What is the ectropion of the cervix, and the danger of this type of change in the body?
Ectropion is a pathological defect in which there is an eversion of the mucous membrane of the cervical canal. In this case, it will look as if turned inside out.
The slimy secret performs a protective function in the body of a woman, not allowing microorganisms from the vagina into the uterus. But with ectropion, the protective functions of the mucous are destroyed. This is due to the fact that it enters the acidic environment of the vagina from an alkaline environment. This can lead to infectious diseases, which, in turn, provoke inflammatory processes and more serious and dangerous pathologies. These include true erosion, endometritis and other diseases of the female reproductive system. But the most dangerous consequence of the presence of ectropion in a woman is cervical cancer.
Basically, this pathology is quite successfully treated. But despite this, there are a number of side effects and complications after undergoing treatment.
Cervical ectropion - what is it? The photo is presented in the article.
The congenital form of ectropion of the cervix of the uterus is diagnosed in young women who have just begun to have sex, have not had pregnancies or childbirth. In medical practice, this type is called cervical ectopia. It is believed that this pathology is formed during fetal development under the influence of many adverse factors. It happens that ectopia is inherited. Women with a congenital form of ectropion may be disturbed by hormonal disorders and failures in the menstrual cycle. As a rule, if there are no inflammatory processes, this type of pathology does not need treatment. Many pass after the first birth with a change in hormonal levels.
Acquired form occurs due to the impact of certain external factors. These include:
- childbirth, especially those with complications,
- multiple pregnancy or large child,
- rupture of the cervical mucosa,
- mechanical impact
- fast delivery
- wrong attempts.
Gaps arising for these reasons require stitching. After this procedure, the process of scarring occurs, during which the blood flow and oxygen enrichment of the epithelium is disturbed in the damaged part of the mucous membrane. All this leads to changes in the cervix, namely, eversion of the mucous membrane.
It is not difficult to identify the acquired ectropion in the event that a woman had previously had a clean cervix without pathologies. In the event that the patient has not previously visited the doctor, it will be very difficult to establish the congenital form.
Symptoms of Ectropion
Ectropion of the cervix has no severe symptoms. In most cases, the presence of pathology is detected by chance at a visit to a gynecologist. Obvious signs of disease appear only when an inflammatory or infectious process is attached. In these cases, the woman may notice the following manifestations:
- failures of the menstrual cycle
- increase in whitish discharge,
- lower abdominal pain that sometimes lumbar,
- too little or too much menstruation,
- there may be a discharge with an unpleasant smell,
- after intercourse, there is bloody discharge and pain,
- there are aching pains in the abdomen,
- the woman feels weak and tired.
Possible forms of ectropion
Due to the fact that ectropion of the cervix reduces the protective barrier, favorable conditions can be created for the development of diseases that can lead to serious complications in a woman. In this regard, the main forms are distinguished in which it is necessary to begin treatment as early as possible. Delay can lead to serious consequences.
Eroded cervical ectropion is a complicated form of erosion. This pathology occurs as a mechanical injury to the cervix, and hormonal failure. Such a deformation of the organ should not be ignored, since the effects of an eroded ectropion can be very serious. Characteristic symptoms may be:
- nagging pains
- bleeding during or after intercourse or gynecological examination,
- sometimes minor bleeding occurs on any given day, regardless of the cycle.
Mostly ectropion and erosion is accompanied by an inflammatory process - cervicitis. This disease is characterized by the following symptoms:
- itching, burning,
- discomfort when urinating,
- increased secretion
- cysts may form,
- when viewed on the cervix can be found whitish bloom and redness.
An accurate diagnosis is made after receiving the smear results. Symptomatology will be more pronounced in case of an intensifying inflammatory process. Then chills, fever, headache can be added to the symptoms.
Ectropion and keratosis
In the absence of timely treatment, cervical tissue begins to change and harden. For a long time, a woman may not be aware of the presence of the disease, since keratosis is almost asymptomatic. Can only occasionally bother the pain during intercourse or small bleeding.
