Classification of ectopy
As already mentioned, ectopia can becongenital and acquired. False erosion can acquire a recurrent character. According to the clinical form, ectopia can be complicated and uncomplicated. It is worth saying that the uncomplicated form of cervical ectopia is considered a normal phenomenon and physiological state of a woman in medicine. Ectopia can take a complicated form as a result of colpitis and cervicitis, which can be caused by infection. If there is a violation of the relationship between the stromal and epithelial elements of the cervix, then in this case the ectopia is called ectropion. Based on histological indicators, papillary and glandular ectopia of the cervix are distinguished, as well as false erosion with squamous cell metaplasia. Glandular ectopia is accompanied by signs of inflammation and accumulation of glands with a branched network of glandular ducts. Papillary ectopia is accompanied by the proliferation of stromal components and the formation of papillary structures covered with cylindrical epithelial tissue. The process of ectopia healing involves the reverse replacement of cylindrical epithelial tissue with cells of mature squamous epithelial tissue. In other words, the so-called transformation zone is formed. Reserve cells also participate in this process, which initially transform into immature and then mature metaplastic epithelial tissue. Completed and unfinished transformation zones can be distinguished using colposcopy. Cellular metaplasia can be interrupted under adverse effects, which will lead to a relapse of cervical ectopia. If the cells of the cervical glands' mouth are covered by a metaplastic layer, a cervical cyst (Nabothian cyst) may form.
What causes cervical ectopy?
During puberty and early childhoodDuring the reproductive period, ectopia is considered a functional feature and a completely normal phenomenon. During these periods, cervical ectopia is based on excessive secretion of the hormone estrogen (relative hyperestrogenism). During pregnancy, false erosion is also normal and is explained by changes in hormonal levels and ovarian function. According to various theories, uterine ectopia can occur as a result of inflammatory processes, dyshormonal, immunological and traumatic factors. The occurrence of cervical ectopia as a result of inflammatory processes is explained by recurrent endocervitis and vaginitis, which are caused by streptococci, E. coli, various pathogens of STDs (ureaplasmosis, mycoplasmosis, chlamydia, gardnerellosis and others). Abnormal and even pathological discharges that affect the vaginal part of the uterus cause the so-called desquamation of flat epithelial tissue with the formation of a real erosion in its place. In 1-2 weeks, the epithelial tissue of the endocervix spreads to the surface of the erosion, covering it, and an ectopic area is formed in its place. Infection of the uterus can be facilitated by various birth injuries, mechanical damage to the cervix during abortions, trauma to the uterus when using spermicides and barrier contraceptives. It is believed that the development of ectopia can also be provoked by ovarian dysfunction. Very often, ectopia occurs with diseases such as endometriosis, uterine fibroids, ovarian stromal hyperplasia, hormonal imbalance and menstrual cycle failure, and other conditions caused by increased estrogen secretion. It is believed that a decrease in immunity can also cause a weakened immune system. Very often, ectopia can be provoked by early onset of sexual activity, frequent change of intimate partners, diabetes, smoking, multiple births, etc.
Symptoms and Diagnosis of Cervical Ectopy
Uncomplicated form of uterine ectopia does notis accompanied by no symptoms and is usually detected during a routine gynecological examination. But most often, women have a complicated form of ectopia (in 80% of cases), which is combined with various inflammatory processes and precancerous changes (cervical polyps, dysplasia, etc.). In the presence of colpitis or endocervitis, there is a discharge of leucorrhoea from the cervical canal, dyspareunia, itching, contact bleeding. Primary disorders that lead to ectopia of the uterus can cause menstrual irregularities and even infertility. Diagnosis of ectopia is possible during a routine gynecological examination. The presence of congenital pseudo-erosion is established during the first visit to the gynecologist. If acquired ectopia is diagnosed, its formation on the surface of the cervix, which has never changed before, is taken into account. The gynecologist can see ectopia while examining the patient on the gynecological chair. Ectopia is presented as a bright red lesion with irregular outlines in the area of the external os. When a false erosion comes into contact with a gynecological instrument, slight bleeding is possible. If ectopia of the uterus is detected, the doctor prescribes an extended colposcopy, which will reveal an atypical area represented by cylindrical epithelial tissue and transformation zones. Very often (in 40% of cases), when performing an iodine test (Schiller test), an abnormal colposcopic picture is observed: puncturation, mosaic, leukoplakia, iodine-negative zones. If such signs are detected, a more in-depth examination is required. Diagnostics involves bacteriological culture, microscopy, PCR testing. In addition, a cytological examination of the scraping is considered a mandatory procedure. Such a study will reveal an inflammatory process, the presence of cells of cylindrical and squamous epithelial tissue. If abnormal colposcopic and cytological picture is observed, it is necessary to perform a uterine biopsy or separate diagnostic curettage with subsequent histological examination. The function of the ovaries can be studied using special functional tests and hormonal status studies. If any hormonal disorders are detected, a consultation with a gynecologist-endocrinologist is necessary.
Treatment, prevention and prognosis of ectopy
As already mentioned, the uncomplicated formectopia does not require treatment. However, dynamic observation is necessary, which will allow timely detection of any deviations in the development of false erosion. Treatment of complicated pseudo-erosion should be carried out taking into account the existing changes. As a rule, etiotropic anti-inflammatory and antiviral therapy is prescribed, the correct selection of a contraceptive is carried out, hormonal and immune disorders are corrected. After these procedures, destruction of pseudo-erosion foci is performed by laser coagulation, cryogenic exposure, chemical coagulation, radiosurgery. If nabothian cysts of the cervix are detected, they are opened. How can pseudo-erosion be prevented? Firstly, it is recommended to visit your gynecologist as often as possible. The frequency of visits should be at least 2 times a year. Secondly, any sexually transmitted infections should be treated immediately. Inflammatory diseases also require urgent treatment. Frequent change of sexual partners can only provoke the appearance of false erosion, try to avoid sexual contacts with different men. Treatment of pseudo-erosion is carried out for the following purposes:
- To eliminate the concomitant inflammatory process;
- for the correction of immune and hormonal disorders;
- for correction of vaginal microbiocenosis;
- for the destruction of pathologically altered uterine tissue.
Hospitalization is indicated only in cases wherea cervical biopsy is required. Sexual activity can be resumed no earlier than 4 weeks after the biopsy. Regular visits to the gynecologist with subsequent examination, a healthy lifestyle, proper rational nutrition and a culture of sexual life will help avoid such a disease. Remember that a weakened immune system makes the body vulnerable to all diseases. Therefore, try to consume all the necessary vitamins and microelements, give up bad habits, limit yourself in drinking alcohol. Have sex with a trusted man, avoid promiscuous sexual relations. These simple rules will help to avoid many gynecological diseases, including ectopia. Good health to you.
