Table of contents:
- Erosion of the cervix - the risk of occurrence
- Cervical erosion - types of erosion
- Erosion of the cervix - causes of formation
- Erosion of the cervix - symptoms and complaints
- Erosion of the cervix - treatment
- Erosion of the cervix - electrocoagulation
- Cervical erosion - summary
Erosion of the cervix - risk of developing
Erosion is the most common lesion of the vaginal part of the cervix. It is estimated that cervical erosion is seen in one in four women. It is not a condition that directly threatens a woman's life; however, like any disease, it cannot be ignored. Neglected and untreated erosion can lead to the development of much more serious conditions, such as cancer. Untreated erosion predisposes to cervical cancer. Most often, due to the frequent lack of obvious symptoms accompanying erosion, it is only diagnosed during a routine gynaecological examination. In the speculum, a vivid red, clearly demarcated cavity with an uneven surface can be seen on the visible vaginal area of the cervix, the so-called disc. It is undoubtedly worth taking a closer look at it to fully understand the nature of the formation of these lesions.
A normal, unchanged cervix is covered by two types of epithelium. The vaginal part of the cervix is covered on the outside with squamous epithelium, while on the inside, the so-called cervical canal, it is lined with glandular epithelium. The two epithelia come into contact with each other at the so-called thyroid gland, i.e. the outer mouth of the cervix.
Erosion of the cervix - types of erosions
Depending on the mechanism of erosion formation, we distinguish between true erosion, pseudomembranous erosion and precancerous erosion. Verrucous erosion is defined as the loss of epithelium under the influence of various factors such as mechanical trauma, vaginal inflammation and others. Pseudomembranous erosion is defined as a change resulting from the replacement of the squamous epithelium covering the outer surface of the vaginal area of the cervix by the epithelium lining its canal. This phenomenon is called metaplasia. Very rarely, metaplasia transforms into cervical dysplasia, which in turn carries the risk of cervical cancer. This type of erosion can be encountered most frequently.
Erosion of the cervix, photo: panthermedia
A so-called congenital erosion is considered to be a physiological condition in sexually mature women. This is a lesion in which there is a small reddening of the external orifice of the cervix. It can be caused by hormonal changes during the menstrual cycle, after pregnancy or if contraceptives are used.
Erosion of the cervix - causes of formation
There are many causes of cervical erosion. The most commonly mentioned are various viral, bacterial and fungal infections leading to inflammation of the reproductive tract. Erosion is much more common in sexually mature women. Erosion is undoubtedly related to the fact that these women are more prone to various hormonal disorders, which can also be the cause of erosions.
Of great importance in this group of women is their obstetric past. Numerous births, miscarriages and associated mechanical damage to the cervix are also not indifferent to this delicate organ and may be the cause of erosion. The number of a woman's sexual partners is also important. Frequent change of partners is undoubtedly associated with a greater risk of various inflammatory conditions resulting from infection with e.g. cervix or chlamydia. The long list of causes of cervical erosion also includes poor social and economic conditions and a family predisposition to this condition.
Erosion of the cervix - symptoms and complaints
Erosion most often does not cause any discomfort or symptoms. Sometimes, the symptoms experienced by a woman are so slight that they are difficult for her to perceive. This is particularly true of small erosions. Women most often visit the doctor because of insignificant discharge, which is generally not associated with the presence of erosions. Depending on the size of the lesion, the discharge may be more or less intense.
Erosion produces a very large amount of mucus. Combined with the inflammation, this results in a copious discharge, usually yellowish or greenish in colour. These usually have a very unpleasant odour and can cause various types of irritation to the vulva, so that the woman may feel burning and itching in the area. In the case of more advanced erosion, contact bleeding, pain during intercourse, lower abdominal pain or intermenstrual spotting can be worrying symptoms.
Erosion of the cervix - treatment
Undoubtedly, most erosions should be treated. Choosing the best treatment depends on a number of factors starting with the type of erosion, the extent of the lesion, the result of the cytological examination or the underlying cause. Before proceeding with any treatment, a gynaecological examination is necessary, during which the probable causes of the lesion can be determined on the basis of a thorough history taken with the patient.
Erosion of the cervix, photo: panthermedia
Determining the cause is extremely important because it sometimes happens that when the causative agent is eliminated, as for example in erosions caused by chemicals (e.g. contraceptive globules and foams), the erosion heals itself. Spontaneous disappearance of erosions can also be seen in young women, in whom the erosion was most likely caused by hormonal changes in the body.
The basic step after the diagnosis of cervical erosion is to take a cytological smear to check for the regularity of the cervical epithelial cells. The result of the cytology usually determines further treatment. If the erosion is very small and the cytological smear did not show any abnormalities, only frequent observation of the patient and more frequent cytological examinations can be undertaken. If the cytology reveals only inflammation, then anti-inflammatory treatment is most commonly administered with the recommendation of vaginal globules. After this treatment, it is possible that the lesions regress. A repeat cytological smear should then be performed to assess the effectiveness of the treatment. If the cytological result indicates any abnormality of the epithelial cells, additional tests should be carried out, as in the case of suspected cervical cancer.
It is possible to treat erosions with chemical agents. Due to the very low efficacy of such treatment and the fact that it is very lengthy, laborious and requires frequent visits to the gynaecologist's office, this method is used extremely rarely.
When conservative treatment fails to produce satisfactory results, particularly if the erosion is large, a more invasive but much more effective method should be used.
Erosion of the cervix - electrocoagulation
The most commonly used method for treating cervical erosion is electrocoagulation. It is commonly referred to as burning, as it involves burning the affected cells using an electric spark. The advantage of this procedure is undoubtedly its short time. It lasts only a few minutes and does not require anaesthesia. The procedure is usually performed just after menstruation to reduce the risk of transmitting endometriosis. After the procedure, the patient may experience very heavy watery discharge, which is not an abnormality but a symptom that accompanies the healing of the erosion. This treatment is sometimes abandoned for women who have not yet given birth, as it can result in various types of scarring on the cervix, which can cause complications during childbirth (e.g. problems with cervical dilation).
Cryotherapy is another very commonly used treatment for erosions. This involves freezing the lesion with liquid nitrogen. This method is most commonly used for large lesions. The procedure takes a few minutes and is painless for the patient. However, it often needs to be repeated several times.
There are also two less well-known methods, such as laser therapy (photocoagulation), in which the diseased tissue is destroyed using a laser beam, and electroconvulsive therapy, which involves cutting out the diseased tissue with an electric knife.
Cervical erosion - summary
There is no doubt that any patient diagnosed with erosion should be under the constant supervision of a gynaecologist. Regular visits will help to protect a woman not only from erosion but also from many other diseases that are most often diagnosed only during such visits.
