The state of the cervix determines whether a woman can bear the fetus during pregnancy, and also give birth normally. Neck ruptures, mucosal structure impairment, inflammation are all serious pathologies that can lead to a significant deterioration of reproductive health and even serious complications. One of the common diseases is cervical ectropion. The danger of the condition depends on the cause of its occurrence. If a woman wants to become a mother, she should be especially attentive to timely treatment of this disease.
- What distinguishes ectropion from other diseases of the cervix uterus
- Types of ectropion, causes
- Congenital ectropion
- Acquired ectropion
- Possible effects of ectropion
- Impact on conception and pregnancy
- Symptoms with ectropion
- Drug therapy
What distinguishes ectropion from other diseases of the cervix uterus
The cervix consists of 2 sections: the cervical canal and the pharynx that goes into the vagina. Inside they are lined with mucous (epithelial) membrane, and in the channel itself epithelial cells have a cylindrical shape, and in the area of the pharynx - flat.
Ectropion - This is a condition in which approximately 1/3 of the lower part of the channel is turned outwards, so that the cylindrical epithelium ends up in the vagina. But in the area of flat epithelium, he does not go.
There are other types of diseases, consonant in name.
Ectopia. In this pathology, the cervical canal is not modified, but its mucosa crosses the border between it and the cervix. The cells of the cylindrical epithelium appear on top of the flat epithelium, which leads to the formation of cysts (they are called Nabotov). This disease is also called pseudoerosis.
Cervical erosion - this is damage to the mucous membrane of its pharynx during normal canal form and location of epithelial cells.
Perhaps the emergence of complicated forms of the disease, when ectropion is accompanied by ectopia and erosion.
The formation of the ectropion of the cervix may occur during the laying of the genital organs in the fetus. This happens as a result of a certain hormonal shift in the future mother's body. Usually, as a girl grows and develops, her ectropion disappears. By adolescence, the cervical canal, as a rule, takes on a normal appearance.
If this does not happen, then we speak of a functional disorder of the development of the genital organs, the cause of which is an imbalance of the hormonal balance in the body. Such a violation may be manifested by other symptoms: cycle irregularities, deviations in the nature of menstruation.
About its occurrence speak in the case when a change in the shape of the cervical canal occurred in a woman who had not previously had such a pathology. This condition is also called post-traumatic. Ectropion occurs as a result of ruptures of the wall of the cervical canal, which can occur during childbirth, abortion, the introduction of tools during diagnostic and therapeutic procedures.
Causes of breaks during labor are:
- the birth of a large child
- the birth of several children
- improper location of the fetus in the uterus,
- delivery is too fast
- premature birth of a child when the neck is not elastic enough,
- the need for insertion into the neck of obstetric forceps to retrieve a child,
- artificial birth in late pregnancy, when you have to use special tools.
After stitching, scars remain in place of the tears, deforming the cervical canal, causing it to turn out.
Possible effects of ectropion
Violation of the structure of the cervical canal with ectropion of the cervix leads to the fact that the opening of the throat remains open, which facilitates the penetration into the uterus of infection from the vagina.
The acidic environment of the vaginal mucosa is detrimental to harmful microbes (bacteria, fungi, human papillomavirus). Penetrating into the channel, they fall into an environment that has a much lower acidity, which contributes to their reproduction. As a result, cervicitis develops (inflammation of the mucous membrane of the pharynx), as well as endometritis (inflammation of the mucous membrane in the uterus).
Inversion of the cervical canal leads to the fact that its epithelial membrane is exposed to an acidic environment, which contributes to its irritation and the appearance of pseudo-erosion and true erosion. Epithelial cell death may occur (mucosal atrophy).
Possible consequences are dysplasia (gradual atypical degeneration of mucosal cells). Atypical cells (with a broken structure) are often reborn into cancer cells. Therefore, ectropion in neglected and complicated form can cause a malignant tumor.
Impact on conception and pregnancy
By itself, the protrusion of the cervical canal cannot prevent sperm from entering the uterus, therefore conception occurs quite successfully.
If a woman with a pathology such as ectropion, infertility is observed, then it is not caused by mechanical interference that prevents the penetration of sperm, and concomitant pathology. These include hormonal failure, obstruction of the fallopian tubes, abnormal degeneration of the endometrium and other conditions. Hormonal imbalance, in turn, provokes a violation of mucus production in the cervix, changes in the structure of epithelial cells and aggravation of the development of ectropion.
Complications during pregnancy are associated with processes that very often accompany cervical ectropion (infectious diseases, scarring of tissues after inflammation). Therefore, often the consequences of this pathology are miscarriages, intrauterine infection of the fetus. The loss of shape and elasticity of the cervix leads to complications of childbirth: the appearance of tears, a decrease in the tone of the uterus and the need for a cesarean section, as well as the development of postpartum inflammatory processes.
