- defect, damage to the squamous epithelium of the cervix on its vaginal part around the external os. More often occurs due to endocervicitis and other inflammatory diseases of the genital area, hormonal disorders in the female body. The course can be asymptomatic or manifested by pathological discharge of a mucopurulent, sometimes bloody nature, pulling pains in the sacrum. It is a risk factor for the occurrence of neoplasms of the cervix (polyps, cancer). The main methods for diagnosing cervical erosion are examination of the cervix in the mirrors and colposcopy. In the treatment methods of diathermocoagulation, laser vaporization and cryodestruction, as well as the radio wave method can be used.

The causes of cervical erosion can be different. Changes in the cervical mucosa can develop after childbirth, abortion, due to inflammatory diseases of the cervix, hormonal disorders. A common cause of cervical erosion is sexual infections - chlamydia, bacterial vaginosis, ureaplasmosis, trichomoniasis, etc., the pathogens of which, penetrating into the damaged mucosa, cause inflammation in it. Cervical erosion can occur in adolescence and in nulliparous women.

Types of cervical erosion

Cervical erosions are of the following types:

• true;
• congenital.

True erosion of the cervix

It is customary to call true erosion of the cervix, which is formed as a result of damage and desquamation of the squamous epithelium around the external pharynx of the vaginal part of the cervix. For true erosion of the cervix, the formation of a wound surface with signs of inflammation is characteristic. The most common cause of the development of true erosion of the cervix is ​​irritation of the mucosa with pathological secretions of the cervical canal during endocervicitis. True erosion is usually bright red, irregularly rounded, and bleeds easily on contact. Colposcopic examination and microscopy of the eroded surface show dilated vessels, swelling, infiltration, traces of fibrin, blood, and mucopurulent secretions. After 1-2 weeks, true erosion passes into the healing stage - pseudo-erosion.

pseudo-erosion

In the process of healing, the defect of the squamous epithelium is replaced by a cylindrical one, extending to the erosive surface from the cervical canal. The cells of the columnar epithelium have a brighter color compared to the cells of the stratified squamous epithelium, and the erosive surface remains bright red.

The stage of replacement of squamous epithelial cells with cylindrical ones is the first stage of healing of true erosion of the cervix. Usually at this stage, cervical erosion is diagnosed by a gynecologist.

The growth of the cylindrical epithelium occurs not only along the surface of erosion, but also in depth with the formation of branching glandular passages. In the erosive glands, a secret is released and accumulates, with difficulty in the outflow of which cysts are formed - from the smallest - to those visible during visual inspection and colposcopy. Sometimes large cysts located near the external pharynx superficially resemble cervical polyps. Multiple cysts lead to thickening - hypertrophy of the cervix.

There are pseudo-erosion:

• follicular (glandular) - having pronounced glandular passages and cysts;
• papillary - having papillary growths on the surface with signs of inflammation;
• glandular-papillary or mixed - combining the signs of the first two types.

Pseudo-erosion without treatment can persist for several months and years until the causes of its development and existence are eliminated. Pseudo-erosion itself is a source of inflammation in the cervix due to the presence of infection in the erosive glands.

When the inflammation subsides on its own or as a result of treatment, the process of reverse replacement of the cylindrical epithelium with a flat one occurs, i.e., the restoration of the normal integumentary epithelium of the cervix is ​​the second stage of erosion healing. In place of healed erosion, small cysts (nabotovy cysts) often remain, which are formed as a result of blockage of the ducts of the erosive glands.

Prolonged course of pseudo-erosion and concomitant inflammatory process can lead to pathological changes in epithelial cells - atypia and dysplasia. Erosion of the cervix with the presence of epithelial dysplasia is considered as a precancerous disease.

Pseudo-erosion can be small (from 3 to 5 mm) or capture a significant part of the vaginal segment of the cervix. The predominant localization is around the external os or along the posterior edge (lip) of the cervix. Pseudo-erosion is a modified area of ​​the mucous membrane of irregular shape, with a bright red color, velvety or uneven surface, covered with mucous or pus-like secretions. Along the edges of the healing pseudo-erosion, areas of pale pink squamous epithelium and naboth cysts are visible.

Pseudo-erosion, especially papillary, bleed easily during sexual intercourse and instrumental studies. Also, increased bleeding is noted with pseudo-erosion dysplasia and during pregnancy. The healing of pseudo-erosion is considered complete if the erosive glands and columnar epithelium are rejected and the squamous epithelium is restored over the entire surface of the defect.

Congenital erosion of the cervix

The formation of congenital erosions of the cervix occurs as a result of the displacement of the boundaries of the cylindrical epithelium lining the cervical canal beyond its limits. The displacement (ectopia) of the epithelium occurs even in the prenatal period of fetal development, therefore such erosions are considered congenital.

Congenital erosion of the cervix usually occupies a small area along the line of the external os, has a bright red color, and a flat surface. An objective examination (in the mirrors or colposcopy) shows no pathological secretion from the cervical canal and no symptoms of inflammation.

Congenital erosions of the cervix are detected in childhood and adolescence, often self-healing. If congenital erosion persists until the sexually mature period, its infection, inflammation and subsequent changes are possible. Occasionally, against the background of congenital erosions of the cervix, flat warts develop, malignancy of congenital erosions is not observed.

Causes and mechanism of development of cervical erosion

In the question of the causes and mechanism of development of cervical erosion, the leading role belongs to the inflammatory theory of the origin of the disease. Endocervicitis and cervicitis, accompanied by pathological secretion from the cervical canal and uterus, lead to irritation of the epithelial cover in the area of ​​the external pharynx and subsequent rejection of the epithelium. True erosion is formed, which is inhabited by the microflora of the vagina and cervix.

