Cervical erosion, causes of occurrence in nulliparous women, symptoms and treatment. All features of congenital cervical erosion

Cervical erosion is a defect in the squamous epithelium of the cervix located in the external os. The pathology can be provoked by an inflammatory process or hormonal disorders. The disease may be asymptomatic or accompanied by purulent mucous and bloody discharge. Among the main diagnostic methods are cervical examination and colposcopy. For treatment, diathermocoagulation, laser vaporization, cryodestruction, and radio wave method are used.

True and congenital erosion of the cervix

True cervical erosion- occurs when the tissue of the squamous epithelium near the external pharynx is damaged. In this case, the appearance of wound surfaces and inflammation is typical. The most common cause of true erosion is irritation of the mucous membranes due to pathological discharge that occurs with endocervicitis and comes from the cervical canal.

True erosion has an irregular round shape, is red in color and begins to bleed at the slightest contact. During colposcopy and microscopy, dilated vessels, swelling, traces of blood and secretions are easily visible. After one to two weeks, the healing period begins.

Congenital cervical erosion is formed when the boundaries of the columnar epithelium, which is located in the cervical canal, shift beyond its limits. This displacement is formed at the stage of intrauterine development of the fetus. Therefore, this form of erosion is called congenital.

It often forms in a small area in the area of the external pharynx. It is red in color and has a smooth surface. When examined using colposcopy, neither inflammation nor any discharge from the cervical canal is detected.

It is detected in childhood or adolescence and can heal on its own. Against the background of congenital erosion, condylomas can develop, but the appearance of malignant cells has not been recorded in gynecological practice.

Reasons for development

At birth, the girl’s columnar epithelium is located outside, then it moves into the uterus and takes its place. This process occurs as we grow older, but for some reasons it may slow down or not begin at all.

If the erosion does not change its appearance before puberty, it may begin to become inflamed. This pathology requires treatment.

Symptoms

Erosion is asymptomatic; you can learn about the disease only during an examination by a gynecologist.

During the examination, the gynecologist may detect changes in the cervix. In this case, the doctor prescribes a colposcopy, which allows you to confirm the presence of the disease. Thanks to colposcopy, erosion can be examined in more detail, under multiple magnification: this is how the doctor determines the exact size of the affected area. During the procedure, the gynecologist takes a smear and bacterial culture of the microflora for cytological examination.

The results of the tests should show what changes have occurred in the number of lactobacilli, bifidobacteria and opportunistic organisms, as well as determine whether there are infections that can be transmitted through sexual contact. When the number of opportunistic microorganisms is higher than normal, this can lead to dramatic changes in the structure of the affected surface. Cytological examination allows us to identify various pathological processes at an early stage.

If there is a suspicion of the formation of a malignant tumor at the site of erosion, then the attending physician is obliged to prescribe an extensive analysis, which is carried out by covering the entire affected area with iodine solution. Then, under a microscope, the doctor will look at the changes that occur in the erosion zone. The erosion itself should acquire a light pink tint, the area of dysplasia should become yellow, and the foci of inflammation should turn white. If a yellow color appears, then additional examination with a biopsy should be prescribed. This way it will be possible to determine whether the tumors are benign or malignant.

Treatment

For the congenital form of erosion, special treatment is not required, since it can change during puberty and gradually return to its normal state. In rare cases, this form can develop into a pathological condition that needs to be treated. The risk of developing pathology increases in cases where chlamydia or human papillomavirus infection is associated.

In case of congenital erosion, the girl should be under the supervision of a doctor. This will avoid a possible transition to a malignant form.

Often congenital erosions can be cured during pregnancy. This does not interfere with normal pregnancy or childbirth. And after childbirth, it most often disappears, and the epithelium at the site of the lesion is completely restored.

In modern gynecology, there are many ways in which doctors combat changes occurring in the structures of the cervix. Among them are:

treatment with chemicals;
electrocoagulation;
cryodestruction;
radio wave surgery;
laser therapy;
surgical intervention (such treatment is possible in cases where malignant tumors have been detected).

Development of erosion in nulliparous women

The causes of cervical erosion in nulliparous women are often:

artificial termination of pregnancy;
presence of venereal disease;
papillomavirus or herpes infection;
hormonal imbalances.