This is a very dangerous form of ectropion, which is considered to be a neglected stage. In the absence of adequate treatment, keratosis leads to cervical cancer.
This is another dangerous stage of ectropion, at which changes occur in the structure of cervical tissue. The growth of atypical cells occurs. Symptoms are also not very pronounced. Discomfort bothers only with the development of the inflammatory process. A woman can be bothered by pain, itching, milky, white, heavy discharge, sometimes with streaks of blood.
In this case, treatment should begin as soon as possible, as it can lead to cervical cancer.
Diagnosis of ectropion is not difficult. Performed in several ways.
- Gynecological examination. With the help of mirrors, the doctor is able to see the changes on the cervix - scars, redness, eversion of the mucous membranes, sometimes swelling of the affected organ is visible. It is worth noting that congenital ectropion has a rounded shape, while acquired may differ in shape and size, depending on the reasons for its occurrence.
- Taking smears. To identify the causes of the development of pathology, analysis of the flora, bacterial inoculation from the cervical canal, analyzes of STIs and HPV are taken.
- Colposcopy. This diagnostic method is obligatory, since the type of examination best reveals the pathological conditions of the cervix uterus. With the help of colposcopy, the doctor can view the area under magnification that is necessary for the study, which makes it possible to accurately determine the degree of cervical damage and the location of the folds of the mucous membrane. With an acquired ectropion, the folds are arranged chaotically, and with congenital - evenly.
- Biopsy and histological examination. If during colposcopy abnormal processes on the cervix are found, the doctor takes the affected part of the mucous membrane and sends it to the laboratory for further diagnosis.
- Hormonal studies. If the doctor determined a congenital form of ectropion following a colposcopy, an analysis of hormones is prescribed.
Treatment of cervical ectropion is necessary, since this form of erosion does not go away on its own. The method of treatment depends on the type of disease, its causes and the individual characteristics of the patient. When ectropion drugs are prescribed for a mild form, in the more severe they are used as an adjunct to the main treatment, which includes the complete removal of the deformed area.
To eliminate the pathology in the first place get rid of inflammatory processes and infections. After this, the anatomical shape of the cervix is restored. Then work on the normalization of the vaginal microflora.
To eliminate the deformation using several methods. How to treat cervical ectropion, in each case, the doctor decides. Consider the basic methods used for treatment.
- Chemical coagulation. This method is used to treat small affected areas. It is used to treat erosion. The bottom line is that the pathological area is applied acid, which it is cauterized. At this place there remains a scab separated on its own within ten days. It takes about a month to fully restore tissue. The method is not used for the correction of large areas, as it can lead to a change in the cervix and intoxication of the body.
- Laser vaporization. It is used to treat eroded and simple ectropion. The method is based on the evaporation of pathogenic areas of the cervix. Not applicable in the presence of severe deformities, dysplasia and malignant tumors. The laser is not always able to capture deep scars. A month later, the treated area is covered with a new layer of mucous.
- Electrosurgery. The treatment takes place with the help of electric current. Due to the fact that after the procedure, there are deep scars that can further prevent conception, the method is not used in women who are planning a pregnancy. Recovery lasts up to three months.
- Cryosurgery. Treatment with liquid nitrogen. It is used in non-women. A small portion of healthy tissue is processed along with the affected area. After the procedure, abundant discharge is possible.
- Radiosurgical method. The safest and most gentle. It is used in young virgin women. Very short recovery period, no scarring.
If the disease is detected during pregnancy, an extended colposcopy is performed. In the absence of malignant tumors, treatment begins after childbirth. Taking material for biopsy in the period of carrying a child is strictly prohibited.
If the above methods did not help, then surgical intervention is applied. For the treatment of cervical ectropion surgery is performed in the following ways:
- Excision - deep excision of the pathogenic site.