Dishormonal theory puts forward a change in the level of sex hormones-steroids as the cause of the development of cervical erosion. Clinical observations show the appearance of cervical erosion during pregnancy and regression in the postpartum period with the stabilization of the hormonal background.

Erosions are also formed during ectropion (eversion) of the mucous membrane of the cervical canal during birth injuries. Erosions of the cervix (pseudo-erosion - follicular, papillary, mixed), characterized by a long, persistent, recurrent course, not amenable to conservative therapy, having microscopic signs of dysplasia, prone to contact bleeding, are regarded as precancerous diseases.

Diagnosis of erosion and pseudo-erosion of the cervix

Diagnosis of cervical erosion is often difficult due to the absence of characteristic complaints of the patient or the asymptomatic course of the disease. Changes in the subjective state are usually caused by a disease that causes erosion. Therefore, the main diagnostic methods are visual examination of the cervix in the mirrors and colposcopy, which allows you to examine the pathological focus in detail under multiple magnification.

The method of extended colposcopy is used for suspected malignancy of cervical erosion. The erosion zone is treated with a 5% alcohol solution of iodine and examined under a colposcope. True erosion (pseudo-erosion) has a light pink color, the dysplasia zone is yellow, atypical foci are white. If areas of erosion are found that are doubtful in terms of dysplasia, a targeted biopsy of the cervix is ​​\u200b\u200bperformed with a histological analysis of the tissue obtained.

Treatment of erosion and pseudo-erosion of the cervix

In the treatment of cervical erosion, practical gynecology adheres to the following rules:

• observation of congenital erosions, no need for their treatment;
• true erosions and pseudo-erosions are treated simultaneously with the background diseases that caused or support them;
• if there are signs of inflammation, the therapy should be directed to infectious agents (trichoionads, chlamydia, gonococci, etc.);
• erosion in the active stage of inflammation is treated with sparing methods (vaginal tampons with sea buckthorn oil, fish oil, synthomycin emulsion, aerosols containing antibiotics - chloramphenicol, etc.).

Modern approaches to the treatment of cervical erosion are based on the use of the mechanism of destruction of cells of the cylindrical epithelium, their rejection and subsequent restoration of the squamous epithelium on the surface of pseudo-erosion. For this purpose, the methods of diathermocoagulation, laser vaporization, cryodestruction, and the radio wave method are used.

Diathermocoagulation is a method of cauterization of altered tissue by the action of an alternating high-frequency electric current, which causes significant tissue heating. Coagulation is not used in nulliparous patients because of the risk of scarring that prevents the opening of the cervix during childbirth. The method is traumatic, rejection of necrosis of the coagulated surface may be accompanied by bleeding. Complete healing after diathermocoagulation occurs after 1.5-3 months. After diathermocoagulation, endometriosis often develops, so it is advisable to plan the procedure for the second phase of the menstrual cycle.

Laser vaporization or "cauterization" of cervical erosion with a laser beam is carried out on the 5-7th day of the menstrual cycle. Before laser vaporization, the patient undergoes a course of thorough sanitation of the vagina and cervix. The procedure is painless, does not leave a scar on the cervix, and therefore does not complicate the course of subsequent births. Laser destruction of altered tissues causes rapid rejection of the necrosis zone, early epithelialization and complete regeneration of the wound surface already a month later.

Cryodestruction (cryocoagulation) is based on freezing, cold destruction of cervical erosion tissues with liquid nitrogen or nitrous oxide. In comparison with diathermocoagulation, cryocoagulation is painless, bloodless, does not entail the consequences of cicatricial narrowing of the cervical canal, is characterized by relatively rapid epithelialization of the wound surface after rejection of necrosis. The first day after cryodestruction, there are abundant liquid secretions, swelling of the cervix. Complete epithelialization of the defect occurs after 1-1.5 months.

Radio wave treatment of cervical erosion with the Surgitron apparatus consists in exposing the pathological focus to ultra-high frequency electromagnetic oscillations - radio waves that a person does not physically feel. The procedure takes less than a minute, does not require anesthesia and further postoperative treatment. The radio wave method in the treatment of cervical erosion is recommended for previously nulliparous women, since it does not lead to the formation of burns and scars that make childbirth difficult.

Diathermocoagulation, laser vaporization, cryodestruction, radio wave treatment is carried out after extended colposcopy and targeted biopsy to exclude the oncological process. If malignant degeneration of cervical erosion is suspected, radical surgical treatment is indicated. Even after curing cervical erosion by one of these methods, a woman should be registered with a dispensary and observed by a gynecologist.

All women know that they should visit the gynecologist as planned once every six months. But at the same time, they usually do this rarely, waiting for either the appearance of unpleasant symptoms or pregnancy. At the same time, diseases of the cervix usually proceed secretly and can lead to negative consequences for the female body as a whole. Therefore, in no case should you refuse to visit a gynecologist, based on the alleged absence of complaints or some personal prejudices and fears. 1

What is it and how does it appear

Almost every second patient is diagnosed with cervical erosion at a gynecologist's appointment. In general, the disease is one of the most common pathologies in women of childbearing age. But what is cervical erosion? This is a violation of the integrity, defect or ulceration of its mucous membrane in the vaginal part. Erosion becomes a gateway for infection to enter the uterus and appendages and can provoke the development of chronic inflammatory diseases of the pelvic organs up to the onset of infertility. The most dangerous complication of cervical erosion is its degeneration into a malignant formation. That is why it is so important to identify it as soon as possible. 1

There are many causes and provoking factors for the occurrence of this disease, but the main ones are: 2

Hormonal disorders and decreased immunity, disruptions in the menstrual cycle;

Too early onset of sexual activity, as well as early pregnancy and childbirth;

Frequent change of sexual partners;

Poor personal hygiene;

Mechanical trauma as a result of difficult childbirth, abortion and other medical manipulations; due to incorrect use of vaginal contraceptives or erroneous douching, or too rough sex;

Inflammatory and infectious diseases of the urogenital area, including their untimely and improper treatment;

Bacterial and viral diseases;

Unfavorable heredity.