Symptoms of erosion can only be diagnosed during preventive examinations by a gynecologist. The doctor will find:

Erosion on the cervix or other changes in the organ.
The occurrence of bloody or purulent discharge between menstruation.
The appearance of causeless discharge after sexual intercourse or during an examination.

Erosion therapy is prescribed in a comprehensive manner, including cauterization and the use of pharmaceuticals. The main goal of treatment is to eliminate the source of inflammation.

After using one of these techniques, a woman can cure her problem and subsequently give birth to a healthy child:

Chemofixation. This is a chemical coagulation procedure that is carried out with the help of medications.
Cryodestruction. The process of cauterizing erosion with a low-temperature substance. In this case, liquid nitrogen is used, with the help of which the affected areas are frozen, after which they disappear, and healthy tissue remains in their place, which gradually heals. The period of complete restoration of epithelial tissue lasts about one and a half months.
Laser therapy. This therapy is carried out no later than the seventh day of the cycle, after sanitation. The effectiveness of the technique is quite high.
Radio wave coagulation. This method does not require any preparation or a lot of time, and rehabilitation lasts only two weeks.

For women who have not given birth, the best option would be radio wave or laser therapy. The advantage of the methods is the absence of scars, complete painlessness and quick recovery.

Content

Among various benign pathologies of the cervix, congenital erosion occupies a special place. This is a condition of the cervix that does not lead to cancer. Congenital erosion of the uterine cervix requires observation; in most cases, treatment is not carried out.

Cervical erosion is a so-called defect localized on the mucous membrane of the cervix. The spot appears on the visible part of the cervix, which is located directly next to the vagina.

The cervix is examined by a gynecologist during examination. It is the lower section of the uterus and serves as a kind of connection between the vagina and the organ cavity.

The vaginal part is physiologically lined with multilayered epithelium of flat cellular elements. In the area of the external pharynx, the squamous epithelium passes into single-layer cylindrical tissue, which forms the surface of the cervical canal.

The cervical canal protects the uterine cavity from infections that can enter from the vagina. This defense mechanism is due to the presence of glands that produce the required amount of mucus.

Flat and columnar epithelium differ in appearance. The surface of the vaginal part of the cervix has a pink tint and a smooth texture, while the cervical canal is characterized by a reddish tint and velvety texture.

Congenital erosion is said to occur if the vaginal part of the cervix is lined with columnar epithelium. For many years, this condition of the uterine cervix was considered a pathology. However, modern science has proven that congenital erosion is a stage in the development of the genital organs. It was also found that a congenital defect of the uterine cervix is not a cause of cancer.

The reason that congenital erosion was considered a pathology was that this condition was insufficiently studied. It was not possible to identify a congenital defect in girls before the onset of sexual activity. Accordingly, scientists did not have data that congenital erosion, scientifically called ectopia, appears during the period of intrauterine development. Initially, it cannot be equated to pathology, since its appearance is physiologically determined.

Reasons for appearance

The causes of congenital ectopia lie in the peculiarities of intrauterine development of the organs of the reproductive system. It is known that in girls the epithelium, called cylindrical, is localized on the outer part of the uterine cervix. Contrary to popular belief, this process cannot be the cause of pathology.

Covering the vaginal area of the cervix is normal until a certain age. Before a woman reaches the age of twenty-five, congenital erosion should regress. Untimely regression of an erosive congenital spot often becomes the cause of infection.

Congenital erosion is a stage in the development of the female body. However, experts identify the reasons why the spot does not regress and is diagnosed in adulthood:

unfavorable heredity;
hormonal disorders;
developmental defects;
inflammatory process.

Treatment of congenital erosion is carried out extremely rarely, since it is not cause of serious illnesses. However, if this cervical condition is detected, regular follow-up is necessary.

Symptoms and diagnosis

Cervical erosion, including the congenital form, is asymptomatic. The spot is detected during an examination by a gynecologist using a special mirror.

The clinical picture depends on whether the erosion of the uterine cervix is accompanied by other gynecological diseases. In the absence of an inflammatory process, the following symptoms can be identified:

slight bleeding that occurs upon contact with a gynecological instrument or after sexual intercourse;
mucous discharge associated with the functioning of ectopic glands;
increased content of leukocytes in the vaginal smear.

