etiological factors, which include mechanisms that support the pathological differentiation of reserve cells of the cervix into the cylindrical epithelium.

CLINICAL PICTURE

The diagnosis of congenital ectopia of the cervix is ​​established upon the first visit to the gynecologist of a woman who has recently begun sexual activity.

When diagnosing acquired cervical ectopia, its appearance on a previously unchanged cervix is ​​taken into account.

Colposcopic manifestations of early recurrent ectopia of the cervix are detected 2–3 months after treatment, late - after 6 or more months. Early recurrent cervical ectopia is considered a consequence of inadequate treatment. However, if this is an uncomplicated form, is it worth talking about relapse and inadequacy of therapy?

The uncomplicated form of cervical ectopia does not have specific clinical manifestations, and is most often diagnosed during a preventive gynecological examination.

A complicated form of cervical ectopia is observed in more than 80% of cases. In a complicated form, ectopia is combined with inflammatory, precancerous processes of the cervix. When combined with a violation of the epithelial-stromal relationship of the cervix, ectopia of the cervix is ​​interpreted as ectropion. In the presence of concomitant inflammatory processes of the lower genital tract, patients complain of leucorrhoea, itching, dyspareunia, and rarely contact bleeding. Often the reason for contacting a gynecologist is menstrual irregularities and infertility.

DIAGNOSTICS

PHYSICAL INVESTIGATION

To diagnose ectopia, examination of the cervix using mirrors is used. Around the external pharynx, in the presence of this pathology, an ectopia is detected, which looks like a spot with irregular outlines from pale pink to bright red.

LABORATORY RESEARCH

Cytological examination is used. For cervical ectopia, the following types of cytological conclusions are most typical:

cytogram without features (squamous epithelial cells of the superficial and intermediate layers);

proliferation of columnar epithelium;

cytogram of endocervicosis (corresponds to the clinical diagnosis of cervical ectopia). In the case of a complicated form of cervical ectopia, the following types of cytological conclusions are most typical:

cytogram of inflammation;

cytogram of leukoplakia (dyskeratosis) or dysplasia (CIN) of varying severity.

Bacterioscopic, bacteriological methods, and PCR are also used.

The functions of the ovaries are studied: functional diagnostic tests are carried out, hormonal status is examined (according to indications).

An immunogram is performed (according to indications).

INSTRUMENTAL RESEARCH

To diagnose cervical ectopia, extended colposcopy is performed. Congenital ectopia of the cervix is ​​represented by areas of columnar epithelium with uneven contours. A feature of physiological ectopia (the physiological location of the junction in young women outward from the external pharynx) is considered to be clear boundaries between the squamous and cylindrical epithelium.

Acquired ectopia of the cervix can be represented by columnar epithelium in various combinations with a transformation zone. The columnar epithelium is a cluster-shaped cluster of round or oblong papillae of bright red color. The normal transformation zone against the background of the bright surface of the cylindrical epithelium is visible in the form of pale gray tongues of stratified squamous epithelium, while open and closed gland ducts can be found. A pronounced vascular network is often visible on the surface of the closed gland ducts. In more than 40% of patients with acquired cervical ectopia, along with cylindrical epithelium and a normal transformation zone, abnormal colposcopic signs are detected: leukoplakia, punctation, mosaic, iodine-negative zones.

Targeted biopsy of the cervix and curettage of the cervical canal with histological examination are indicated when atypical cells are detected during cytological examination and (or) in the presence of abnormal colposcopic signs. The most common histological findings for congenital ectopia of the cervix are: glandular papillary pseudo-erosion; for the uncomplicated form of acquired ectopia of the cervix: glandular pseudo-erosion, epidermal pseudo-erosion. With a complicated form of cervical ectopia, any variants of histological conclusions are possible, characteristic of CIN of varying degrees against the background of cervical ectopia.

DIFFERENTIAL DIAGNOSTICS

Differential diagnosis is carried out with:

True erosions of the cervix.

INDICATIONS FOR CONSULTATION WITH OTHER SPECIALISTS

Consultation and treatment with a gynecological oncologist is necessary in the case of a combination of cervical ectopia with grade III CIN.

Consultation with a gynecologist-endocrinologist is indicated in case of complex hormonal disorders.

EXAMPLE OF FORMULATION OF DIAGNOSIS

Cervical ectopia, uncomplicated form.

Uncomplicated forms of cervical ectopia do not require treatment. Clinical observation is indicated for the purpose of timely detection of deviations in the clinical course.