- Conization - the affected area is surgically excised. At the same time there is a scar, there is a long painful recovery.
- by laser
- treatment of ectropion of the cervix with radio waves prevents the risk of bleeding,
- ultrasound - almost never used, as it has many side effects,
- electroconization is the most common method.
For the treatment of cervical ectropion, ancillary drugs are used: antibiotics, antiviral drugs, immunomodulators and hormonal drugs. It all depends on the degree of change and the reasons that caused them.
Feedback on the treatment of cervical ectropion is generally positive. The main thing is the timeliness of its detection, since against the background of this pathology other, more serious diseases may occur.
Rehabilitation after treatment
After the operation, you must perform a number of conditions:
- abandon sexuality until complete healing
- can not lift weights
- do not engage in hard physical labor and sports,
- Do not visit outdoor ponds, pools, saunas and baths,
- Do not use tampons.
The diagnosis of ectropion of the cervix can be heard by absolutely any woman, regardless of age. Especially at risk are those who give birth or have an abortion. The disease is fraught with serious consequences, therefore, timely detection of pathology plays a very important role. In the treatment of early stages of cervical ectropion, the reviews are overwhelmingly positive. The longer the treatment does not begin, the higher the risk of developing dangerous diseases. You need to carefully monitor your body. If you have any suspicious symptoms, especially regarding changes in discharge or irregular menstruation, you should contact your gynecologist as soon as possible, who will prescribe the required tests. According to their results, you should discuss with your doctor the possible methods of treatment and choose the most suitable for you.
Relevance of the topic
Ectropion (or endocervical ectropion) of the cervix is a pathological condition of the mucous membrane of the cervical canal (endocervix), which consists in the inversion of its lower parts towards the vagina. However, participation in this and higher departments is possible, although much less often.
What is dangerous cervical ectropion?
The most common cancer pathology of the female reproductive system is cervical cancer, averaging 12% in relation to all malignant tumors that are detected in women. Among all diseases of the female genital organs, about 10–15% is attributed to cervical pathology, which occurs in 15–20% of women of reproductive age and in 5–9% of women in menopausal age.
In the development of a malignant tumor of this department, a certain staging and phasing of pathological processes occurring with a characteristic clinical and morphological picture is noted. In this regard, and for the purpose of early diagnosis and prevention of cancer, a pre-invasive (zero, initial) stage of cancer is distinguished, and precancerous and background diseases are among benign pathologies.
Benign background diseases are such changes in the mucous membrane of the vaginal section of the cervix uterus, in which the normoplasia of its epithelial cells is preserved - their proper mitotic division occurs, followed by differentiation, maturation and desquamation.
Diseases, which are a predisposing factor, a background for the development of a malignant tumor, among others are false erosion and ectropion of the cervix, true erosion, a polyp, cervicitis and some other pathological conditions.
Many authors regard ectropion as a complicated clinical form of ectopia, that is, pseudo-erosion. In accordance with the International Classification of Diseases of the Tenth Revision, which was introduced into practice in Russia in 1999, this pathology under the code No. 86 refers to the section of non-inflammatory diseases of the female genital organs.
Causes of cervical ectropion and its types
Depending on the reasons, there are two types of it:
- Congenital cervical ectropion, which occurs even in the prenatal period under the influence of maternal estrogens and can persist until adolescence. In this case, it is regarded as a physiological state and passes on its own. The diagnosis of a congenital form as a pathological condition is established by the gynecologist in the case of the first treatment of a young woman, relatively new to sex life. The disease is a functional disorder associated with hormonal imbalances, is very often combined with various disorders of menstrual function and is quite rare among young women who have not given birth and have not had pregnancies.
- Acquired or traumatic cervical ectropion. When diagnosing, its occurrence is taken into account on the mucous membrane unchanged before. The changes are characterized by a violation of the relationship between the epithelial layer of the endocervix and stroma against the background of microcirculatory disorders, impaired innervation and the development of sclerotic changes of the stroma.