Symptoms 2

The situation with cervical erosion is complicated by the fact that this disease does not have pronounced symptoms and in most cases does not manifest itself at all. But in the course of the development of erosion, patients may begin to notice in themselves:

Bloody and sometimes purulent discharge between periods, which may occur, for example, after sexual intercourse.

Profuse vaginal discharge with an unpleasant odor.

Longer and more profuse menstruation.

Pain in the lower abdomen during urination or sexual intercourse.

During the examination of the patient, the gynecologist first examines the cervix in the mirrors. As a result, an epithelium defect may be found on its mucous membrane (epithelium are the cells that cover the vaginal part of the cervix and protect it) in the form of a bright red spot against the background of healthy tissues, which will bleed upon contact with a gynecological instrument. Depending on the types of erosion, there will be other external signs of the disease.

But in any case, colposcopy is additionally performed (examination of the cervix and vagina under magnification) and examination of a cell smear from the erosion surface to exclude oncological diseases. Examination of the cervix using an optical device that magnifies the image by 25-32 times is absolutely painless. These manipulations enable the doctor to make an accurate diagnosis and prescribe treatment. In addition, tests are carried out for infections and sexually transmitted viruses, HIV and hepatitis, swabs are taken for flora, etc. 1

Types of cervical erosion 1

In gynecology, several types of cervical erosion are distinguished: true, pseudo-erosion and congenital. The true appearance is precisely that bright red spot that bleeds when pressed and is found during a routine gynecological examination. Such erosion is dangerous because pus can form on the affected area. As a rule, true erosion lasts about two weeks, then it is covered with connective tissues and develops into pseudo-erosion.

Pseudo-erosion of the cervix is ​​a rounded red area about 5 mm in size, on top of which pus can also appear, especially if the disease has been going on for a long time, which most often happens. Pseudo-erosion is typical for girls with an increased level of female hormones in the blood and can go beyond the cervical canal. The danger of pseudo-erosion is that it can develop into a malignant formation.

Sometimes, when examining girls or adolescents, a gynecologist may find that the cylindrical epithelium in the cervix is ​​​​displaced, and on colposcopy it will be seen that it is colored bright red. This is the so-called congenital erosion, which does not need to be treated, since it almost never develops into an oncological formation.

Treatment 3

Treatment of cervical erosion is mandatory, because leaving this disease unattended is the cause of both benign and malignant formations. It can also lead to the development of severe forms of the disease. Timely complex treatment will not only in no way harm women's health, but will positively affect it in general. Of course, treatment must be individualized.

Non-surgical treatment of cervical erosion can also be effective, the specific method of which is chosen depending on the severity of the course of the disease, the size, structure of the lesion and the presence of concomitant diseases. As part of the drug treatment of erosion, patients are prescribed anti-inflammatory and hormonal drugs, as well as antibacterial and antiviral agents, including topical preparations. As an adjuvant therapy, usually prescribed aimed at increasing immunity and restorative drugs. If the pathology was detected in the early stages, it can be completely cured without the use of surgical methods.

Surgical treatment 3

Some cases of cervical erosion require surgical treatment, which today can be carried out in several effective ways:

1. Laser removal is the most effective and modern method that can provide the highest incision accuracy and at the same time keep healthy tissues intact. As a result, everything heals quite quickly (in 4-6 weeks) and without scarring. As a rule, laser treatment is prescribed for women who have not given birth.

2. Cryodestruction - treatment of the cervix with liquid nitrogen, that is, its freezing. When interacting with nitrogen, the water in the tissue cells turns into crystals, as a result of which the cellular structure of the affected area of ​​the cervix will be destroyed. The healing period in this case is 8-10 weeks, but this method of treatment implies a subsequent long-term observation, since the surface layer can also be damaged along with unhealthy cells.

3. Diathermocoagulation - burning of cervical erosion with high frequency electric current. This is the most common way to treat this pathology in antenatal clinics, but it is also very painful, with subsequent scarring. This treatment is recommended for women who already have children and do not plan to give birth further.

4. Chemical coagulation - during this method, the damaged area of ​​the cervix is ​​treated with special preparations aimed at corroding diseased cells. Scars do not remain after this, so the treatment is also suitable for those who have not given birth.

5. Radio wave treatment - the area of ​​the cervix with erosion is treated with high energy of radio waves, and since there is no pressure on the tissue, tissue damage is minimal. A burn is completely excluded, because this method is based on the evaporation of water molecules from damaged cells. As a result, there are no scars, and the healing time is halved, amounting to about 3-5 weeks. Radio wave treatment is painless.

6. Electroexcision - cutting out the affected area of ​​the cervix.

There is an opinion that it is not required to treat cervical erosion in women who have not given birth. Yes, if erosion of the cervix of a small size is observed, this is sometimes considered as a physiological norm and no types of intervention in the body are prescribed, except for constant monitoring. But we must remember that even such erosion is a gateway for infections, which means that it can indirectly contribute to the occurrence of diseases of the genital organs. 4

Previously, the treatment of women who had not given birth was undesirable, because there were no gentle methods. But today there are all conditions, so it is impossible to postpone the treatment of erosion.