Treatment tactics for patients with complicated forms of cervical ectopia combined with leukoplakia, grade I–II CIN are outlined in the sections devoted to these diseases.

Patients with complicated forms of cervical ectopia combined with grade III CIN should be treated by a gynecological oncologist.

TREATMENT GOALS

Treatment goals for cervical ectopia:

elimination of concomitant inflammation;

correction of hormonal and immune disorders;

correction of vaginal microbiocenosis;

destruction of pathologically altered cervical tissue.

INDICATIONS FOR HOSPITALIZATION

Hospitalization is indicated for a cervical biopsy.

NON-DRUG TREATMENT

Destructive treatment methods are necessary for complicated forms of cervical ectopia. To destroy pathologically altered cervical tissue, methods of cryodestruction, laser coagulation, and radiosurgery are used.

The choice of treatment method corresponds to the pathology with which cervical ectopia is combined.

DRUG TREATMENT

It is necessary to carry out etiotropic anti-inflammatory therapy according to the regimens generally accepted in clinical practice, correction of vaginal microbiocenosis, correction of hormonal disorders, correction of immune disorders.

SURGICAL TREATMENT

Surgical treatment methods are used in cases where ectopia is combined with grade II–III CIN and when there is deformation of the cervix.

APPROXIMATE DURATION OF DISABILITY

Sexual activity after a cervical biopsy is possible after 4 weeks, after the use of destructive methods of treatment - after 6–8 weeks.

FOLLOW-UP

Dispensary observation of patients with an uncomplicated form of cervical ectopia: examinations once a year with colpocytological and bacterioscopic examinations.

After destructive treatment methods, examination of the cervix and colposcopy are carried out no earlier than 6 weeks later.

Dispensary observation of treated patients with complicated forms of cervical ectopia, combined with cervical leukoplakia and CIN - see sections “Cervical leukoplakia” and “Cervical dysplasia”.

INFORMATION FOR THE PATIENT

Pathological changes in the cervix are in most cases asymptomatic. Regular preventive examinations are required (once a year).

The prognosis for cervical ectopia is favorable.

Content:

Cervical ectopia is a displacement of the boundaries of the columnar epithelium onto the vaginal part of the cervix. If the form of cervical ectopia is uncomplicated, no clinical picture may be observed.

If cervical ectopia acquires a complicated form, heavy discharge from the cervical canal in the form of leucorrhoea, sometimes bloody discharge from the vagina, itching and burning in the genital area may be observed. This disease can be detected during a gynecological examination. To accurately establish the diagnosis, an extended colposcopy, cytological examination of scrapings will be required, and sometimes a biopsy is required.

Uncomplicated ectopia of the cervix does not require any treatment, but the complicated form requires etiotropic therapy, destruction of altered foci. Cervical ectopia in medicine is otherwise called pseudo-erosion, glandular-muscular hyperplasia, false erosion, endocervicosis.

In normal condition, the vaginal area of ​​the cervix, which is accessible for inspection in gynecological speculums, is lined on the outside with flat multilayered epithelium. And the inside of the cervical canal is lined with columnar epithelium. If ectopia is observed, the border of the transition of columnar epithelium into flat epithelium shifts to the area of ​​the external pharynx, being located locally or along its circumference.

This disease is typical for 40% of all women, and 11.5% get it from birth. Very often, ectopia is observed in women under 30 years of age. The disease itself is not capable of developing into cervical cancer, but in the presence of ectopia, the likelihood of developing a malignant tumor only increases.

Classification of ectopia

As already mentioned, ectopia can be congenital or acquired. False erosion can become recurrent. According to its clinical form, ectopia can be complicated or uncomplicated. It is worth saying that an uncomplicated form of cervical ectopia in medicine is considered a normal phenomenon and physiological state of a woman. Ectopia can take a complicated form as a result of colpitis and cervicitis, which can be caused by infection.

If there is a violation of the relationship between the stromal and epithelial elements of the cervix, then ectopia is called ectropion.

Based on histological indicators, papillary and glandular ectopia of the cervix, as well as false erosion with squamous metaplasia, are distinguished.

Glandular ectopia is accompanied by signs of inflammation and accumulation of glands with an extensive network of glandular ducts.

Papillary ectopia is accompanied by the proliferation of stromal components and the formation of papillary structures, which are covered with cylindrical epithelial tissue.

The healing process of ectopia involves the reverse replacement of columnar epithelial tissue with cells of mature squamous epithelial tissue. In other words, the so-called transformation zone is formed. Reserve cells also participate in this process, which initially turn into immature and then mature metaplastic epithelial tissue.