In case of infection and the presence of an inflammatory process, the patient may observe the following signs:

pathological discharge, both with and without odor;
pain localized in the lower abdomen;
bleeding;
menstrual irregularities;
discomfort in the genital area.

If symptoms uncharacteristic of congenital erosion appear, you should consult a specialist and undergo an examination. It must be remembered that sometimes dysplasia can be masked as a background process, which can cause a malignant tumor.

In order to differentiate a congenital defect and other pathologies of the uterine cervix, it is necessary to undergo an examination. Congenital ectopia is detected during examination of the cervix. The gynecologist determines a rounded reddish spot at the external pharynx, which usually rarely shows signs of inflammation.

A feature of congenital erosion is the presence of a visible transformation zone. Normally, the transition from squamous to cylindrical epithelium is not visualized, since this area is located deep in the external pharynx formed by the cervical canal. However, with congenital erosion, the transformation zone is displaced.

The columnar epithelium on the vaginal part of the cervix is quite vulnerable. The erosive spot may bleed when examined by a doctor.

To identify the causes of erosion and exclude other diseases, it is necessary to perform an examination.

Colposcopy. The procedure is performed in a simple and advanced version. Simple colposcopy involves examining the cervix using a colposcope. The lighting and magnifying system of the device allows you to visualize the features of the spot on the uterine cervix. During extended colposcopy, the cervix is treated with special solutions to evaluate the colposcopic picture.
Biopsy. This study is recommended only for oncological suspicion. During colposcopy, the doctor removes a small piece of tissue for histological examination, which is carried out under a microscope in the laboratory.
Analyzes. The patient is recommended to undergo a general smear and bacterial culture. Of particular importance is the diagnosis of sexually transmitted infections using the modern PCR method.
Cytological examination. This is a basic examination method that involves performing a smear to identify atypical cells. A smear for oncocytology shows the development of an inflammatory and precancerous process.

Ultrasound as a diagnostic tool for congenital erosion of the cervix will not be used.

Treatment methods

Elimination of a congenital spot on the cervix is performed extremely rarely due to the gradual regression of the formation. As the epithelium of the uterine cervix matures, ectopia usually disappears.

However, in some cases, infection is observed. In this situation, the patient is recommended conservative treatment, which is aimed at normalizing the vaginal microflora and eliminating inflammation.

Drug treatment for congenital erosion of the uterine cervix includes:

antibacterial agents with a wide spectrum of action;
antiviral drugs in the presence of HPV, herpes virus;
antifungal suppositories, ointments or tablets;
antiseptics for local treatment.

Before prescribing therapy, it is advisable to perform PCR diagnostics to determine the sensitivity of microorganisms. This will increase the effectiveness of the therapy and prevent relapse of inflammation.

Typically, surgical tactics for the congenital nature of ectopia are not indicated. Sometimes, with this condition, constant relapses of infection occur due to trauma and the functioning of cylindrical cells in an environment unusual for them. In such cases, the issue of cauterization of congenital ectopia is considered.

Several decades ago, surgical methods were contraindicated in nulliparous girls due to their aggressive effect on the uterine cervix. Elimination of ectopia was carried out after reproductive function was achieved. Modern gynecology uses effective, gentle techniques that make it possible to treat ectopia in patients of different age groups.

Cauterization of a congenital spot can be carried out using the following techniques.

Chemical coagulation. The method is effective for minor tissue damage. During the process of chemical coagulation, the cervix is treated with special solutions several times, which causes a burn. As the tissue heals, the area of erosion becomes covered with flat cells.
Diathermocoagulation. Cauterization with electric current is performed only in patients who have given birth due to the high traumatic nature of the method. After diathermocoagulation, the cervix may lose elasticity due to scar deformation.
Cryodestruction. Freezing the affected area with liquid nitrogen is recommended for minor ectopia. After the procedure, copious watery discharge is observed.
Laser vaporization. Cauterization with a laser beam is carried out in a non-contact manner. Some gynecologists believe that this tactic has the highest percentage of relapses due to the contamination of tissue with cylindrical cells during their evaporation.
Radio wave cauterization. Using the Surgitron device allows you to painlessly and effectively treat the formation, as well as simultaneously sterilize the wound. Radio wave treatment is considered the most preferred method of eliminating ectopia.