Note: After eliminating timely detected ectropion and conducting anti-inflammatory treatment, conception occurs normally, the pregnancy proceeds without complications.
Usually, doctors recommend that women planning a pregnancy, in order to avoid unpleasant consequences, restore the state of the cervix using one of the minimally invasive surgeries.
Symptoms with ectropion
Ectropion as an independent pathology of symptoms does not have. However, almost always in a woman of reproductive age, this condition is accompanied by inflammatory processes and erosion. Therefore, it is often found in women who applied to the gynecologist for the following symptoms:
- Abundant white or yellowish vaginal discharge. Sometimes there are impurities of pus in the mucus, there is a sharp unpleasant smell, it irritates the skin.
- The appearance of bleeding between menstruation or after sexual contact, exercise.
- Burning and itching in the vagina.
- A feeling of discomfort in the lower abdomen or pain, radiating to the lower back and sacral region.
- Cycle frustration - copious frequent menstruation or scarce and rare.
With a routine gynecological examination using mirrors, neck bulging can be seen visually. Eroded cervical ectropion is manifested not only by the inversion of the mucous membrane, but also by the formation of white and red spots on it - areas of displacement and damage to the epithelium.
To clarify the condition of the cervical epithelium after visual inspection, a colposcopy is performed in the mirrors - the study of the channel surface with an optical device that illuminates it and magnifies the image many times.
Colposcopic signs of congenital ectropion are the presence of evenly spaced folds in the canal, and acquired - their chaotic arrangement. About the complications says uneven color and structure of the mucous.
When signs of inflammation are detected, a microscopic examination of the vaginal smear and the cervical canal is carried out to detect infections. Such methods as bacteriological seeding of mucus, genetic analysis of microflora (PCR) are used to clarify their type.
If suspicious areas are found on the cervix, they are checked for oncology, for which they conduct a biopsy and histological examination of the material. To find out the cause of ectropion, which is accompanied by menstrual disorders, conduct a blood test for hormones.
The treatment is aimed at eliminating cervical damage to the cervix uteri and subsequent anti-inflammatory and antibacterial therapy.
Cryodestruction, laser therapy, radio wave destruction, electrocoagulation, diathermocoagulation are used as minimally invasive surgical methods.
Sometimes cervical conization is performed (removal of the cone-shaped area of the affected epithelium using a radio-wave knife) or electroscission (removal of tissues using a special electrode). Such operations are carried out if the pronounced ectropion of the cervix is complicated by mucosal dysplasia, that is, it has precancerous changes. In some cases, the correction of the shape of the uterus by the method of plastic surgery.
When ectropion is detected in a pregnant woman, her condition is continuously monitored to prevent complications. The operation to eliminate the pathology is performed several months after delivery.
During the medical treatment of inflammatory and infectious complications, antiviral and anti-inflammatory tablets (ciprolet, acyclovir, virolex), as well as suppositories (suporon, depantol, hexicon) are used. If necessary, appointed antibacterial (doxycycline, metronidazole), as well as antifungal drugs (diflucan).
In case of hormonal disorders, treatment is carried out by means of regulating the level of estrogen in the body. Among them, Diana 35, Yarin and others.
In order to eliminate the risk of damage to the cervix and the occurrence of pathologies in it, doctors advise to prevent the onset of unwanted pregnancy using suitable contraceptives. This will avoid abortion. When signs of gynecological diseases appear, you should immediately consult a doctor, especially if you plan to conceive and give birth to a child.
Causes of pathology and classification of its forms
Erosive ectropion is a pathological condition of the cervix in which the mucous membrane of the cervical canal is turned in the direction of the vagina. This phenomenon leads to the development of the inflammatory process and may cause complications.
The causes of cervical ectropion depend on whether the patient has given birth or not. A whole group of factors can provoke pathology.
In young girls, ectropion is considered a functional disorder, which eventually goes away even without special treatment. The disease is associated with hormonal changes in puberty.
Acquired erosion occurs under the influence of the following reasons:
- premature birth, accompanied by rupture due to incomplete disclosure of the cervix,
- ongoing surgical treatment in this area
- postponed abortion and scraping,
- the birth of a large child
- multiple births
- use of obstetric forceps.
The ectropion of the reproductive organ can be dangerous even for the patient’s life. It is a predisposing factor for the development of oncology. Complications of ectropion entail serious consequences.
The classification of the disease includes 2 main forms:
Congenital ectropion develops in girls during fetal development. It occurs under the influence of the mother's estrogen hormone. Pathology can continue until adolescence, and then self-healing.