You can distinguish between completed and unfinished transformation zones using colposcopy. Cellular metaplasia may break off under adverse influences, which will lead to recurrence of cervical ectopia. If the cells of the mouth of the cervical glands are covered with a metaplastic layer, the formation of a cervical cyst (Nabothian cyst) is possible.

What causes cervical ectopia?

During puberty, as well as in the early childbearing period, ectopia is regarded as a certain functional feature and a completely normal phenomenon. During these periods, cervical ectopia is based on excessive secretion of the hormone estrogen (relative hyperestrogenism). During pregnancy, false erosion is also normal and is explained by changes in hormonal levels and ovarian function.

According to various theories, ectopia of the uterus can occur as a result of inflammatory processes, dishormonal, immunological and traumatic factors.

The occurrence of cervical ectopia as a result of inflammatory processes is explained by recurrent endocervitis and vaginitis, which are caused by streptococci, Escherichia coli, and various STD pathogens (ureaplasmosis, mycoplasmosis, chlamydia, gardnerellosis and others). Abnormal and even pathological discharge that affects the vaginal part of the uterus causes the so-called desquamation of squamous epithelial tissue with the formation of real erosion in its place. In 1-2 weeks, the epithelial tissue of the endocervix spreads to the surface of the erosion, covering it, in place of which an area of ​​ectopia is formed.

Infection of the uterus can be caused by various birth injuries, mechanical damage to the cervix during abortion, trauma to the uterus when using spermicides and barrier contraceptives.

It is believed that the development of ectopia can also be provoked by ovarian dysfunction. Very often, ectopia occurs in diseases such as endometriosis, uterine fibroid, ovarian stromal hyperplasia, hormonal imbalance and menstrual cycle disruption, and other conditions caused by increased estrogen secretion.

It is believed that decreased immunity can also cause a weakened immune system in the body. Very often, ectopia can be triggered by early onset of sexual activity, frequent changes of intimate partners, diabetes, smoking, multiple births, etc.

Symptoms and diagnosis of cervical ectopia

The uncomplicated form of ectopia of the uterus is not accompanied by any symptoms and is usually detected during a routine examination by a gynecologist. But most often, women experience a complicated form of ectopia (in 80% of cases), which is combined with various inflammatory processes and precancerous changes (cervical polyps, dysplasia, etc.). In the presence of colpitis or endocervitis, discharge of leucorrhoea from the cervical canal, dyspaurenia, itching, and contact bleeding are observed.

Primary disorders that lead to ectopia of the uterus can cause disruptions in the menstrual cycle and even infertility.

Diagnosis of ectopia is possible during a routine routine examination by a gynecologist. The presence of congenital pseudo-erosion is established upon first contact with the gynecologist. If acquired ectopia is diagnosed, its formation on the surface of the cervix, which has never changed before, is taken into account.

A gynecologist can discern ectopia by examining the patient on a gynecological chair. Ectopia is presented in the form of a bright red lesion with irregular outlines in the area of ​​the external pharynx. When false erosion comes into contact with a gynecological instrument, slight bleeding may occur.

If ectopia of the uterus has been detected, the doctor will prescribe an extended colposcopy, which will reveal an atypical area represented by cylindrical epithelial tissue and transformation zones. Very often (in 40% of cases) when performing an iodine test (Schiller test), an abnormal colposcopic picture is observed: puncture, mosaic, leukoplakia, iodine-negative zones. If such signs are detected, a more in-depth examination is required.

Diagnostics involves bacteriological culture, microscopy, and PCR studies. In addition, a cytological examination of the scraping is considered a mandatory procedure. Such a study will reveal the inflammatory process, the presence of cells of cylindrical and flat epithelial tissue. If an abnormal colposcopic and cytological picture is observed, it is necessary to perform a uterine biopsy or separate diagnostic curettage followed by histological examination.

Ovarian function can be studied using special functional tests and hormonal status studies. If any hormonal disorders are detected, a consultation with a gynecologist-endocrinologist is necessary.

Treatment, prevention and prognosis of ectopia

As already mentioned, the uncomplicated form of ectopia does not require treatment. But nevertheless, dynamic observation is necessary, which will allow timely identification of any deviations in the development of false erosion.

Treatment of complicated pseudo-erosion should be carried out taking into account existing changes. As a rule, etiotropic anti-inflammatory and antiviral therapy is prescribed, the correct choice of contraception is carried out, and hormonal and immune disorders are corrected. After these procedures, destruction of pseudo-erosion foci is performed using laser coagulation, cryogenic exposure, chemical coagulation, and radiosurgery. When Nabothian cysts of the cervix are detected, they are opened.