Do's and don'ts after treatment

No matter how the treatment of cervical erosion is carried out, after it certain recommendations must be followed, which, in particular, include a complete renunciation of sexual life for 6 weeks. It will be possible to have sex again only after the permission of the gynecologist, obtained on the basis of an examination of the cervix.

Also at this time it is advisable to refuse to visit baths, saunas, swimming pools and taking a bath. No need to temporarily use sanitary tampons. There are restrictions on lifting weights and on intense physical activity.

Alternative methods of treating erosion, usually consisting of tampons with one or another remedy and various types of douching, cannot actually cure this pathology. However, some of them are suitable for recovery in the postoperative period. 6

Also, after treatment, women should monitor the condition of vaginal discharge, an increase in which is a normal component of normal recovery. If the discharge is clear and slightly bloody, pink or brown in color and not profuse, then there is no need to worry. Everything proceeds without complications. After 8-20 days after the operation, slight bleeding is possible, which will end on its own in a few hours. This is a normal physiological process. But if the discharge is profuse, bloody and accompanied by pain and fever, you should consult a doctor as soon as possible or call an ambulance, because this condition requires immediate intervention. 3

However, as with any discomfort in the gynecological field, it is always better to play it safe. After successful treatment of cervical erosion, women can plan pregnancy without fear. Especially if at the same time treatment for all chronic diseases was carried out. There are no contraindications for conception after modern operations, or, even more so, after non-surgical treatment of cervical erosion.

Prevention of cervical erosion 5

Answering the question of what cervical erosion is, one cannot but say about the methods of its prevention. The most important and important preventive measure is regular examinations by a gynecologist (it is desirable that there is a permanent attending physician), who can promptly identify and eliminate any changes in the mucous membrane of the cervix and vagina. In addition, great attention should be paid to the treatment of other diseases of the reproductive system, which can also lead to damage to the mucosa, which can later cause erosion of the cervix. Since a woman, as a rule, does not experience any symptoms with this pathology (except for rare discomfort during sexual intercourse and minor bleeding after it), there are no specific recommendations. Of course, it is also important to observe the rules of personal hygiene, and to have a permanent sexual partner with the avoidance of casual relationships, but these are general norms for maintaining women's health in general. To identify and cure erosion of the cervix, without waiting for its serious consequences, is possible only through constant, once every six months, preventive examinations by a gynecologist. This is her main prevention. Knowing what cervical erosion is and what is the prevalence of this disease, you should not be too afraid of it, especially given the variety of sparing treatment options. Rather, you need to be wary of the consequences of the lack of timely treatment, as this is fraught with a variety of complications up to the oncological diseases. Erosion is perfectly treated today, there is no need to try to resort to folk methods, which, with their apparent external effectiveness, can only exacerbate this problem.

• 1. Prilepskaya V. N., Rudakova E. B., Kononov A. V. Ectopia and erosion of the cervix //M.: MEDpress-inform. - 2002. - T. 6. C 18
• 2. Ovsienko A. B., Zekoreeva Z. M. Causes of occurrence and progression of cervical ectopia // Resort Medicine © 2012. P. 16-18
• 3. Burtushkina N. K. Methods for the treatment of benign diseases of the cervix // Siberian Medical Journal (Irkutsk). - 2009. - T. 87. - No. 4. From 34
• 4. Ievleva N. F., Chizhova G. V. Modern approach to the treatment of pathologies of the cervix in young nulliparous women //Bulletin of physiology and pathology of respiration. - 2002. - no. 11. p. 12
• 5. Gracheva E. A. Cervical erosion // Modern view on treatment and prevention. Doctor advises: health tactics and strategy. St. Petersburg: All. - 2005. - T. 128. S. 44-58
• 6. Botoeva E. A. Phytotherapy in gynecology // Bulletin of the Buryat State University - 2012. - no. 12. p. 23

Cervical erosion causes- this is a list of mechanisms that provoke the formation of local wound damage on the cervix. In fact, true erosion is an open wound (shallow ulcer), an area without surface epithelium with an exposed underlying layer, glands and vessels. The reasons for its development are varied and are still being studied.

The cervix has the appearance of a hollow tube, and the cervical canal that lies inside communicates with the vaginal and uterine cavities. Two physiological narrowings of the cervical canal, called "pharynx", are located at the base of the uterine and vaginal ends. The external os is visible at the base of the cervix on normal examination.

From the inside, the cervical canal is lined with cylindrical epithelial cells. The surface of the cervix, like the vagina, is covered with a squamous epithelium arranged in several rows. The upper row of flat cells is constantly updated, thus protecting the genital tract from unwanted infections and inflammation. Inside the external pharynx, on the border separating the cervical epithelium from the mucous membrane of the cervical canal, there is a "transformation zone". Due to its deep location, it is impossible to see it without the appropriate equipment.

Under the influence of traumatic factors, sometimes a wound (ulcer) is formed on the surface of the cervix - a true erosion of the cervix. The causes of cervical erosion are ambiguous, sometimes they even depend on lifestyle. However, the external characteristics and cellular structure of all erosions are identical: they are formed only with the participation of ordinary cells present on the neck or in its canal.

Damage of any origin on the surface of the cervical mucosa, like wounds of other localization, epithelialize with the help of the growth of the surrounding elements, that is, from the reserve cells of the stratified squamous epithelium. The healing process of the damaged mucosa occurs regardless of the cause of cervical erosion, epithelialization usually does not take more than two weeks, and in the absence of complications, it is asymptomatic. True erosion due to a short existence and asymptomatic course are observed by doctors infrequently (2%).