Pathogenesis and effects
Brief information about the anatomical features and the histological structure of this department of the internal genital organs of a woman makes it easier to understand the causes, the mechanism of formation of acquired pathology, its consequences, how to treat ectropion of the cervix and ways to prevent it.
The vaginal segment of the cervix, which is 2-3 cm in length, and about 1.2 cm in thickness, is outside covered with a stratified squamous epithelium consisting of four layers (ectocervix). One of them (the parabasal layer) consists of a two-row epithelium, whose cells have a high capacity for mitosis (division) and provide for the regeneration, maturation and differentiation of flat multi-layered epithelium.
The cervical canal connects the uterine cavity with the vagina. It is covered with a mucous membrane (endocervix) consisting of a cylindrical epithelium that produces viscous mucus. Due to the presence of lactobacilli, the vaginal environment is acidic, unlike the alkaline environment of the cervical canal. In addition, lysozyme and immunoglobulins are present in the latter. Due to these factors, the cervical canal is one of the obstacles to the penetration of microorganisms into the uterus.
The border between the ectocervix and the endocervix is located at the level of the external pharynx and is a transitional zone between the stratified squamous epithelium of the ectocervix and the cylindrical epithelium of the endocervix.Next to this zone, which is called the transformation zone, the layer of cylindrical epithelium is supplemented with a layer of so-called reserve cells, which in normal conditions provide regenerative processes in the first.
In the case of hormonal imbalance or inflammatory processes, cellular metaplasia occurs, that is, the transformation of reserve cells into squamous epithelium. As a result, malignant tumors most often develop in the transformation zone.
Connective tissue, elastic and smooth muscle circular (around the side walls) and longitudinal fibers are located under the mucous membranes of the vaginal segment of the cervix. Various injuries of the cervix, accompanied by a rupture, especially bilateral, of its soft tissues lead to rupture of the circular muscles, while the longitudinal muscles in the region of its anterior and posterior lips remain. Reduction of the latter in the absence of opposition from the circular muscle fibers leads to a gaping external os, a slight inversion and exposure of the mucous membrane of the lower portion of the cervical canal, that is, to the formation of ectropion.
The cervical ectropion is most often formed after childbirth, which is associated with traumatic injuries and ruptures of soft tissues with:
- large fruit,
- multiple babies,
- fast delivery
- instrumental expansion of the external pharynx and dissection of the fetal bladder,
- extensor presentation of the fetus,
- extraction (extraction) of the fetus through the imposition of abdominal forceps,
- cicatricial changes and rigidity (insufficient tissue elasticity) of the cervix,
- premature labor, when the cervix is not sufficiently prepared, etc.
The development of pathology is also promoted by inflammatory and erosive processes, frequent abortions and late abortions, diagnostic curettage, prolonged use of chemical contraception, surgical manipulation of the neck and improper suturing during its rupture.
Reversed mucosa with a disorder of innervation and microcirculation, with a broken boundary between the single-layered cylindrical and flat-layered epithelium falls from an alkaline environment into an acidic one. As a result of all these changes, pseudo-erosion develops on it, which, almost always, accompanies the eversion of the mucous membrane - the so-called erosive ectropion of the cervix.
The latter is accompanied by impaired mucus secretion and a significant decrease in the barrier functions of this uterine region, which leads to an easy penetration of the vaginal microflora in the ascending path into the cervical canal.
As a result, inflammatory processes develop in the form of endocervicitis and subsequent cervicitis and endometritis, which are the basis of precancerous conditions and malignant cell transformation, especially when infected with oncogenic strains (16 and 18) of human papillomavirus.
Along with these processes, hypertrophic and glandular-cystic degenerative changes occur, growths of connective tissue structures and scar deformity of the cervix, conditions for the development of infertility appear.