How to prevent the appearance of pseudo-erosion? Firstly, it is recommended to visit your gynecologist as often as possible. The frequency of visits should be at least 2 times a year. Secondly, any sexually transmitted infections should be treated immediately. Inflammatory diseases also require urgent treatment. Frequently changing sexual partners can only provoke the appearance of false erosion; try to avoid sexual contact with different men.

Treatment of pseudo-erosion is carried out for the following purposes:

• To eliminate the accompanying inflammatory process;
• for the correction of immune and hormonal disorders;
• for correction of vaginal microbiocenosis;
• for the destruction of pathologically altered uterine tissue.

Hospitalization is indicated only in cases where a cervical biopsy is necessary. You can resume sexual activity after a biopsy no earlier than 4 weeks later.

Regular visits to the gynecologist with subsequent examination, maintaining a healthy lifestyle, proper balanced nutrition and a culture of sexual life will allow you to avoid such a disease. Remember that a weakened immune system makes the body vulnerable to all diseases. Therefore, try to consume all the necessary vitamins and microelements, give up bad habits, and limit yourself in drinking alcohol. Have sex with a trusted man, avoid promiscuity. These simple rules will help you avoid many gynecological diseases, including ectopia. Good health to you.

Discussion 0

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Cervical ectopia and chronic cervicitis are one of the most common diseases that are localized in the cervix. In most situations, these pathologies are diagnosed simultaneously and can accompany each other’s development.

The inner surface of the cervical region is called the cervical canal. This intermediate section is a kind of bridge between the vagina and the uterine cavity. The inside of the cervical canal is lined with single-layer cylindrical glandular epithelium, and the vaginal area of ​​the cervix is ​​lined with stratified squamous epithelium. It is the zone of change from one cell to another that is the place where ectopia most often occurs - partial deformation of cells.

According to statistics, inflammatory processes quite often occur in the area of ​​the cervical canal, and over time the cervix loses its protective properties. After such changes, infection and the development of inflammatory diseases, in particular cervicitis, most often occur. In most situations, cervicitis develops acutely and is accompanied by a sharp deterioration in health. If at this stage a timely diagnosis is carried out and individual treatment is prescribed, the disease will not become chronic.

Depending on the origin, it is customary to distinguish congenital and chronic forms of cervical ectopia. The nature of the disease can be recurrent, and the clinical course can be complicated or uncomplicated.

Uncomplicated cervical ectopia may be a variant of the physiological norm in women of reproductive and postmenopausal age. In most situations, the complication of this disease is associated with the parallel development of colpitis and cervicitis, the cause of which is infection. When the relationship between epithelial cells and building elements in the cervical area is disrupted, the disease is usually called ectropion (a complicated form of ectopia).

When conducting a histological examination, it is customary to distinguish the following forms:

Glandular ectopia is characterized by the accumulation of glandular tissue, branching of the network of glandular ducts and the presence of an inflammatory reaction. When the papillary form occurs, the stromal components grow significantly, and papillary elements covered with columnar epithelium are formed.

The repair processes of ectopia are based on the repopulation of the columnar epithelium with squamous epithelial cells (the formation of a transformation zone occurs). Reserve cells take part in the progression of this process, which, in the process of maturation, turn from immature into mature metaplastic epithelium.

Through the use of colposcopy, it is possible to identify completed and incomplete transformation zones. When exposed to unfavorable external factors, cellular metaplasia may break off and cervical ectopia may recur.

Etiology of combined pathology

The combination of cervical ectopia and chronic cervicitis can have many etiological reasons for its development, but the most common are:

• Viral infection. occupies a leading position due to its danger. Its peculiarity is its easy penetration into the epithelial cell and the development of dangerous changes that contribute to the development of precancerous conditions (for example, cervical dysplasia).
• Bacterial infection. It is often transmitted sexually during unprotected intercourse. Chlamydia is the most common infection that contributes to the development of ectopic epithelial lesions.
• Inflammatory diseases. Inflammation of the vulva, vagina, STDs are the causes of development, which later turns into ectopia.
• Failure to maintain intimate hygiene and imbalance of microflora. The proliferation of pathogenic bacteria and a decrease in protective functions can lead to the development of many diseases.
• Unreasonable use of antibiotics. Due to the effect of these drugs on the vaginal flora, it becomes imbalanced and opportunistic bacteria predominate.
• The presence of the following diseases: , polyposis, .
• Hormonal imbalance. Excessive growth of cells in the cervical canal may be due to an increased concentration of estrogen in a woman’s body. The cause of this condition may be the use of oral contraceptives.
• Presence of concomitant diseases. Due to the excessively close location of the urinary tract organs, the spread of bacteria is possible. The weakening of the epithelium can also be influenced by the presence of diabetes mellitus and other metabolic pathologies.