Sometimes the eroded surface on the neck does not heal correctly: the cylindrical epithelium lining the inside of the cervical canal crawls onto the damaged surface and closes it. The open wound is eliminated, but a visible defect remains on the surface of the neck - a mucosal area formed by "wrong" cells, called false erosion (ectopia). Almost all diagnosed erosions are ectopic columnar epithelium. They form in children and nulliparous girls, accompany every fifth gynecological disease, and are diagnosed in half of the patients who have undergone surgery.

Thus, there are two successive stages of a single process: damage to the cervical epithelium (true erosion) and incorrect restoration of its integrity (ectopia). Therefore, the oral use of the term "erosion" in all cases is fully justified.

An exception is congenital erosion of the cervix. The reasons for the formation of erosion on the neck in utero are non-traumatic in nature, it is always a false erosion, and not an open ulcer.

Perhaps it is hardly possible to find an adult woman who does not know about the gynecological pathology called. However, patients should remember that under the primary conclusion with the wording "cervical erosion" may well mean true, false (ectopia) or congenital erosion. Detailing the pathological process on the cervical mucosa is carried out during additional diagnostic measures.

Causes of cervical erosion

According to the causes of cervical erosion, it is classified:

- Traumatic erosion of the cervix. The reasons for the formation of a wound surface on the neck: abortion, severe traumatic childbirth, instrumental surgical manipulations. In elderly patients with displacement of the genital organs, an ulcer on the cervix causes mechanical damage to the mucosa when using a uterine pessary (ring).

- Specific erosion of the cervix, the causes of which may be far from the genitals. It is diagnosed very rarely in patients with or.

Sexual infections can also cause damage to the cervix. As a rule, they are detected and eliminated quickly enough, and the cervix does not have time to be damaged. Erosion against the background of genital infections can appear only if they have a long-term negative impact on the epithelium of the cervix.

- Inflammatory erosion of the cervix, the causes of which are always infectious. Some infections are so aggressive that they can cause the development of local inflammation on the neck, followed by necrosis and rejection of the pathological infected area. Inflammatory erosions are always accompanied by signs of an infectious lesion: edema, hyperemia, purulent plaque and slight bloody discharge from damaged vessels.

- Burn erosion. Diagnosed as a result of therapeutic measures. To eliminate false cervical erosion, several methods are used that have a common goal - the destruction of the modified focus and the subsequent restoration of the proper mucous layer above the surface of the former erosion. More often they resort to electrocoagulation (“cauterization”), cryodestruction (“freezing”), chemical treatment or laser exposure. Regardless of the method of exposure, further events have a single scenario: the surface layer of the "wrong" cells dies, forming a scab (crust), which covers the underlying mucous layer. Under the scab, recovery processes begin, and, as the mucosa heals, the crust is gradually rejected. If epithelialization does not occur correctly, the scab falls off prematurely, leaving behind an uncovered ulcer (true erosion).

- Trophic erosion of the cervix, the causes of which lie in violations of the process of normal nutrition and blood circulation of tissues. It is often diagnosed during menopause in conditions of hypoestrogenism and atrophic processes in the mucous membranes of the genitals.

— Physiological erosion. For unknown reasons, it appears in healthy women up to the age of 25, and then disappears without a trace without external intervention.

The state of immune defense mechanisms significantly affect the course and outcome of erosion therapy.

Causes of cervical erosion in nulliparous

The opinion among patients that erosions appear on the neck only in adult women after childbirth is absolutely wrong. Cervical erosion also occurs in young girls, adolescents, and nulliparous young women. The reasons for the formation of erosion on the "nulliparous" neck can be divided into:

- Congenital. Congenital erosion of the cervix is ​​essentially a physiological ectopia of the cylindrical epithelium. In the prenatal period, the correct formation of the integumentary epithelium of the cervix and cervical canal occurs, and the presence of a zone of cylindrical cells outside the external pharynx is considered the norm. Gradually, as estrogen is “included” in the process of development, the transition zone between the cylindrical and squamous epithelium rises up beyond the external pharynx, therefore it becomes invisible during visual inspection. As a rule, when the time of puberty ends, the congenital false erosion of the cervix also disappears. The reasons why it continues to exist on the neck are often hormonal in nature.

Congenital ectopia is diagnosed during the first visit to the gynecologist after the onset of sexual activity. More often, its presence is accompanied by signs of hormonal dysfunction. Congenital pseudo-erosion is not considered as a disease. They are considered a temporary physiological state of the cervical mucosa and are not treated.

- Acquired. A large group of reasons for the development of erosion, including internal and external provoking factors. Among the internal causes, chronic infectious (including non-gynecological) diseases, a decrease in immune defense, and hormonal dysfunctions dominate.

Early sexual debut (up to 18 years), sexual infections, disordered intimate life, mechanical damage to the cervix during abortions are external causes of cervical erosion.

- Physiological. Sometimes in healthy girls who have not overcome the 25-year-old milestone, a false erosion of the cervix is ​​​​visualized on the neck, the causes of which cannot be established. If such an ectopia passes on its own without outside intervention, it is correlated with a physiological process.

Regardless of the origin, complicated true and false erosions are treated. An unpleasant ability of erosions is their recurrence. The causes of repeated erosion of the cervix are associated with an incorrectly performed procedure for its elimination, when a section of cylindrical epithelium remains on the cervix. Also, a recurrence of erosion can occur due to an incompletely cured background infectious process.

Some patients believe that there are psychological causes of cervical erosion. True erosion is a short-term ulcer on the neck, and false erosion refers to its consequences. Their causes are organic or hormonal in nature, and the significant participation of psycho-emotional disorders in their formation has not been established, so the opinion that there are psychological causes of cervical erosion is incorrect.

Causes of cervical erosion after childbirth

Postpartum true erosion of the cervix always have a traumatic origin. In the process of forward movement of the fetus through the birth canal, the cervix, due to the presence of elastic and muscle fibers, is significantly stretched. With an incorrect birth process, small injuries or even tears appear on the neck.