Clinical manifestations and diagnosis
Directly, the eversion of the mucous membrane is not manifested by any specific clinical symptoms and is detected by the gynecologist only during a routine examination or examination for another reason. The congenital form of the pathology is accompanied by various disorders of the menstrual cycle, but the latter are associated with the previous hormonal imbalance, but not directly with the ectropion.
During the formation of pseudo-erosion, activation of a co-infection and the addition of the inflammatory process (cervicitis and endocervicitis), which almost always accompany the pathology in question, the following symptoms appear:
- Increasing the amount of clear discharge, the appearance of whitish or white purulent discharge from the genital tract, sometimes abundant and with an unpleasant odor.
- Itching and burning sensation in the region of the external genital organs and vagina.
- Soreness during or after sexual intercourse.
- Bloody spotting.
- Violations of the menstrual cycle in the form of menoragies.
- Contact bleeding (after intercourse, long walk, physical exertion, douching).
- The feeling of heaviness in the lower abdomen.
- Unstable, but prolonged aching pain in the lower abdomen, radiating to the lumbar and sacral spine, sometimes to the coccyx.
During the gynecological examination in the mirrors around the external pharynx in the region of the anterior (more often) or posterior lip, the reversal of the cylindrical epithelial layer is determined by round or irregular outlines. In the presence of pseudo-erosion, reddish swollen and whitish spots are noted.
In colposcopy, ectropion is defined as a section of a cylindrical epithelium with a characteristic palm-like folding of the mucous membrane of the cervical canal. The folds are arranged evenly according to the type of spruce branches in case of congenital eversion and chaotically - in the case of traumatic. In addition, marked foci of marked hypertrophy of the mucous membrane, defects of the epithelial epithelial layer, and during a long process - foci of its atrophy. In some cases, in the peripheral regions visible transformation zone with open and closed glandular ducts.
When combined with the inflammatory process, hyperemic and moderately edematous mucous membranes, an extended capillary network under the epithelial layer, which manifests itself in the form of reddish spots and “smeared” points, are determined.
With a significant inflammatory process, swelling of the mucous membranes is pronounced, they have a bright red color and are easily injured and bleed during even minor contact with vaginal mirrors. For a chronic process characterized by moderate discharge, on the edematous neck of the uterus marked foci of hyperemia.
The method involves cauterization of the ectropion of the cervix by means of alternating electric current of high frequency. Ectropion treatment with diathermocoagulation has been used for a long time all over the world. However, it has a number of significant drawbacks:
- deep damage to healthy underlying tissues due to different (for a given current strength) coagulation depth,
- a long process of morphological tissue repair after treatment (up to 9-12 months),
- lack of the possibility of histological examination of the material (due to its destruction) and timely diagnosis of cancer in its initial stages (pre- and micro-invasive cancer),
- a wide range of complications during surgery and at various times after it, developing in 36-54% of treated patients.
Due to these disadvantages, diathermocoagulation treatment is currently hardly used at all.
Electrical excision and conization
Electrosurgical excision consists in layer-by-layer excision of pathological tissues without damaging them, and conization is the same way, but the removal of tissues is carried out within the cone, which is apexed towards the internal throat.
This method allows not only radical removal of pathological tissues within healthy tissues, but also to establish the final diagnosis based on in-depth morphological study of staged serial tissue sections. In addition, it is characterized by relatively rapid healing, a small percentage of complications, the ability to preserve the physiological function of the body.
Excision of pathological tissues by conization, with cervical ectropion
At the same time, the main disadvantages of diathermocoagulation conization are:
- significant temperature damage to adjacent tissues,
- the need to remove pathological tissues with a considerable reserve of healthy borderline tissues,
- The possibility, although quite rare, of marked scarring with the development of cervical canal stenosis (after 6-24 months) is a complication called coagulated cervix syndrome,
- post-coagulative endometriosis,
- disease recurrence
- reduction of its length and some others.