In the presence of congenital cervical ectopia, chronic endocervicitis can occur against its background. The fact is that columnar epithelium is less resistant to aggressive influences than flat epithelium, and the presence of the first mark in the cervical area increases its vulnerability to all pathogenic and conditionally pathogenic microorganisms.

Features of the course of combined pathologies entirely depend on the stage of their progression and the strain of pathological disorders. The chronic course of cervicitis is characterized by vague symptoms. Specific manifestations, as a rule, develop during exacerbations of the disease and the occurrence of concomitant gynecological pathologies.

Among the manifestations of cervical ectopia and chronic cervicitis, it is customary to distinguish:

Visible manifestations of diseases can be identified during a gynecological examination, since the low intensity of the pathological process contributes to the development of hypertrophy of cervical tissue. The epithelium of the cervical canal gradually extends beyond its limits and spreads to the vaginal part of the cervix. It is the processes described above that lead to the formation of cervical ectopia, the course of which is complicated by chronic cervicitis.

Diagnosis of gynecological pathologies

At the moment, absolutely all gynecologists are convinced that timely detection of cervical pathology is the key to successful treatment. Diagnosis of the patient should begin with the collection of complaints and anamnestic data.

A clinical diagnosis is made after a thorough examination of the patient in the mirrors and a series of tests. When conducting research, the specialist should pay attention to the presence of hyperemia, mucous or purulent discharge from the vagina. To confirm the suspected diagnosis and determine the true cause of the disease, additional types of diagnostics may be required:

Each patient needs blood and urine diagnostics.

A biopsy sample is taken when the results of cytological diagnostics and colposcopy are ambiguous. After examining the biopsy, the doctor can evaluate the nature of the epithelial changes and their similarity to dysplasia and cervical cancer.

At the moment, in gynecological practice, the combination of cervical ectopia and chronic cervicitis is a dangerous pathology. In the absence of timely therapy, serious complications may arise, such as the growth of benign and malignant neoplasms, infertility and the impossibility of bearing a fetus.

The organization of prevention of the above diseases is of great importance. To ensure the prevention of the development of the above-described pathology and other gynecological diseases, every woman is recommended to follow the rules of intimate hygiene, avoid constant changes of sexual partners, unwanted pregnancies ending in abortions, and any other surgical interventions. All diseases of the reproductive system require timely diagnosis and treatment. To do this, you need to conduct a systematic annual medical examination.

If uncomplicated congenital ectopia of the cervix is ​​detected, etiological and pathogenetic treatment is not carried out. Patients are subject to systematic monitoring over time, which helps to promptly notice deviations in the course of the identified pathology.

The prescription of therapy for complicated forms of ectopia is selected taking into account the existing disorders. The use of etiotropic antiviral treatment and anti-inflammatory therapy is carried out in parallel with the choice of contraceptives, correction of immune and hormonal changes.

To prevent the development of an infectious process, destruction of ectopic foci is carried out due to cryogenic exposure, laser coagulation or chemical exposure. Borovaya uterus can be used to reduce the inflammatory reaction.

Prevention of gynecological diseases and prognosis

The best option for preventing the development of cervical ectopia is a complete preventive gynecological examination. In parallel with this, correction of disturbances in the functioning of the hormonal and immune systems, simultaneous treatment of inflammatory diseases and prevention of casual sexual relationships should be carried out.

When diagnosing pseudo-erosion, systematic colpocytological monitoring is indicated to reduce the likelihood of developing pathological precancerous conditions. With cervical ectopia, the prognosis is favorable.

The main thing is to remember that the development of any disease is easier to prevent than to treat it later. Therefore, each patient must independently take care of her well-being and health, so that in the future she will be able to become pregnant and bear a child. A systematic annual gynecological examination is the key to timely detection of precancerous conditions of the female reproductive system.

Video: how to treat cervical ectopia

Video: cervical ectopia

Video: Concept, causes and methods of treatment of ectopia (erosion) of the cervix

Video: signs and treatment of chronic cervicitis

Video: treatment of colpitis, cervicitis and erosions with natural suppositories

To answer the question of what ectopia is, it is necessary to understand the essence of the process occurring in a woman’s body.