Despite the fact that all birth injuries of the cervix are carefully sutured, they often become the source of the formation of postpartum erosion. Three or four days after birth, an ulcerated surface with signs of acute inflammation forms on the neck in the area of ​​damage. On visual examination, postpartum erosion is a small, rounded sore of bright red color with pronounced edema around the edges, covered with a dense pus-like coating. At the bottom of the ulcer there are damaged blood vessels, so when touched, the erosion bleeds a little.

Under conditions of well-functioning local immune defense mechanisms, on the fifth day after the appearance, the bottom of the erosion begins to self-clean from necrotic elements, and when the entire damaged surface becomes “clean” (that is, it turns into a normal wound), healing processes start.

Postpartum true erosion is diagnosed in the postpartum department. To prevent the possibility of secondary infection of the wound surface and "help" the neck to cope with the injury, the area of ​​erosion is cleaned of necrotic elements using wipes soaked in disinfectant solutions. When the wound is completely cleansed, proceed to ointment antibacterial applications. Fully epithelialization of the eroded surface ends on the 12th day.

When patients who know that they had postpartum erosion come to the first routine examination and hear that there is “erosion” on the cervix, they are very surprised and ask what are the reasons for repeated erosion of the cervix. In fact, in such a situation, the epithelialization of true postpartum erosion did not occur correctly: instead of the proper stratified epithelium, it was “closed” by the cylindrical epithelium of the cervical canal, and an ectopia was formed.

The principles of treatment of pseudo-erosion formed after childbirth are similar to those in all other patients.

Damage to the mucous membrane of the uterine pharynx in the form of a bleeding wound, slight redness, inflammation, which is accompanied by internal discomfort and blurred symptoms.

This is how many medical sources describe cervical erosion, recalling the prevalence of this disease and the need to eliminate it. But is it worth looking back at the causality of the pathology?

In this article, you will learn what are the causes of cervical erosion in women, what causes the disease and what causes it.

Appearance factors: where does it come from and why does it arise

The latter fact explains the "suddenness" of the diagnosis and the need under the strict supervision of a specialist.

However, in order to develop an effective therapeutic algorithm requires a thorough examination of the patient, as well as an accurate the development of pathology, since it is this point that is decisive in eliminating the problem:

Hormonal causes	Often erosion appears "out of the blue" due to age-related changes: the formation of the hormonal background (in young girls under 21); its instability (with a significant decrease in the level of estrogen and, as a result of which the structure of the epithelium changes); aging of the female body and deficiency of certain hormones. Sometimes even a banal failure of the menstrual cycle leads to the appearance of cervical erosion.
infectious	According to medical sources, the main infectious cause of the development of pathology are: sexually transmitted diseases; diseases of a venereal nature; urogenital/vaginal infections ( , ); candidiasis; vaginal dysbacteriosis; herpes. Each infection is accompanied by an inflammatory process of varying severity, which provokes changes in the mucous membrane, its partial destruction.
Mechanical	The birth process, medical abortion, rough sexual intercourse, the installation of a spiral, improper douching - all this can cause erosion. But! Only in "tandem" with reduced immunity, which slows down tissue repair, allows pathogenic bacteria to enter them.
Chemical	Many contraceptives/drugs can cause irreparable harm to women's health (internal burn) if their choice is not discussed in time with an experienced specialist.

From what and where else does cervical erosion appear? Less often, but still there are other causes of pathology:

Myths about erosion from the program “Everything will be kind”:

What is formed in young girls and adult ladies

There is often an opinion among women (rather a myth) that erosion can be diagnosed only in those who are already lucky enough to become a mother, knowing all the delights of natural childbirth.

For young girls, and especially virgins, this pathology is simply unknown. However, doctors dispel such an erroneous opinion., finding their strong arguments about each category of women / girls:

Teenagers	In girls, a cylindrical epithelial layer predominates on the cervix from birth, the decrease of which occurs gradually as puberty progresses. This is not considered a pathology and is independently eliminated under the influence of estrogen / general hormonal background.
Virgins	If a girl is already in reproductive age, but has not yet begun to have sex, her hormonal imbalance, inflammatory processes of varying severity, improper use of hygiene items, addiction to bad habits can cause destruction of the mucous membrane of the cervix.
	Expectant mothers are required to be tested for infections, which are considered the main catalyst for the development of erosion. If they are not detected, but there is damage to the mucous membrane of the uterine pharynx, reduced immunity, stress, hormonal failure, mechanical damage to the genital tract are considered as a potential cause of the pathology.
	Inappropriate methods of contraception, earlier/late onset of sexual activity, rough sex, infectious/venereal/inflammatory diseases, hormonal imbalance - all these factors can cause cervical erosion.
	The main cause of pathology in this category of women is rightly considered trauma during the birth process, abrupt changes in hormonal levels. However, all of the other factors mentioned above may also be present.

As for the reproductive age in general, it can rightly be attributed to the "top" of the causal pyramid.

Since about 75% of women face a similar problem due to frequent changes in hormonal levels, regular or not very sexual life, concomitant diseases.

Cervical erosion - a disease or physiological condition:

The influence of age

Does a woman's age affect her likelihood of developing cervical erosion? Rather yes than no.

According to medical sources, Most often, the disease is diagnosed between the ages of 20 and 40., that is, at the peak of sexual life, activation of the childbearing function.

Pregnancy, childbirth, hormonal “jumps” due to the lactation period, active contraception provoke changes in the mucous membrane of the uterine pharynx and require medical supervision.