The acquired form of the disease is extremely rarely diagnosed among women who have not had pregnancies and childbirth. Occurs due to injuries received during gynecological procedures, childbirth. Sometimes found along with other inflammatory diseases.
You can understand what ectropion of the cervix uterus is like by considering the signs of the disease. Uncomplicated type is almost asymptomatic. It is easier to suspect the disease if there is a co-infection or inflammation of the cervical canal.
Symptoms of ectropion are as follows:
- lower abdominal pain and feeling of heaviness
- abundant clear discharge from the genitals,
- the occurrence of purulent impurities in mucus,
- discomfort during intimacy,
- pain in the lower back.
Directly, the reversal of the endocervix does not cause unpleasant manifestations, the woman does not notice anything. With congenital forms of the disease, girls may experience menstrual failures.
The condition of the vaginal mucosa may also change. Itching and burning of the external genitalia. There is a small amount of blood between the months.
There may be spotting after sexual intercourse, douching, heavy physical exertion, and long walks.
Examination using special mirrors allows the doctor to determine the deformation of the neck. The rounded epithelial layer acquires irregular outlines, and eversion is clearly visible. If the pathology is accompanied by pseudo-erosion, the gynecologist will see tissue sections with edema and white spots.
This cervical pathology is treated using high frequency electric current. Such cauterization has been used throughout the world for many years. However, this tactic has serious drawbacks:
- deep tissue damage within healthy areas,
- long rehabilitation period (up to a year),
- the inability to conduct a histological study of the excised material,
- postoperative complications.
Because of the wide range of unpleasant consequences, the treatment of cervical pathology in this way is not performed frequently.
Electrical excision and conization
During the surgical procedure, all damaged tissues are removed in layers. It is possible to preserve their integrity in order to conduct histology.
At conization, the same method is used, but the tissues are excised according to the shape of a cone. Epithelium heals quickly, complications rarely develop. After the elimination of pathological changes in the cervix, the woman retains reproductive ability, can bear and give birth to a child.
This surgical method has the following disadvantages:
- not only defective, but also healthy tissues are removed,
- after a while, scarring may occur,
- There is a risk of post-coagulation endometriosis.
Treatment of cervical lesions in this way leads to shortening of the cervical canal. The risk of re-development of ectropion remains.
Treatment of ectropion of the cervix with radio waves
In diseases of the uterus is widely used radio wave method. The advantages of erosion and ectropion therapy in this way are as follows:
- healthy soft tissue is not destroyed,
- Scars are not formed
- the procedure is painless,
- minimal risk of blood loss
- no relapses.
The functions of the cervical epithelium are quickly restored after this surgical intervention. Pathology is considered defeated.
Laser beams can be of different types. The procedure is painless, and the wound surface heals very quickly. Healthy tissues are preserved. The mucosa of the cervical canal is quickly restored.
The disadvantages of the method of laser therapy include the following factors:
- high risk of increased bleeding,
- probability of secondary infection,
- formation of adhesions,
- postoperative endometriosis.
Often you have to repeat the procedure. It is impossible to obtain a biomaterial from the neck for histological examination. The effectiveness of treatment depends on the depth of the ectropion source.
The need for surgery arises when, in addition to ectropion, the uterus suffers from pseudo-erosion, cervical deformity, and hypertrophy. The most effective methods are the methods of Emmett and Sturmdorf.
Surgical treatment is carried out when other treatment options are contraindicated or have proved ineffective.
Cervical ectropion and pregnancy - compatible concepts. A woman can conceive, bear and give birth to a healthy child.
The possibility of getting pregnant is not affected by the presence of even a congenital form of the pathology. If conception does not occur, it is worth conducting a detailed examination of the hormonal background and identifying infectious and inflammatory diseases.
A woman can become pregnant with such a diagnosis if there is no acute inflammation and cicatricial changes on the neck due to previous interventions. Occasionally, the ectropion of the organ after birth has healed itself. However, in most cases, a planned surgical treatment is required.
Possible complications of the disease
If the ectropion is defeated in time, complications do not arise. Late treatment or lack thereof leads to the following problems:
- development of a malignant tumor of the cervical organ,
- hormonal imbalance,
- inflammatory processes in the pelvic organs,
Occasionally even a qualitatively performed surgical treatment causes some consequences:
- narrowing of the cervical canal,
- recurrence of pathology,
- joining a secondary infection,
- the appearance of foci of endometriosis.
A woman should pay attention to any changes in her state of health, hormonal disruptions and irregular menstruation. The disease may not make itself felt by visible signs, but a planned visit to the doctor will allow you to identify the pathology in the early stages and heal it quickly without the development of complications.