The term ectopia refers to the movement of the layer of cells and mucous membrane (epithelium) covering the cervical canal to the outer part of the entrance to the uterus.

This false erosion is characterized by the growth of the inner layer of the uterine canal into its outer part and manifests itself as redness, noticeable during a medical examination.

Cervical ectopia does not cause damage to the mucous membrane, so it is not a disease, but in case of complications, it becomes a risk area for the development of pathologies.

That is why it is necessary to know the symptoms of a possible disease in order to promptly treat cervical ectopia in order to eliminate complications.

Typically, gynecologists believe that ectopic columnar epithelium of the cervical pharynx is normal in 40% of women of childbearing age. Based on its origin, it is divided into congenital and acquired and in the absence of pathology is invisible to perception.

The fact is that between the external pharynx and the anatomical internal pharynx of the cervix, the cervical canal is located. If the vagina and external os are covered with stratified squamous epithelium, then the canal is covered with columnar epithelium, which produces mucus. It acts as a protective barrier for the body and at the same time promotes the penetration of sperm.

Normally, this cylindrical epithelium should not extend beyond the canal, and if this happens, the process is called ectopia of the cervix.

Congenital pseudo-erosion occurs as a result of hormonal imbalance or genetic predisposition. If an acquired disorder manifests itself, it is necessary to establish the reasons why cervical ectopia may occur.

So, the causes of acquired false erosion may be:

1. disruption of the body's immune system;
2. injury to the external os or cervical canal;
3. infection and associated inflammatory process;
4. ovarian dysfunction;
5. genetic predisposition;
6. changes in hormonal levels.

Even acquired pseudo-erosion may not manifest itself in an uncomplicated form, and only pathological changes. such as ectopia of the cervix, and its symptoms give cause for concern.

The following symptoms may be a reason to consult a doctor:

• o presence of bleeding after sexual intercourse;
• o pain that occurs during intimacy;
• o itching sensation;
• o presence of leucorrhoea;
• o disturbance in the menstrual cycle.

If there is at least one of the signs listed above, you must contact a gynecologist for a comprehensive examination.

If pathology is detected, ectopia of the cervix and its treatment at an early stage always gives the best result and is a guarantee of effective therapy.

Methods for diagnosing ectopia

The existing ectopia of the cervix is ​​confirmed by visiting a gynecologist, who can make a diagnosis and visually determine the need for further procedures.

Acquired pseudo-erosion can be established from the patient’s words or on the basis of a medical record. The need for treatment can be reliably established only after a comprehensive laboratory and clinical diagnosis.

A confirmed diagnosis is made based on the following data:

1. analysis of the development of the disease, the appearance of pain, discharge, leucorrhoea, itching;
2. the presence of hereditary, transmitted and sexually transmitted diseases;
3. terms and dates of the menstrual cycle;
4. the presence of gynecological diseases, surgical intervention and the number of births and pregnancies;
5. a gynecological examination is performed;
6. if necessary, analysis of colposcopy data;
7. results of studies of the cytological method;
8. biopsy analysis;
9. analysis of hormonal disorders;
10. presence of sexually transmitted diseases.

The need for such a detailed study is based on the possible development of oncological and other formations against the background of such a diagnosis as cervical ectopia.

The focus of pseudo-erosion on the external pharynx is noticeable upon examination, but in some cases there is a need for a more thorough examination using the colposcopy method. The method makes it possible to identify in detail both areas of isolation of columnar epithelium and zones of transformation.

As a result of summing up all the data, it is possible to classify the presence of ectopia according to the degree of possible development of the disease. The attending physician can assess the woman’s health, both by clinical condition and by cellular composition based on histology results. The need for treatment and strategy will depend on the type of ectopia and the degree of its development.

The growth of CE (cylindrical epithelium), in an insignificant size and not representing a wound open to infection, is qualified as uncomplicated ectopia. It does not require treatment, but requires periodic examination by a doctor. Whereas the complicated nature of the development of pseudo-erosion is an open wound and is the source of the possible occurrence of a focus of the disease.

As for the composition of the cells of the tissues of the external pharynx of the cervix, there are three main manifestations, namely:

• glandular ectopia, histology confirms the presence of glandular formations with an existing inflammatory process;
• epidermal ectopia, among the expanded CE there are obvious foci of squamous epithelium, prone to self-healing and not requiring treatment;
• papillary ectopia, when the CE has the appearance of papillae with its own vascular loop.