Thus, electroconization is an effective method of treatment, allowing histomorphological control, but characterized by a significant number of negative consequences.
Laser destruction and vaporization are carried out using carbon dioxide, neodymium, argon, ruby and other high-energy lasers. The procedure is almost painless, and healing takes place at about the same time as during radio wave exposure. In addition, damage to adjacent healthy tissues is minimal, there is no risk of cicatricial changes and cervical stenosis.
Laser vaporization is more accessible, since laser conization can be carried out only with the help of expensive foreign devices of the latest models.
The use of laser destruction can have complications:
- increased bleeding in cases of simultaneous vaporization in the presence of extensive or / and deep (more than 3 mm) lesions,
- the formation of adhesions and adhesions between the vaginal wall and the posterior cervical surface,
- frequent (about 22%) development of secondary infection,
- frequent post-coagulative endometriosis.
The main disadvantages of the method include:
- the complexity of the treatment of the affected area in terms of obtaining the destruction of the required depth and uniformity,
- the need for repeated procedures (in the case of a vast area of the pathological area) in order to achieve completeness of treatment results,
- lack of opportunities to conduct a control histological study,
- dependence of treatment effects on the area and depth of the nidus,
- the need for expensive equipment and specially equipped premises.
Among all the malignant neoplasms of the female reproductive system, cervical cancer occupies the leading place. Since the start of the process of malignancy, the involved anatomical structure undergoes certain changes, which take place in several stages and stages.
In medical practice, isolated so-called precancerous conditions, which in the absence of proper treatment, develop into oncology. One of the factors that may eventually lead to the formation of a cancer is the ectropion of the uterine cervix.
If we take into account the data of the International Classification of Diseases (mcb-10), the disease in question refers to the non-inflammatory pathologies of the organs of the female reproductive system.
Depending on the nature of the reasons, it is customary to distinguish such varieties of cervical ectropion:
- Posttraumatic or acquired ectropion. This type of the mentioned pathological condition most often occurs in case of mucosal injuries during surgical procedures such as therapeutic and diagnostic curettage, setting up an intrauterine contraceptive, as well as instrumental abortion.
- Congenital ectropion, which occurs with anomalies of intrauterine development against the background of the negative effect of mother estrogen on the fetus. This type of disease is regarded as a variant of the physiological norm.
It is possible to characterize congenital ectropion as a pathology if the diagnosis is made to the woman primarily, after the recent onset of sexual activity.
Another common cause of this pathological condition is childbirth, as a result of which the cervix was injured. Not only post-operative scars, but also incorrectly applied stitches can serve as an impetus for the formation of an ectropion.
The risk factors for the occurrence of this disease include the long-term use of combined oral contraceptives, the large size of the fetus in a pregnant woman, the extensor prevalence of the child in the womb, and low rates of elasticity of the cervix. Indirectly provoke the emergence of ectropion, can such additional factors:
- Fetal extraction with abdominal forceps,
- Multiple pregnancy
- The rapid course of the birth process
- Insufficient readiness of the cervix during preterm labor.
Erosive and inflammatory processes in the organs of the reproductive system play a significant role in the mechanism of the formation of cervical ectropion.
The so-called inversion of the mucous membrane of the cervix in the direction of the vagina is not accompanied by any specific clinical signs. The presence of a defect is usually detected by a gynecologist during a routine medical examination.
If a woman suffers from a congenital form of ectropion, then she faces severe violations of the ovarian-menstrual cycle, which arise not because of the formation of ectropion, but against the background of those dyshormonal disorders that have developed in her womb.