Causes and types
The disease is formed against the background of various factors. The ectropion of the cervix can be congenital, then the treatment is not carried out, since the given condition passes on its own through time if there is no infection or inflammation. Acquired forms are traumatic.
If a girl is not giving birth, most often ectropion appears on the background of hormonal imbalance. Such disorders develop as a result of other gynecological diseases or when the body functions improperly. Traumatic ectropion of the cervix occurs for the following reasons:
- Injuries of the cervical canal - most often they appear after abortions at a late period, when the doctor expands the cervix artificially, which leads to eversion of the cervical canal.
- Mechanical damage during childbirth or due to the resulting scar - changes occur as follows: the longitudinal and circular muscle fibers are torn, and a scar occurs at this place. The blood flow in such tissues is much worse, because of which the mucous gradually turns inside, turning into ectropion.
- Use obstetric forceps when the need for obstetric aid arises.
- The birth of too large fetus, multiple fetuses.
Sometimes the pathology is caused by sexually transmitted infections that, in tandem with erosion, provoke inflammation. Long-term presence of microbes in the body leads to the fact that cancer develops. Therefore, it is very important to identify the causes of the development of pathology in time to select the appropriate treatment.
Pathology increases the risk of developing more serious diseases and infections. First of all, this is due to the minimal cellular protective barrier.
There are a number of diseases that develop with ectropion:
- Cervicitis - inflammation of the cervical canal. The condition has no definite symptoms, so it is most often diagnosed when a smear is taken.
- Keratosis - if ectropion is not treated, soon the tissues begin to regenerate and harden. To identify the pathology, the doctor must perform a colposcopy and biopsy.
- Dysplasia - the risks increase against the background of eversion, sometimes there is oncology.
- True erosion - ectropion often causes this type of erosion.
All these diseases are serious enough, they need compulsory treatment, as there is a danger of developing cancer, which is much worse therapy, and sometimes leads to death.
Cervicitis is an inflammation of the cervix. Pathology is a consequence of endocervicitis. These conditions are considered precancerous, especially if a woman is infected with human papillomavirus stamps 16 and 18. On examination, a gynecologist can observe puffiness, redness, ulcers, dilated vessels, a whitish bloom, etc.
When the stage is chronic, all these symptoms are mild. Cysts are formed, clogged ducts of the glands appear and hypertrophy (enlargement of the neck) develops. To treat cervicitis, doctors prescribe anti-inflammatory suppositories.
Some infections are transmitted to a partner, so sometimes both a woman and a man must undergo treatment.
Ectropion together with keratosis is a case that requires mandatory treatment, as the condition is precancerous. Usually, the occurrence of concomitant diseases occurs with advanced forms. The secretion of the vagina for a long time affects the mucous membrane of the neck, because of which the cells are rearranged and dysplastic. This process is called keratosis.
Pathology is the keratinization and thickening of the mucous. Such a state is very dangerous, since metaplastic processes begin in cells, from which they can grow uncontrollably in the future.
Both diseases go unnoticed, the only signal is pain or discharge during sex.
With the addition of inflammation, the clinical picture becomes brighter.
Erosion and ectropion
Doctors consider ectropion to be the most complicated form of ectopia (pseudo-erosion - for more details, see the article Ectopia of the cervix - what is it?). There is another opinion when, in the traumatic form of the pathology, the affected area begins to eroziruyutsya, then becomes infected with microbes or viruses, because of which the inflammation begins. During a gynecological examination, the doctor can deliver true erosion, but with careful examination of the pathology, ectropion is determined.
The eroded ectropion of the cervix differs from the usual form by its surface on which ulcers appear.
The long existence of the disease leads to maceration and expression, which is why concomitant erosion develops. Such a condition is no less dangerous than all of the above, since eroded ectropion is a precancerous condition, ready at any moment to develop into oncology.
Dysplasia is a precancerous condition of the cervix, accompanied by structural changes in the epithelium of the cervix. The disease is characterized by an increase in atypical cells when they grow and lose their shape. All these changes will soon lead to oncology, so it is important to diagnose the disease in time.
Usually the process proceeds calmly, with inflammation there is pain, discharge with blood streaks, copious secretion of white, milky color, itching and burning of the external organs. Treatment of severe stages is made by immunomodulatory drugs, after which surgery is prescribed.
What is dangerous ectropion
Running form is very dangerous for women. Constant exposure to vaginal secretion on the appearance of mucosal inversion and a change in topic causes metaplasia, which leads to the development of cervical cancer. That is why oncology can be considered a complication of ectropion.
In addition, untreated pathology causes infertility. This is due to the deformation of the cervical canal and impaired reproduction. Sperm can not normally pass through the cervical canal to the egg, so fertilization is impossible.