Congenital erosion of the cervix is not dangerous and cannot cause formation of a malignant tumor. However, like any background process, this condition requires observation and treatment if indicated.

Erosion is the formation of small lesions in the form of ulcers or wounds on the mucous membrane of the cervix. It is one of the most common diseases in the field of gynecology, its danger lies in the fact that it does not have characteristic signs, therefore it is not always diagnosed in a timely manner.

Cervical erosion also occurs in adolescents or women who have not yet given birth.

ATTENTION! Lack of treatment for this disease can lead to the development of oncology of the woman’s reproductive system.

In gynecology, this disease is usually classified into two types: true erosion and pseudo-erosion.

The difference between these types of erosion is as follows:

True erosion. Occurs in rare cases, when the epithelium of the vaginal part of the cervix is disrupted, dies and exfoliates. Occurs as a result of chemical or thermal damage, the consequences of inflammatory diseases of the reproductive system in women.
. There are congenital and acquired types. Congenital erosion develops in the fetus in the womb or during puberty due to disruption of the formation of the uterine epithelium. It is characterized by a bright color, has an irregular shape, and there are no signs of inflammation.

With the acquired form of pseudo-erosion, the epithelial supravaginal layers are replaced by the vaginal layers of the uterus. This pathology is a consequence of abortions, operations, hormonal disorders, and sexually transmitted diseases.

The mechanism of formation of erosion on the cervix in nulliparous women has not been thoroughly studied; the probable causes for its occurrence are considered to be:

, started at an early age;
promiscuous sexual relations, frequent change of sexual partner;
menstrual irregularities;
hormonal changes in the body;
decreased immunity and protective properties of the body to the influence of external factors;
inflammatory processes of the reproductive system that have not been treated for a long time: thrush, inflammation of the mucous membrane - vaginitis or endocervicitis, bacterial vaginitis;
heredity.

The presence of infectious diseases that are sexually transmitted significantly increases the risk of developing erosion:

All of these reasons lead to the appearance of cracks in the cervix, into which cells of nearby epithelial areas that have other properties penetrate. Such a dangerous neighborhood can develop into an oncological tumor.

Diagnosis and symptoms

Since the cervix does not have pain receptors, the woman does not experience any special manifestations of these sensations. This pathology can be detected during examination on a gynecological chair using a mirror, during which the gynecologist detects a defect that has appeared on the cervix. It is an area of epithelium with pronounced hyperemia against the background of healthy tissue, which bleeds upon contact with the instrument.

The condition is accompanied by the following symptoms:

To determine the method of the cervix, it is necessary to identify the occurrence of the disease. To do this, the woman undergoes the necessary examination, tests for the presence of inflammatory processes or sexually transmitted diseases in the body, which are recommended to be cured first.

To treat cervical erosion in a nulliparous woman, various methods are used, which are divided into conservative and performed using surgical procedures.

For young and nulliparous women, approaches that do not leave scars after treatment and reduce the risk of problems when planning pregnancy are considered preferable:

Treatment with medications is carried out using topical preparations: tablets, tampons, injections, solutions. It is used at the initial stage for small lesions, using agents with the following effect:

anti-inflammatory;
restoring damaged tissues;
regulating hormonal levels;
increasing immunity.

Among the suppositories, patients receive positive reviews from Depantol, Suporon, and Hexicon; these forms of medications act directly on inflamed areas. Complex treatment involves the use of antiviral and antimicrobial tablets to eliminate the cause of erosion: “Tsiprolet”, “Acyclovir”, “Virolex”.

Chemofixation. The advantage of this method is the rapid healing of the wound surface after the procedure, the low probability of scar formation after it, which allows it to be used before pregnancy.

Chemofixation is a painless procedure, carried out without the use of specialized equipment, and does not require adherence to strict rules during recovery. Complete healing of the wound takes about three weeks; a woman can return to her usual rhythm of life within a few days. Some patients note the appearance of mild pain in the lower abdomen after surgery and a burning sensation in the vagina.

There are cases when it is necessary to undergo a second application if, in the opinion of a specialist, the primary procedure did not eliminate the problem.