In 80% of cases, the constant companions of this pathological condition are endocervicitis, cervicitis, pseudo-erosion, as well as other infectious-inflammatory and erosive processes. In this case, the woman will be disturbed by the following clinical signs of ectropion:
- Minor bleeding from the vulva,
- An increase in the volume of white or clear vaginal discharge, most often, this discharge is accompanied by an unpleasant odor,
- Menstrual dysfunction (menorrhagia),
- Burning sensation and itching in the mucous membrane of the vagina and vulva,
- Discomfort and mild pulling pain in the lower abdomen,
- Bleeding from the genital tract after exercise, douching, and also after intimacy,
- Dull pain in the lumbosacral spine, and less frequently in the coccyx.
When performing a general gynecological examination in the mirrors, the gynecologist discovers in the region of the posterior or anterior cervical lip, around the external os, a cylindrical epithelial inversion. If white or red spots are identified on the surface of the mucous membrane, then we are talking about the development of a pseudo-erosive process.
In addition to the general gynecological examination, the method of colposcopy is used to diagnose cervical ectropion. During the study, pathological inversion is defined as a cylindrical epithelial formation that has a characteristic folding.
The folds of the ectropion have the appearance of spruce branches, which is characteristic of the congenital form of the defect. In addition to these signs, during colposcopy, foci of mucosal hypertrophy, areas of atrophy, or structural defects of the epithelial integumentary layer are identified.
If the cervical ectropion is combined with an inflammatory process, the cervical mucosa will have an expanded capillary network, as well as signs of swelling.
It is important to know if cervical ectropion was diagnosed, that this disease belongs to the surgical profile, and any options for conservative therapy are completely excluded.
There are several common methods for eliminating structural defects, but the choice of operational tactics depends on the severity of cicatricial changes, as well as on the depth of the lesion. There are such methods of surgical treatment of cervical ectropion:
To eliminate the structural anomaly, high-frequency alternating electric current is used, by means of which the ectropion is cauterized. This method of treatment, until recently, was widely used in gynecological practice throughout the world.
The potential disadvantages of diathermocoagulation are the lack of the ability to perform a diagnostic biopsy, the depth of the thermal damage of healthy tissues, the long rehabilitation period, as well as a wide range of intra- and postoperative complications.
This technique refers to atraumatic methods of ectropion elimination, since the dissection of soft tissues is carried out using high-frequency radio waves. The procedure itself is painless, is not accompanied by bleeding and involves a short recovery period.
Thanks to this technique, specialists have the opportunity to remove a structural defect within the surrounding healthy tissue. In addition, doctors have the opportunity to perform a detailed study of tissue sections. As the positive sides of electrosurgical conization, we can distinguish a minimum percentage of intra- and postoperative complications, preservation of the functions of the cervix, as well as a short period of regeneration.
For excision of the cervical ectropion, an argon, carbon dioxide, or ruby laser is used. This procedure is almost painless, and the period of postoperative regeneration is close to the time when performing radiosurgical conization.
As probable complications of laser destruction can highlight the risk of secondary infection, an impressive blood loss, the formation of adhesions between the posterior surface of the cervix and the vagina, as well as post-coagulation endometriosis.
In addition to the mentioned techniques, in more rare cases for the treatment of ectropion, Emmett plastics are used. Если рассматриваемое состояние протекает в сочетании с эрозивным поражением слизистой оболочки, то пластическая хирургическая методика является наиболее подходящим вариантом лечения.In the expanses of the global network, you can easily find information about what it is cervical ectropion, photos and videos that demonstrate the treatment of this anomaly.
Despite the fact that this formation is a structural defect, its presence does not affect the possibility of conceiving and carrying a child. In the congenital form of the disease, infertility may be associated not with the defect itself, but with those dishormonal disorders that exist in the female body from the moment of birth.
The reasons provoking the development of ectropion can be divided into groups depending on what causes the pathology.
- Causes related to mechanical damage. Special attention should be paid to postpartum damage. Usually, after a heavy labor process, a scar can form on the cervix. Because of this, the blood circulation is disturbed, which in turn causes the part of the cervix to be reversed into the vagina.