How to treat ectropion of the cervix
When diagnosing pathology, surgical removal of the affected area is mandatory. Before proceeding with the operation, the patient undergoes anti-inflammatory and antibacterial therapy. The choice of treatment for ectropion of the cervix depends on the severity of scars, the depth and area of the lesion.
The following methods are used as therapy:
- Diathermocoagulation - cauterization by electric current is effective, but the method has many shortcomings: too deep an impact, causing healthy tissue, as well as long-term healing, many complications, no histological examination of cancer,
- Electro excision - layer-by-layer excision of pathological tissues within healthy. The method allows to examine tissue sections to check cells for oncology. For electroscission characterized by rapid healing, rare negative effects and preservation of reproduction. The negative aspects include the removal of a certain amount of healthy tissue, their temperature damage, sometimes the development of cervical stenosis and possible relapses,
- Radiosurgery is a more benign method involving the dissection of pathological tissues with radio waves without destroying soft ones. The method is practically painless, bleeding is minimal, healing is fast. The main advantage is the absence of scars and relapses in the future,
- Laser cauterization of cervical ectropion - a high-energy laser is used. Painless, gentle way, after which the wound heals quickly, leaving no scars. Disadvantages: repeated cauterization is sometimes required, difficulties in controlling the depth of exposure, which is why a relapse is possible, expensive cost,
- Full-fledged surgery - the method is used for ectropion with pseudo-erosion, neck deformities and when other methods are powerless.
It is important to bear in mind that congenital pathology is not treated, only acquired eversion needs treatment.
The pathology itself does not affect conception, pregnancy and childbirth. In the congenital form, infertility occurs not because of ectropion, but as a consequence of the inflammatory process or hormonal failure.
If the pathology is combined with pseudoerosis, scarring of the cervix and other gynecological diseases, the woman cannot bear the child, and infection occurs.
In addition, there are often ruptures of the cervix during labor, infectious complications such as metroendometritis, cesarean section is indicated. Pregnancy and cervical ectropion are very versatile concepts.
In one case, the woman calmly bears the fetus and gives birth without consequences, in the other there are many complications in the form of miscarriages, difficult or premature birth, etc.
Planning of pregnancy is better to be postponed until the pathological area is removed and adequate anti-inflammatory therapy is carried out.
With pathology, you can get pregnant, but no one guarantees that the whole process will end safely.
How to prevent pathology
As with any gynecological disease, the prevention of ectropion consists in regular visits to the doctor. In addition, a woman should avoid abortions and frequent operations on the uterus or cervix. It is important to treat inflammatory and infectious diseases in time, as well as to avoid injuries during childbirth. To prevent complications, you need to look in advance for a good specialist who will select the right tactics and help give birth without negative consequences.
Ectropion after delivery
Postpartum ectropion develops due to many factors. Usually, the reasons for this are:
- Rupture of the uterus or its canal at the birth of a large fetus or extensor biased child.
- Incorrect stitching.
- Imposition of band forceps, etc.
If the uterus is badly damaged, all layers are included in this process. After an injury, scarring occurs, tissues cannot normally feed, and the cervical canal is turned inside out.
The mucous membrane of the cervical canal, which is turned inside the vagina, is adversely affected by the acidic environment. As a result, inflammation, infertility, develop comorbidities.
In order not to risk her health, a woman must visit a gynecologist on time, treat any infectious diseases, avoid abortions, using contraceptives.
What is it, the ICD-10 code
Erosion (ectopia, pseudo-erosion) - this is a change in the layers of the epithelium lining the cervix on the vaginal surface.
This state of the tissues of the body is found in almost half of women of child-bearing age. Erosion is associated with the zone of transformation - the permanent transformation of epithelial cells.
In the normal state, the cervix is lined with a multi-layered sheath with a flat structure. In the process of transformation, this layer is replaced by a cylindrical type of epithelium.
Changes occur with the growth of reserve cells. This process is cyclical. In medicine, this transformation is called squamous metaplasia.
When examining a gynecological chair, the doctor sees a change in the layer of the epithelium. The cervix reddens during erosion. Its structure with such changes is heterogeneous.
Ectopia is not considered a disease.therefore, it is not registered in the International Classification of Diseases (ICD-10). The condition refers to a number of physiological features.
Ectropion is a complicated form of erosion.. The disease can be congenital or acquired.
When ectropion in the canal of the lower part of the cervix is the inversion of the mucous membrane. This condition is considered pathology.
Complicated erosion of the cervix, like ectropion, requires treatment, the disease code according to ICD-10 is No. 86.
What is ectropion and cervical erosion:
Differences and similarities
What is different concepts:
There are similarities between these states. by visual inspection of the woman. The mucous surface is noticeably highlighted in both cases and is covered with red non-uniform foci.