13 to 20 years old erosion occurs infrequently, although it can occur due to the hormonal formation of the body.

As for the climax, then it is also accompanied by significant changes in the hormonal nature, although this rarely leads to pathological processes on the cervix (after all, the probability of all potential catalysts for the development of the disease is significantly reduced).

Therefore, most often erosion is already present at the time of menopause and does not depend on its features.

Is psychosomatics to blame

What else causes cervical erosion, why does it appear? Women are sensitive, emotional, react sharply to the behavior of a man, his attitude to their appearance.

Is it possible to associate such a feature of the weaker sex with the development of diseases of the reproductive system? According to psychologists, yes.

If a lady is not satisfied with her personal life, does not feel desired, loved and sexual, she is not satisfied with intimacy with the chosen one, as well as his attitude towards her, she begins to suppress her feminine principle on a subconscious level.

And this manifests itself in diseases of the genital organs, including erosion of the cervix.

Feminists are also at risk. who basically reject their feminine essence and try to replace it with masculine energy.

However, rarely only one factor provokes the development of the disease. After all, erosion is difficult to diagnose on your own.

Yes, and to single out one reason, given the huge role of immunity, concomitant diseases, internal complexes, is almost unrealistic.

Cervical erosion is not a clinical diagnosis of the disease. This term is only a statement by the gynecologist of the presence of changes that are not always pathological, but require certain diagnostic studies to clarify the diagnosis. To understand what is meant by this concept and why cervical erosion is dangerous, it is necessary to have a general idea of ​​​​the structure of the organ.

Brief anatomy of the uterus

In the uterus, the sections are conditionally distinguished: the bottom, the body and the neck. In the latter, in turn, the upper part (supravaginal) is isolated, into which the uterus passes, and the lower one, located in the vagina and accessible for examination by a gynecologist. Throughout the entire cervix, a narrow cervical (cervical) canal passes, opening with an internal pharynx into the uterus and an external one into the vagina.

All departments differ in their functions, histological structure and, accordingly, diseases. The upper layer of the mucosa of the cervical canal is represented by a cylindrical epithelium, and the surface of the cervix from the side of the vagina is a multi-layered flat non-keratinizing, which slightly passes into the canal in the area of ​​the external pharynx. The boundary between these types of epithelium is called the transformation zone. This is exactly the area where erosion is formed.

What is erosion

Normally, the transformation zone is distinguishable only when viewed with a significant optical increase or during a histological examination. In diseases and even in some physiological conditions, the border shifts to the vaginal surface of the cervix and is already determined visually without optical magnification. This occurs due to the growth of the cylindrical epithelium of the cervical canal beyond the border zone.

Currently, such changes are called ectopia (displacement, movement to an unusual place). Despite the change in terminology, the former name (erosion) remains more familiar to patients when communicating with a doctor. At the same time, the correct understanding by gynecologists of the meaning and difference between these terms affects their purposeful elucidation of the causes of the pathological condition and how to treat cervical erosion - conservative or radical methods.

But until recently, all visible changes were called erosion, which was divided into true and false (pseudo-erosion). However, there is nothing in common between them. True erosion (corrosion, destruction) can result from:

• burns in the rejection of the scab formed after treatment with chemicals, cryodestruction, electrical destruction;
• inflammatory processes that accompany vaginitis (colpitis) or cervicitis - inflammation of the mucous membrane of the vagina or mucous membrane of the cervical canal;
• trophic disorders (impaired blood supply) in postmenopause, with uterine prolapse, after radiation therapy;
• the collapse of a cancerous tumor;
• primary syphilis during the formation of a chancre on the cervix.

In the first two cases, erosion usually heals on its own within a maximum of two weeks or may turn into pseudo-erosion (ectopia).

1. Cervix without pathology
2. Ectopia of the cervix

Causes of ectopia

In girls and girls under 18 years of age, erosion can be congenital and be detected after the onset of sexual relations. Many experts classify ectopia in all nulliparous women as congenital. In girls under 21 years of age and women during pregnancy, as well as during the period of involution, erosion is considered the result of hormonal changes. In these cases, changes often disappear on their own and require only examination and observation.

However, ectopia occurs in more than 50% of women with cervical pathology and is dangerous because it can be a background, that is, a non-specific sign of precancerous diseases and sexually transmitted infections. Therefore, it is referred to the group of "background" pathological conditions. In the structure of the general morbidity of the female genital organs, it is 9%, during preventive examinations it is detected in various forms on average in 38.8%, of which 17-22% are nulliparous young women.

Specialists in various fields of medicine have identified and proven multiple causes of cervical erosion, among which factors are distinguished, both exogenous (external) and endogenous (in the body itself). The first ones include:

1. Early sexual debut (the beginning of sexual intercourse before the age of 16-18).
2. Early first pregnancy (before 18 years).
3. Sexual contact with several partners or frequent change of the latter.
4. Refusal to use barrier methods of contraception.
5. Dysbacteriosis, sexually transmitted infections - gonorrhea, chlamydia, trichomoniasis, human papillomavirus, herpes virus. These infections first cause inflammatory processes, and then contribute to the formation of precancerous diseases.
6. Inflammation caused by conditionally pathogenic microorganisms - gardnerella vaginal and candidomycosis.
7. Frequent abortions and damage to the cervix during abortions or complicated births, as well as chemicals and certain drugs.
8. Low social, cultural and economic standards of living.

Endogenous causes:

1. Hormonal dysfunctions during puberty, pregnancy, menopause, as well as when using hormonal contraceptives.
2. Violation of the function of the endocrine glands - the thyroid gland, adrenal glands, ovaries.
3. Changes in the immune state of the body.
4. Metabolic disorders.