Based on these diagnostic signs, the gynecologist determines the need for treatment of pseudo-erosion and selects the most effective ones for each specific case.

How is false erosion treated?

The need for one or another method of treatment, as well as the choice of method and strategy, is decided by the gynecologist; we will only consider the main methods of therapy.

The goal of treating ectopia is to destroy the columnar epithelium extending beyond the cervical canal. After this, flat, stratified epithelium grows into the space surrounding the external os of the cervix.

Methods of influencing CE can be based on chemical, thermal and physical principles and consist of the following types:

• pharmacological and chemical coagulation, serves to destroy the epithelium with a mixture of acids or using drug treatment;
• electrosurgery, while highly effective, often causes complications during coagulation;
• radio wave surgery, an effective method that does not leave scars;
• cryosurgery, exposure of the affected area using low temperatures;
• thermocoagulation, cauterization, requires local anesthesia;
• laser destruction, CO2 laser is used, does not lead to damage or bleeding, is highly accurate;
• surgical methods, direct impact on the area of ​​manifestation of ectopia.

The chemical method of exposure is also carried out using a physiotherapeutic method with zinc, and using the drugs Solkovagin and Vagotil. With the medicinal method, doctors use the drug Vulnostimulin, which can be combined with other types of treatment.

The radio wave method involves the use of high-frequency radiation, which evaporates the upper layer of the CE and allows squamous epithelium to appear. The method does not cause complications in the form of scars, therefore it is popular among patients planning subsequent conception.

Cryodestruction affects the lesion by deep freezing and thawing, but its effectiveness is not very high, since it is quite difficult to assess the depth of the effect in each particular case.

Thermocoagulation gives a good effect and consists of cauterizing the CE with the aim of replacing it with squamous epithelium in the future. The method is painful and has a long healing process.

Laser destruction is the most precise method and does not damage healthy tissue, and in case of bleeding, it allows for coagulation of damaged vessels. The method is characterized by increased efficiency.

After treatment, a gentle regime is necessary. There is a risk of rebleeding or other adverse effects.

To avoid this, you need to fulfill a number of simple requirements, namely:

1. abstain from sexual activity for a month, there is a risk of damage to the healing wound and infection;
2. physical activity is contraindicated, since muscle tension can cause bleeding;
3. do not use tampons or douche;
4. do not overcool to avoid infection of the body;
5. In case of any ailments, consult your doctor.

In the future, in order to prevent relapses, it is necessary to visit the gynecological office at least twice a year, promptly treat genitourinary diseases, and also avoid hypothermia. You need to be selective in choosing sexual partners, maintain hygiene and lead a healthy lifestyle.

We examined ectopia of the cervix, comprehensively covering the causes, symptoms, and treatment for diseases. Pseudoerosion does not always require treatment, but you should always monitor your health.

Inattention can lead to a condition where treatment is lengthy, expensive and not always effective. Take care of yourself and consult a doctor if you have the slightest ailment.

Cervical ectopia is an atypical localization of cuboidal (cylindrical) epithelium, which lines the inner part of the cervical canal, on the vaginal part of the cervix; during normal development of the body, it is covered with squamous epithelium. If ectopia of the uterus is not complicated, then it does not give a clinic; if they are present, then there is a possibility of bleeding, dyspareunia, itching in the genital area, and leucorrhoea. This disease can be diagnosed during a gynecological examination, and the diagnosis is clarified through the use of extended colposcopy, cytological analysis of scrapings, and, if necessary, biopsy.

First of all, you need to find out what cervical ectopia of the cervix is, and only then move on to the specifics of treating this disease. The following terms are used to refer to the disease in gynecology: endocervicosis, false erosion, glandular muscle hyperplasia, pseudo-erosion. In the normal state of the body, the vaginal part of the uterus, which can be examined without the use of electronic equipment, is covered on the outside by a multilayered squamous epithelial layer, but the inside of the cervical canal is lined directly with columnar epithelium.

Ectopic cervix

During the development of this disease, the border of the transition of cylindrical to squamous epithelium shifts towards the external pharynx, localizing locally or along its circumference. Ectopia is determined in 40% of the fairer sex, and in 11.3% of patients this feature passes into the congenital stage. The maximum incidence of cervical ectopia (approximately 45%) is diagnosed in women under 30 years of age. The disease is fraught with serious complications, however, ectopia alone can never lead to cervical cancer, although the disease increases the likelihood of such serious consequences.