Often, erosion and ectropion of the cervix - the joint statecomplementing each other. The reason for this phenomenon in the relationship of pathological processes associated with changes in the structure of the epithelium.
Eroded ectropion - a complicated form of erosion. With her, the cervix becomes vulnerable.
Ectropion leads to the development of gynecological pathologies:
If a woman is examined and treated, the risk of complications is reduced.
The choice of therapy depends on the factors:
- severity of pain,
- nature of discharge
- plans for pregnancy
- childbirth and abortion in history
- stage of pathology,
- chronic diseases.
Removal of the pathological layer of the epithelium is carried out in several ways:
Methods for treating cervical erosion:
In the treatment of ectropion destructive therapies are used.. Drug treatment is prescribed as an additional.
The main direction is to restore the protective and reproductive functions of the cervix. To do this, use drug therapy.
Depending on the degree of organ damage and the woman’s well-being, prescribe drugs:
- hormonal pills,
- antibacterial agents
- candles to restore the microflora of the vagina.
After the elimination of the local inflammatory process, the type of erosion is determined using colposcopy and cytological analysis.
According to the survey cervical damage is of several types:
- true erosion
True erosion provokes vaginal injuries.. This often happens after giving birth. Contraceptive caps, douching, and forced sexual contact can provoke injury.
Minor ulcerations are restored if the source of injury is eliminated. For rapid healing apply special ointment, which is introduced into the vagina.
If ectopia is complicated by ectropion, drug treatment prescribed as a supplement. The removal method depends on the degree of damage and the presence of associated diseases.
Small areas of ectopia do not require treatment. Ectropion is removed by surgery and combined with medication.
Removal of ulcerations reduces the risk of cell degeneration into a malignant tumor. Pathology often passes without any signs.
So that the disease does not go into a difficult stageA woman needs to regularly visit a gynecologist.
Symptoms: how to recognize the pathology of the cervix in time
There are no specific manifestations of ectropion. In most cases, the disease is detected by chance during examination by a gynecologist.During the examination, the doctor may notice the eroded surface of the cervix and refer the patient for targeted examination.
All women should visit the gynecologist for 1 month after giving birth and continue to visit the doctor every year.
When making a diagnosis of acquired ectropion take into account the fact that the cervix was previously clean. If the woman was observed by the doctor during the entire pregnancy, it would not be difficult to set the diagnosis. It becomes obvious that erosive ectropion arose soon after the birth of a child. In other situations without special studies to prove that this is an acquired pathology, and not a complicated congenital ectopia, it is rather difficult.
The following forms of pathology are distinguished:
Inversion of the cervical mucosa of the cervix rarely proceeds without inflammatory reactions. In most cases, cervicitis occurs on the background of erosion, and the following symptoms appear:
- Moderate or heavy discharge from the vagina,
- Itching and burning in the genital tract,
- Discomfort when urinating,
- Drawing pain in lower abdomen.
The intensity and color of the pathological secretions will depend on the microorganisms that caused the development of the inflammatory response. Severe inflammation can lead to fever and symptoms of general intoxication (weakness, chills, headaches).
In case of damage to the cylindrical epithelium, located outside the cervical canal, a defect in the form of an ulcer is formed, and bloody discharge appears. This is not a complete bleeding, but only a scant or moderate discharge: blood stains on linen and pads.
When eroded ectropion appear bloody discharge from the vagina.
Some criteria will help distinguish this complication from other gynecological diseases:
- Spotting with eroded ectropion occurs after sexual intercourse, the introduction of a tampon, pelvic examination,
- Allocations can occur on any day of the cycle, they are not associated with menstruation,
- Severe pain is not typical, but there may be weak nagging pains above the womb.
Spotting occurs in various pathological processes, so do not delay with a visit to the doctor.
Ectropion with keratosis
A dangerous condition considered to be a precancerous process. With this pathology there is a significant transformation of the cylindrical epithelium and its keratinization. The disease is asymptomatic for a long time and can be felt only by rare contact bleeding. Without treatment, it is possible the development of cervical cancer.
In practice, the first two forms of pathology usually go together, and eroded ectropion is combined with cervicitis. The development of keratosis speaks of a far advanced process and the beginning malignant degeneration.
Complications, or what will happen if not treated
Cervical ectropion is a serious problem that requires mandatory medical supervision. You should not refuse treatment if there is unequivocal evidence for it. Otherwise, serious complications may develop:
- Progressive growth of erosion and the formation of a deep epithelial defect,
- Decrease in the protective properties of the mucous membrane and the formation of a nidus of chronic infection,
- Imbalance of the vaginal microflora in the background of inflammation,
- Inability to live a full life due to frequent bleeding,
- Problems in the intimate sphere and a decrease in libido against the background of abundant pathological secretions,
- Malignant degeneration and development of cervical cancer.