Symptoms of cervical erosion

Sometimes, in 2-6% of cases, cervical erosion does not manifest itself and is diagnosed during preventive gynecological examinations or examinations not related to cervical pathology. Most often women complain about:

1. Yellowish or white discharge (80% on average).
2. Contact bleeding (in 6-10%). They lie in the fact that bleeding during cervical erosion occurs during intercourse or after physical exertion on the abdominal muscles.
3. Dyspareunia - difficulty in sexual intercourse due to the occurrence of psychological disorders or pain before, after or during its implementation.
4. Menstrual disorders.
5. Unexpressed and inconsistent soreness or heaviness in the lower abdomen.

Diagnostics

Examination with a speculum

When examined by a gynecologist with the help of mirrors, a bright red area with uneven contours is visually determined in the area of ​​​​the external pharynx, which can bleed slightly with a light touch.

Colposcopy

A highly informative, accessible and painless diagnostic method is a simple colposcopy for cervical erosion, which allows using a 10-fold magnification to approximately examine and get an idea of ​​the state of the mucous membrane, its epithelium and underlying vessels. The surface of a healthy mucous membrane is shiny and has a pink color. Vessels under it are not visible.

Ectopic areas, depending on the severity of the process, have the form of cluster-like bright red clusters of an elongated shape or spherical papillae. In the transformation zone, one can see ectopic fragments and open glands in the form of dark dots around the external pharynx, areas of immature epithelial cells in the form of "tongues", vesicles with yellowish contents (retention cysts).

A clearer picture is presented during an extended colposcopy using simple additional samples - acetoacetic and Schiller. The first is that unchanged areas of the cervical mucosa become pale after being treated with acetic acid (3% solution). At the same time, the accumulations of papillae become vitreous and resemble bunches of grapes in shape, and the vessels are sharply narrowed.

During the Schiller test (lubrication with Lugol's solution), unchanged areas of the cervical surface are stained with a uniform dark brown color as a result of the combination of iodine contained in the solution with epithelial glycogen. The color intensity depends on the content of the latter in the cells. The transformation zone takes the form of a clear, even line. Ectopic zones, as a result of treatment with a Lugol solution, are not stained.

Required laboratory tests

When diagnosing ectopia, mandatory tests will also be:

• smear for bacteriological examination (for flora);
• tests for urogenital infections, HIV, RW, hepatitis HBS and HCV;
• scraping for cytological examination;
• if necessary, a biopsy of the cervix.

Treatment of cervical erosion

The decision on the need for dynamic monitoring or treatment, and the choice of conservative or surgical methods of treatment, is made only after the woman has been examined by a gynecologist using laboratory and instrumental methods, as well as after consultation with an endocrinologist (if necessary).

Conservative therapy

Conservative treatment of cervical erosion is:

• conducting non-specific anti-inflammatory therapy;
• treatment with drugs that inhibit the growth and development of fungal bacteria and a sexually transmitted viral infection (if detected);
• correction of hormonal and immune disorders;
• the use of physiotherapeutic methods (rarely) - vaginal tampons with therapeutic mud, irrigation with mineral waters, iontophoresis with drugs, ultraviolet and short-wave ultraviolet therapy, microcurrent and ozone therapy, helium-neon laser.

In some cases, the removal of cervical erosion is carried out using chemicals that lead to a chemical burn (chemical destruction). One of these tools is Solkovagin. It is an aqueous solution of zinc citrate, nitric, oxalic and acetic acids. The solution is characterized by a selective coagulating effect on the cylindrical epithelium of the cervical canal without involving the stratified squamous non-keratinized epithelium. As a result of the treatment of the mucous membrane, it penetrates to a depth of 2.5 mm and has an effect after a single, in extreme cases, a double procedure.

Another drug is an aqueous 36% solution of Polycresulene, which has cauterizing, antiseptic and astringent effects.

Surgical methods

Cryodestruction

A safe, easy to use and easily tolerated surgical procedure that does not require hospitalization is liquid nitrogen freezing of cervical erosion, or cryosurgery. It is based on the formation of tissue necrosis under the influence of a very low temperature that occurs during the rapid evaporation of liquid nitrogen. However, the effect of exposure is little controlled and can extend to a tissue depth of up to 5 mm or more, and therefore it is possible to form a narrowing of the external os of the cervical canal. In addition, often the cryodestruction procedure requires repetition.

Laser vaporization

Sometimes laser destruction (vaporization) is used - removal of cervical erosion by a laser, for which high-energy laser radiation devices are used. It includes ruby, argon, carbon dioxide and neon lasers. The advantages of this method are the ability to control the area and depth of tissue necrosis, in the absence of bleeding and inflammation after the procedure. The disadvantages include pain and high cost of laser treatment.

radio wave surgery

At present, it has received wide distribution in medical centers, antenatal clinics and hospitals with the help of the Surgitron apparatus. The method is a controlled limited incision of tissues without contact with them. This is possible due to the high thermal energy that occurs when the radio waves emitted by the device act on the pathological area of ​​the mucous membrane. As a result of the influence of concentrated energy, cells are destroyed and evaporated.

The advantage of removing ectopia by radiosurgery is the speed of an almost painless (due to the coagulating effect of nerve endings) procedure, the absence of pain after surgery, the accuracy of exposure, the absence of bleeding, the bactericidal effect and the rapid healing of the wound without scarring, leading to neck rigidity and the possibility of its rupture when childbirth. This method has been successfully used for .

The isolated use of conservative or surgical methods sometimes does not allow to achieve lasting results. Only complex treatment taking into account endogenous and exogenous factors, prevention and adherence to the culture of sexual relations, the use of modern contraceptive methods make it possible to prevent the formation of a new erosion of the cervix.