Cervical Erosion


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The medical term for cervical erosion is 'cervical ectopy'. It is a condition in which cells that normally line the inside of the cervical canal extend on to the surface of the cervix.

Normally, the inside of the cervical canal is lined with columar epithelium and the outside with squamous epithelium. These connect at the squamo-columnar junction. In cervical erosion, the columnar epithelium may extend further down ad protrude on the surface of the cervical os and onto the vaginal portion of cervix. It may also undergo squamous metaplasia and transform to stratified squamous epithelium.

Causes of Cervical Erosion

Estrogen level

Cervical erosion is believed to be a response to high levels of circulationg estrogen in the body. Estrogen levels may be high at different times in a woman's life.

  • In Pregnancy: Cervical Erosion is a very common finding during pregnancy - believed to be due to the high levels of estrogen levels in the body at that time.

    It can cause mild bleeding during pregnancy, usually during sexual intercourse when the penis touches the cervix.

    The erosion disappears spontaneously 3 - 6 months after childbirth.

  • In Women on Birth Control Pills: All birth control pills contain the hormones, estrogen and progesterone in different strengths. Cervical erosion is more common in women taking pills with a high level of estrogen.

  • At Birth: Cervical erosion is found in at least 1/3rd of all female babies. Many researchers believe that this is a response to the maternal estrogen that the babies are subjected to while still in the uterus. The erosion disappears in early childhood as the influence decreases.

  • In Women on Hormone Replacement Therapy(HRT): HRT in menopause mainly consists of replacement of estrogen in the body through pills, patches, creams etc. This estrogen can cause cervical erosion.

In Postmenopausal Women not on HRT: Cervical erosion is rarely seen in women after the menopause as the level of estrogen in the blood is very low.

Cervical Erosion
Cervical erosion

Infections

The theory that infection is the cause of cervical erosion is slowly losing ground. Evidence is increasing that infection does not cause cervical erosion but it is rather the other way around - the changed cells of cervical erosion are more susceptible to various bacteria and yeast and tends to get infected very easily. So cervical erosion and cervical infections are often seen together, leading to the belief that infection causes cervical erosion.

Miscellaneous Causes

It is believed by many that chronic infection of the vagina, vaginal douching and chemical contraceptions like anti-sperm gels can change the normal level of acidity of the vagina and cause cervical erosion. But these theories are yet to be proved.

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Signs and Symptoms of Cervical Erosion

Most women with cervical erosion do not have any symptoms. But women with a large area of erosion can suffer from:

  • Increased Vaginal Discharge: The vaginal discharge is usually copious, clear or cloudy and slippery to the touch. If infections occur, there may be pus cells making the discharge muco-purulent. Infections can also cause the vaginal discharge to have a foul smell.

  • Bleeding: The columnar cells of cervical erosion are fragile and breaks easily causing bleeding. This is usually seen after sexual intercourse or even after passing hard stool.

    Pregnant women who complain of mild bleeding in early pregnancy or blood stained vaginal discharge (brown, black or red) should always be asked if they had had sex in the 12 hours prior to the episode of bleeding.

  • Other Symptoms of Cervical Erosion: Many symptonms like backache, chronic ill health and even infertility have been said to be due to cervical erosion. But it is more likely that these are the symptoms of chronic pelvic infection which may be present together with cervical erosion.

  • On Examination:The area of cervical erosion is seen as a bright, red surface around the external os (mouth of the cervix). It extends inside the cervix. The margin is well defined and the whole area may be smeared with cervical discharge. It feels soft but a little granular to the touch of the examining finger. It can bleed a little during examination. It can look like and be mistaken for cervical cancer.

Tests for Cervical Erosion

Cervical erosion has to be differentiated from other cervical ulcers caused by carcinoma, syphilis and other sexually transmitted diseases. A cervical biopsy should ideally be carried out.

Treatment of Cervical Erosion

If the cervical erosion has no symptoms but has been discovered on routine examination, treatment is not necessary. In many cases, the erosion tend to dissappear spontaneously.

If symptoms are present however, active treatment becomes necessary. The aim of the treatment of cervical erosion is to destroy the columnar cells so that normal squamous cells can grow in their place:

  • Electrocautery: The cells are burned off by using heat generated by electric current.

  • Diathermy: High temperature is applied to the area of cervical erosion via shortwave or microwave electric current or by ultrasound to generate deep heat so that the cells are damaged.

  • Cryocautery: Extreme cold generated by the application of nitrous oxide gas is used to destroy the cells.

Infections: Infections should also be controlled by antibiotics.

Post-operative advice:The area of cervical erosion takes 6-8 weeks to heal. So the patient is asked to avoid sex and not to use tampons or douches during this period to avoid any injury.

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