By origin, acquired and congenital ectopia of the cervix can be distinguished. Pseudo-erosion can have a recurrent course, while the clinical form is complex and significantly complicated. Modern calposcopic nomenclature is able to consider uncomplicated ectopia of the cervix as a normal phenomenon and one of the variants of the physiological condition. If there are complications of ectopia, care should be taken for treatment; ectopia of the cervix in this case will be accompanied by cervicitis and colpitis.

With the loss of the relationship between stromal and epithelial cells, ectopia can be considered as ectropion. Histologically, there are papillary, glandular ectopia of the cervix, as well as pseudo-erosion along with squamous metaplasia. With the glandular variety, the accumulation of glands with fairly branched glandular ducts, manifestations of the inflammatory process, is determined. In the presence of papillary ectopia, there is a possibility of proliferation of stromal elements and the formation of papillary structures that are covered by columnar epithelium.

Regeneration of cervical ectopia may be accompanied by reverse pinching of the columnar epithelium by cells of squamous mature epithelium, that is, the formation of a transformation area. Spare cells will be involved in this process; as a result of differentiation, they first turn into immature and then into metaplastic epithelium of a mature type.

The implementation of colcoscopy allows you to find the difference in completed and unfinished areas of transformation. If adverse effects are present, then cellular metaplasia may break off, causing recurrence of cervical ectopia. If there is an overlap of the metaplastic layer of cells at the mouth of the cervical glands, Nabothian cysts are formed, that is, retention-type cervical cysts.

Before starting treatment, it is necessary to determine the reasons for the ectopia of the columnar epithelium of the cervix. This is very important because this information is used in the treatment of this disease. Further treatment therapy directly depends on the factor that led to the occurrence of this pathological condition. Let's look at each reason in more detail, they include the following factors:

1. Hormonal imbalance. This is one of the main causes of ectopia, the fact is that the problem does not occur at all in girls during menopause, and approximately 50% of all women of reproductive age had problems with this pathology. As a result of such observations, it was possible to establish that changes in the cylindrical epithelium are carried out under the influence of various hormones. In this case, it will not lead to a slow inflammatory process, because the mucous membranes of the cervix are not damaged. A prerequisite for the appearance of cancer is only the area of ​​​​transformation of the epithelium.
2. Inflammatory process in the cervix area. The presence of sexually transmitted diseases, as well as cystitis in a recurrent form, adnexitis and other stages of inflammation of the elements of the reproductive system, leads to exfoliation of the squamous epithelium on the external os of the cervical canal. Inflammation does not disappear anywhere; on the contrary, the process of its progression continues. This course makes the cervix quite vulnerable to the occurrence of cancer: on the surface you can notice not only the transformation zone, but also a sluggish inflammatory process.
3. Mechanical injury. A non-healing wound may occur on the surface of the cervical canal, which may be the result of violent sexual intercourse, the result of birth injuries, or the use of vaginal contraceptives or suppositories. In this case, cervical ectopia poses a danger not only due to the degeneration of epithelial cells into cancerous ones, but also due to the lack of protection against various infectious diseases.

There may be several reasons for the appearance of cervical ectopia

Each of the above factors leads to the occurrence of this disease. You first need to determine the exact cause of this condition, and only then move on to treating the problem.

Treatment

Colcoscopy is used as a diagnostic measure for ectopia. There are two types of examination: conventional and extended colposcopy. As a rule, to clarify the exact diagnosis, it is enough to conduct a simple examination using gynecological speculum.

In situations where a specialist needs to determine the type of ectopia, extended type colposcopy is used, in which the pathologically altered area of ​​the cervix is ​​examined under several times magnification through the use of a colposcope.

Modern therapeutic measures include a large number of methods to combat erosion. Some of them do not have scars, so they are suitable for those representatives of the fairer sex who wish to become pregnant in the future. For this reason, you need to choose the method that your doctor recommends, but he needs to know exactly about your future plans. For treatment the following are used:

• radio wave surgery;
• cryodestruction;
• thermocoagulation;
• laser destruction.

Each of these methods has a number of positive aspects and shows good results in the treatment of such a complex disease. The choice of a specific method depends on various factors, primarily on the cause of the pathology, the degree of damage to the body, the woman’s age and desire to become pregnant in the future. Ectopia of the cylindrical epithelium of the cervix, like ectopia, is a rather dangerous problem, since at any moment it can acquire a malignant nature, which is fraught with serious consequences. At the same time, a large number of women face this problem; if there are no complications and reproductive functions are realized normally, then there is no reason to worry, and experts do not recommend resorting to radical treatment.