The cryodestructive method consists of treating erosion areas with liquid nitrogen. Under the influence of low temperature, the damaged part of the tissue is frozen without affecting healthy areas. Safe, painless and effective method, without scarring on the cervical canal.

Laser treatment involves cauterization of damaged tissue with a laser beam. Healthy areas are not damaged, since the procedure is controlled by precise equipment. Laser therapy does not change the elasticity of the tissues of the reproductive system, which is important for a woman planning a pregnancy.

Treatment with radio waves. It is highly effective; there is no bleeding after treatment due to the treatment of the nerve endings of the wound with a radioelectrode. This method eliminates the possibility of thermal injury, the development of an inflammatory process, and reduces the recovery time after surgery.

The attending gynecologist will help you choose the right treatment method; it is prohibited to independently prescribe medications without examination and confirmation of the diagnosis.

The procedure for cauterizing cervical erosion in nulliparous women should be entrusted to an experienced specialist in this field. Damage to healthy tissue during this operation can lead to the formation and narrowing of the cervical canal, which performs an important function during pregnancy and gestation.

The consequences of such treatment may be:

insufficient resistance of the cervix and cervical canal to the increased load from fetal growth during pregnancy, which causes premature pregnancy and spontaneous miscarriage;
tissue scarring, leading to serious ruptures during childbirth;
infertility.

Many nulliparous patients believe that erosion should not be paid attention to until pregnancy and childbirth are completed; the opinion of doctors on this matter is the opposite.

IMPORTANT! Effective and safe treatment exists, but it must be carried out by a high-level specialist.

Not in every case does cervical erosion degenerate into a malignant tumor. Nulliparous women need to regularly visit a gynecologist, promptly identify pathology, and carry out treatment in order to eliminate possible complications when planning a pregnancy.

Video: cauterization of erosion for nulliparous women

Video: erosion (ectopia) of the cervix in nulliparous women. Cauterization (destruction)

“After an examination by a gynecologist, it turned out that I have “congenital erosion.” The doctor said that there is no need to treat it yet, it makes sense to wait. Why? And isn’t it dangerous? My husband and I are planning to have a child soon, I’m worried it won’t hurt Will my unborn baby have erosion?
Irina M., 25 years old, Novgorod

Answered by Doctor of Medical Sciences, employee of the Scientific Center for Obstetrics, Gynecology and Perinatology of the Russian Academy of Medical Sciences in Moscow, gynecologist Svetlana Ivanovna Rogovskaya.

First of all, you need to decide what “congenital erosion” is. This is a completely natural process that occurs in the body of a girl or young woman.
The fact is that the main female organ - the uterus - resembles a jug with a narrow neck. This neck is the neck, which is covered with a strong mucous membrane - epithelium. It serves as a barrier against bacteria, chemical and physical damage. Normally, it comes in two types: flat on the outside of the neck and glandular on the inside.
In a newborn girl, the glandular gland is initially located outside. But as he grows older, he gradually shifts inward - this should be ideal.
There are cases when this process slows down, and a young woman retains the “girlish” state of her neck. This happens for various reasons: age, hormonal levels, heredity and even nationality. Then we are talking about “congenital erosion”.
Most often, there is really no need to treat it; erosion goes away on its own as a result of the so-called hormonal shock. This happens either during puberty or during pregnancy and childbirth. That is, everything returns to normal on its own.
So your doctor’s advice is reasonable: if you are planning to have a child, then it is better to leave the erosion alone for now. During childbirth, it cannot interfere in any way; moreover, during pregnancy - and this happens in most cases - it will disappear on its own.
It is all the more undesirable to cauterize “congenital erosion” using crude methods, since during the first birth the process of dilation of the cervix and its elasticity are very important. And due to cauterization, these moments may be disrupted.
The only exception is when “congenital erosion” is accompanied by an inflammatory process. But this situation can also be controlled. It is enough to visit a gynecologist once every six months. In addition to consultation and examination by a doctor, you need to take a smear and culture for vaginal flora and sexually transmitted infections: chlamydia, ureaplasma, mycoplasma, toxoplasmosis and herpes simplex virus type II. But the main diagnostic procedure today is examination of the cervix under a microscope, or colposcopy. It gives the most accurate picture of what is happening.
Those who have been diagnosed with human papillomavirus need to be especially careful. Since in this case, inattention to oneself can lead to “degeneration” of erosion and oncology.
If necessary, the doctor may suggest treatment. When making a decision, it is reasonable to be guided by the following principle: choose the lesser of two evils. Since infections can cause you and your baby much more harm than “prenatal” treatment for erosion.
There are several basic techniques. These are cryodestruction - exposure to liquid nitrogen, diathermocoagulation - with electric current and laser coagulation - using a thin laser beam. They are all sensitive but not painful.
Recently, laser has become the most popular; it is the most modern procedure. It allows you to accurately hit the target - to cauterize the erosion and not injure neighboring tissues. Other methods have significantly higher errors. Although all of them are widely used and, when carried out correctly, are quite effective.
There are rare cases when “congenital erosion” persists during childbirth or even develops into a more complex pathology. In this case, treatment is mandatory, and try not to delay it too much.