If you do not treat cervical ectropion, then the woman may have problems in the intimate sphere and a decrease in libido.
Predicting the effects of untreated ectropion is quite difficult. Reviews gynecologists indicate that the rejection of the recommended therapy almost always leads to the development of chronic inflammation and the gradual progression of the disease. Many women note that treatment of eroded and inflamed ectropion requires a lot of effort, time and patience. It would be much easier to get rid of the problem in the early stages of its development and prevent the occurrence of complications.
Ectropion during pregnancy
Uncomplicated pathology of the cervix does not interfere with the conception of the child, the successful bearing and birth of the baby in the period laid by nature. Minor and shallow defects in no way affect the condition of the woman and do not interfere with the possibility of becoming pregnant and happy motherhood.
Complicated ectropion can maintain persistent inflammation in the genital tract. During pregnancy, the body's natural defenses are reduced, and physiological immunosuppression occurs. Against this background, chronic diseases are exacerbated, the microflora in the vagina is disturbed, and cervicitis develops. Inflamed erosion begins to bleed, the future mother is taken to the maternity hospital with suspected placental abruption or miscarriage, are being examined. All this does not contribute to the smooth course of pregnancy and childbirth.
Extensive ectropion with severe inflammation is dangerous for young women and may prevent the conception of a child. The cervical canal narrows, sperm cannot enter the uterus, fertilization does not occur. Often, chronic cervicitis leads to the development of endometritis - inflammation of the mucous layer of the uterus. This condition threatens with infertility, frequent miscarriages, and intrauterine infection of the fetus. Significantly increases the risk of ectopic pregnancy.
If ectropion is detected, it is recommended to undergo treatment before conceiving a child in order to avoid problems during pregnancy.
The depression of immunity during pregnancy exacerbates chronic diseases. The inflammatory process in the cervix can lead to cervicitis.
Inspection in the mirrors
During the examination, the doctor may see a pink or red spot on the cervix - eversion of the cylindrical epithelium. The spot may be located around the throat, on the upper or lower lip. In the case of cervicitis, signs of inflammation are visible: redness and swelling of the mucous membrane, abnormal discharge from the cervical canal. Detection of erosion on the cervix is a reason for further examination of the patient.
To determine the type of erosion, a Pap smear test is taken (test for oncocytology). The ectropion is indicated by the discovery in the material of cylindrical cells characteristic of the cervical canal. In contrast to congenital ectopia, when ectropion also visible areas of coarse connective tissue, elements of muscle fibers. All this indicates that the defect was obtained as a result of a previous injury (in childbirth, abortion, etc.).
A smear on oncocytology is not taken during menstruation. Before the examination, you should refrain from intimate intimacy (48 hours), do not use vaginal suppositories, tampons, and drugs for douching. A smear is taken before the gynecological examination and colposcopy.
In order to identify a concomitant infectious pathology and the causes of inflammation, it is recommended to be examined:
- Bacteriological seeding from the cervical canal (allows to identify opportunistic flora, diagnose vaginal dysbacteriosis),
- PCR for HPV - it is this virus that causes cervical malignant tumors,
- Screening for chlamydia and other STIs.
According to the test results, the doctor will select drugs for local treatment, which will get rid of the inflammatory process and proceed to the direct treatment of ectropion.
Colposcopy is the “gold standard” in detecting cervical disease. The doctor examines a suspicious area under high magnification, conducts special tests. Modern colposcopes allow not only to display information on the screen, but also to take a photo, as well as video recording.
Using the method of extended colposcopy, the doctor can accurately determine the presence of pathological foci and assess their condition.
Colposcopically ectropion is a section of the cylindrical epithelium with its inherent folds. With congenital abnormalities folds are evenly arranged in the form of a Christmas tree. The acquired nature of the disease is indicated by the chaotic spread of folds.
In congenital ectropion, the appearance of a transformation zone is characteristic - the boundaries between bright red clusters of cylindrical epithelium and pale gray stratified squamous. Well visible network of small vessels.
In half of all women, along with the normal transformation zone with ectropion, pathological changes are also detected:
- Signs of keratinization,
- Iodine-negative zones.
Acquired ectropion is characterized by violation of the normal boundary of the transformation zone. The eversion of the epithelium of the cervical canal is clearly visible.
When abnormal colposcopic signs are detected, targeted biopsy is shown. A special tool is taken suspicious area of the mucous membrane and sent for histological examination in the laboratory. According to the results of histology, such types of ectropion can be distinguished:
- Glandular - glands are formed that produce a large amount of mucus,
- Metaplastic - the formation of several layers of cylindrical cells, blockage of the ducts of the glands with the subsequent appearance of nabotovyh cysts,
- Epidermidizing - foci of dystrophy and the gradual replacement of the cylindrical epithelium of multilayer flat.