– defect, damage to the squamous epithelium of the cervix on its vaginal part around the external pharynx. More often it occurs as a result of endocervicitis and other inflammatory diseases of the genital area, hormonal disorders in the female body. The course may be asymptomatic or manifested by pathological discharge of a mucopurulent, sometimes bloody nature, nagging pain in the sacral area. It is a risk factor for the occurrence of cervical tumors (polyps, cancer). The main methods for diagnosing cervical erosion are examination of the cervix in the speculum and colposcopy. Methods of diathermocoagulation, laser vaporization and cryodestruction, as well as the radio wave method can be used in treatment

General information

The term “cervical erosion” refers to a defect, a violation of the integrity of the epithelium of the vaginal segment of the cervix. Cervical erosion is one of the most common gynecological pathologies and occurs in 15% of women. The cervix is the lower part of the uterus that protrudes into the vagina, within which runs the narrow cervical (cervical) canal. The upper section of the cervical canal ends with the internal os, the lower section ends with the external os. The external pharynx opens on the vaginal part of the cervix and has the shape of a transverse slit in women who have given birth and a round shape in women who have not given birth. Damage to the stratified squamous epithelium around the external os of the vaginal part of the cervix manifests itself in the form of cervical erosion.

Protruding into the vagina, the cervix is exposed to infections, injury during sexual intercourse and medical procedures. The long-term existence of cervical erosion can lead to changes in epithelial cells and the appearance of benign neoplasms (cervical polyps) and malignant tumors (cervical cancer).

The reasons for the development of cervical erosion can be different. Changes in the cervical mucosa can develop after childbirth, termination of pregnancy, due to inflammatory diseases of the cervix, hormonal disorders. A common cause of cervical erosion is genital infections - chlamydia, gardnerellosis, ureaplasmosis, trichomoniasis, etc., the pathogens of which, penetrating the damaged mucosa, cause inflammation in it. Cervical erosion can occur in adolescence and in nulliparous women.

Types of cervical erosions

Cervical erosions are of the following types:

true;
congenital.

True cervical erosion

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 os of the vaginal part of the cervix. True cervical erosion is characterized by the formation of a wound surface with signs of inflammation. The most common cause of the development of true erosion of the cervix is irritation of the mucous membrane by pathological secretions of the cervical canal during endocervicitis. True erosion is usually bright red, irregularly round in shape, and bleeds easily on contact. During colposcopic examination and microscopy of the eroded surface, dilated vessels, swelling, infiltration, traces of fibrin, blood, and mucopurulent discharge are visible. After 1-2 weeks, true erosion enters the healing stage - pseudo-erosion.

Pseudo-erosion

During the healing process, the defect of the squamous epithelium is replaced by a cylindrical one, spreading to the erosive surface from the cervical canal. Columnar epithelial cells are brighter in color than stratified squamous epithelial cells, and the erosive surface remains bright red.

The stage of replacement of flat 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 cylindrical epithelium occurs not only along the surface of the erosion, but also in depth with the formation of branching glandular ducts. In the erosive glands, a secretion is secreted and accumulated, and when the outflow is difficult, cysts are formed - from the smallest to those visible during visual examination and colposcopy. Sometimes large cysts located near the external pharynx look like cervical polyps. Multiple cysts lead to thickening - hypertrophy of the cervix.

There are pseudo-erosions:

follicular (glandular) – having pronounced glandular ducts and cysts;
papillary - having papillary growths on the surface with signs of inflammation;
glandular-papillary or mixed - combining the characteristics 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 inflammation subsides independently or as a result of treatment, the process of reverse replacement of the cylindrical epithelium with flat epithelium occurs, i.e. restoration of the normal integumentary epithelium of the cervix - the second stage of healing of erosion. At the site of healed erosion, small cysts (Nabothian cysts) often remain, formed as a result of blockage of the ducts of the erosive glands.

A long course of pseudo-erosions and the accompanying inflammatory process can lead to pathological changes in epithelial cells - atypia and dysplasia. Cervical erosion with the presence of epithelial dysplasia is considered a precancerous disease.

Pseudo-erosions can be small in size (from 3 to 5 mm) or cover 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-erosions are a modified area of the mucous membrane of irregular shape, with a bright red color, a 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 Nabothian cysts are visible.

Pseudoerosions, especially papillary ones, bleed easily during sexual intercourse and instrumental examinations. Increased bleeding is also observed with pseudoerosion dysplasia and during pregnancy. Healing of pseudo-erosion is considered complete if the erosive glands and columnar epithelium are rejected and squamous epithelium is restored over the entire surface of the defect.

Congenital cervical erosion

The formation of congenital erosions of the cervix occurs as a result of displacement of the boundaries of the columnar epithelium lining the cervical canal beyond its limits. Displacement (ectopia) of the epithelium occurs during 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 pharynx, has a bright red color, and a smooth surface. An objective examination (in speculum 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 and often heal on their own. If congenital erosion persists until puberty, infection, inflammation and subsequent changes are possible. Occasionally, against the background of congenital erosions of the cervix, flat condylomas 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 populated by the microflora of the vagina and cervix.

The dishormonal theory puts forward changes in the level of sex hormones-steroids as the cause of the development of cervical erosion. Clinical observations show the appearance of cervical erosions during pregnancy and regression in the postpartum period with stabilization of hormonal levels.

Erosions are also formed during ectropion (eversion) of the mucous membrane of the cervical canal due to birth injuries. Cervical erosions (pseudo-erosions - 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 erosions and pseudo-erosions of the cervix

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

The extended colposcopy method is used if malignancy of cervical erosion is suspected. The erosion zone is treated with a 5% alcohol solution of iodine and examined under a colposcope. True erosion (pseudo-erosion) is light pink, the dysplasia zone is yellow, and atypical lesions are white. If areas of erosion that are questionable for dysplasia are detected, a targeted biopsy of the cervix is performed with histological analysis of the resulting tissue.

Treatment of erosions and pseudo-erosions of the cervix

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

monitoring of congenital erosions, no need for their treatment;
true erosions and pseudo-erosions are treated simultaneously with the underlying diseases that caused or maintain them;
if there are signs of inflammation, therapy should be aimed at infectious agents (trichoionases, chlamydia, gonococci, etc.);
erosion in the active stage of inflammation is treated with gentle methods (vaginal tampons with sea buckthorn oil, fish oil, syntomycin 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 columnar epithelial cells, their rejection and subsequent restoration of squamous epithelium on the surface of pseudo-erosion. For this purpose, diathermocoagulation, laser vaporization, cryodestruction, and radio wave methods are used.

Diathermocoagulation is a method of cauterization of altered tissue by exposure to high-frequency alternating electric current, causing significant heating of the tissue. Coagulation is not used in nulliparous patients due to the risk of scar formation that prevents the dilation 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 days 5-7 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 labor. Laser destruction of altered tissue causes rapid rejection of the necrosis zone, early epithelization and complete regeneration of the wound surface a month later.

Cryodestruction (cryocoagulation) is based on freezing, cold destruction of cervical erosion tissue 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, and is characterized by relatively rapid epithelization of the wound surface after rejection of necrosis. The first day after cryodestruction, abundant liquid discharge and cervical edema are noted. Complete epithelization of the defect occurs after 1-1.5 months.

Radio wave treatment of cervical erosion with the Surgitron device involves 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 and does not require anesthesia or 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 complicate childbirth.

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