With a complicated ectropion, various histological findings characteristic of a particular pathology are possible.
Only histological verification uniquely distinguishes benign cervical changes from cancer.
Treatment methods for acquired cervical ectropion
Unlike congenital abnormalities, acquired ectropion requires mandatory therapy. This is a form of erosion that does not pass on its own, does not disappear under the influence of hormonal, immune and other factors. To treat ectropion is necessary - it is an axiom. The only question is what treatment to choose in order to ensure that the problem is eliminated and to prevent recurrence.
Acquired ectropion requires treatment, because the lack of therapy increases the risk of developing more serious cervical diseases, including cancer.
Conservative non-drug therapy
For the treatment of ectropion apply the following methods of exposure:
- Laser vaporization - evaporation of erosion by a laser beam. In the treatment of ectropion is rarely used, as it does not always allow to capture deep defects, especially those that have arisen against the background of cicatricial post-traumatic deformation of the cervix,
- The radio wave method is the most comfortable, gentle and effective method for the treatment of cervical pathology. Used in women who have not given birth, leaves no scars. In modern gynecology, the radio wave installations Surgitron and Fotek are popular;
- Cryodestruction - burning with liquid nitrogen. The long recovery period, copious discharge after the procedure somewhat limit the application of this method,
- Electrocoagulation - exposure to high frequency currents. Healing after DEK goes about 6 weeks, possibly the formation of scars. Not applicable to women who have not given birth. In young patients, you can use a variety of DEC - a technique of argon plasma ablation.
The radio wave device "Fotek" allows you to quickly and painlessly get rid of cervical abnormalities.
The choice of treatment method will depend on the size and depth of the defect, the presence of complications and the reproductive status of the woman. Regardless of the type of procedure after therapy, you should follow some rules:
- It is forbidden to sexually lead to the complete healing of the epithelium,
- It is not allowed to lift weights, play sports, hard physical work,
- Should not be douching, use tampons,
- It is forbidden to visit saunas, baths, swimming pools, take a bath.
If these rules are observed, the chances of complete healing of the mucous membrane and recovery are very high.
Ectropion of the cervix reduces the protective cellular barrier, which creates favorable conditions for the development of other diseases that pose an even greater risk to the health of a woman. When they are detected, mandatory therapy is required, because otherwise there is a high risk of cancer, which can not only impair health, but also be fatal.
For cervicitis (cervical inflammation) there is no obvious symptoms, therefore, it is possible to diagnose the disease only by taking a smear for laboratory research. Pathology develops as a result of endocervicitis and is classified as a precancerous condition (especially for women infected with 16 or 18 strains of the human papillomavirus).
During the examination of the cervix, the gynecologist can identify:
- whitish bloom
- dilation of blood vessels.
In the case of the chronic form of cervicitis, the listed symptoms are less pronounced. However, instead of it, cysts can form, the cervix itself increases markedly in size.
For the treatment of cervicitis special anti-inflammatory candles are used.
The lack of adequate treatment for ectropion often causes keratosis (rebirth and hardening of mucous tissues). The only obvious symptom of a pathology for a woman is pain during intercourse; therefore, the disease can only be diagnosed with confidence when performing a biopsy and colposcopy.
In combination with keratosis, ectropion is also evaluated as a precancerous condition, therefore, it is not recommended to neglect treatment with such a diagnosis.
What is the danger of ectropion?
Most dangerous is this pathology in a neglected form, since it causes metaplasia and subsequent cancer. In addition, ectropion causes deformation of the cervical canal, which becomes cause infertility (the spermatozoon cannot reach the egg cell, the sexual process does not occur).
Impact on pregnancy
Ectropion itself not an obstacle to childbirth or conception baby However, hormonal disruptions, infections, scarring, or pseudo-erosive changes that may occur may well have a negative effect on female reproductive function.
It is almost impossible to predict exactly how ectropion will affect childbearing and childbirth in each individual case. However, it is most reasonable to plan a pregnancy after surgery for the removal of the eversion.
The only reliable way to ensure prevention of ectropion is regularly be examined by a specialist. Recommended avoid abortions and other operationsaffecting the cervix. It should promptly carry out the treatment of all identified infectious and inflammatory diseases.
Guaranteed to avoid the development of ectropion will not succeed (especially for women who have already given birth or had abortions). If the pathology has already been identified, then you should immediately discuss with the doctor the possibility of surgery (in the case when it comes to the acquired form of the disease). Those patients who have not been diagnosed with such a diagnosis should undergo regular routine check-ups with a gynecologist.