- Particular attention is paid to the development of this pathology due to injuries produced during surgery. Often after a poorly performed abortion or due to frequent scraping for all sorts of indications. A special danger to the development of ectropion is abortion at a late period, at which artificially expand the cervix.
- The reason associated with impaired hormones. This problem can occur even for non-females.
- Causes of ectropion, which are caused by infections and pathologies. Often, this problem may arise against the background of an existing pathology. For example, due to cervicitis, endometritis, cancer. And these diseases, in turn, arise against the background of persistent chronic infection.
There is another concept that develops for similar reasons, it is eroded ectropion. It usually arises as a complicated form of pathology and necessarily conceals in itself infectious and viral diseases of the urinary organs.
Ectropion of the cervix is divided into two classes.
- Congenital form. It is commonly called cervical ectopia. This pathology originates in girls who do not live sexually and who have not given birth. This type of pathology is also not combined with injuries caused to the cervix. This form of ectropion is a congenital problem, which is formed and laid in the womb. It is believed that the cause of this type of ectropion is hormonal failure.
- Acquired form. Inversion of the cervical canal to the outside occurs for a number of reasons, which are indicated in the previous subtitle. Recall that the acquired form of ectropion occurs against a background of injury to the cervix caused by abortion and childbirth. Acquired form also occurs against the background of pregnancy due to an excess of female hormones.
Symptoms and signs
There is a continuous connection between the pathologies of ectropion and erosion. Since ectropion is a complication of erosion, the symptoms of these pathologies are quite similar. Of course, if the disease has just begun to develop, then it will not give obvious signs. The initial stage can be detected by a gynecological examination. If the disease has been developing for some time, then it can make itself known by several types of manifestations.
- Cycle failure With such a diagnosis, a woman’s menstruation may come earlier or later than usual, and it is possible to change the amount of discharge.
- Sensations during sexual contact may not be pleasant. The girl feels pain and discomfort. Later, she may begin discharge after sex, such as white or red. As a result, she will lose all interest in sex.
- Constant pulling or aching pain in the lower abdomen, which find an echo in the lumbar region. They may increase with walking or exercise.
- In the half cycle, the girl may notice in her presence of discharge in a large volume. They can be transparent, turbid and have an unpleasant smell.
- The weakening of the general state of the organism. The patient may feel constant fatigue, drowsiness and body aches. This is also a consequence of the development of pathologies in the female body.
All of these symptoms will be observed if infections are attached to them.
Impact on conception, pregnancy and childbirth
Conception ectropion of the cervix is not affected in any way. If this pathology is congenital, then problems may arise against the background of a disease or hormonal failure. In this case, the concomitant disease must be cured and the woman will be able to have children.
But what if the patient became pregnant and discovered ectropion on the background of this condition? The pathology itself does not interfere with the birth process (if inborn). Acquired ectropion may be accompanied by the following phenomena:
- Infection of the child in the womb,
- Cervical rupture during labor
- The need for cesarean section
- Postpartum endometritis.
After the patient discovered this pathology, she needs special care and supervision. If you eliminate the diseases associated with ectropion, then pregnancy and childbirth will be successful.
Congenital ectropion not complicated by itself does not need treatment. Treat the pathology that is acquired over time. Cure ectropion possible in two ways. Consider each of the methods in more detail.
After antibacterial therapy, a surgical intervention is prescribed, which depends on the affected area and the development of ectropion. There are several options:
- Diathermocoagulation. This cauterization of the affected area with the help of current.
- Conization Cutting off the diseased part of the cervix in the form of a cone.
- Radiosurgical method. Moxibustion inverted part of the radio waves.
- Laser destruction is the effect on the unhealthy portion of the cervix with a laser.
- The knife method implies the plasticity of ectropion. At the moment, the method is only gaining popularity.
The main thing in prevention is timely visit to a female doctor. At least 2 times a year. In addition, actions that can cause damage to the cervix: abortion, curettage should be avoided in every way.
So, if someone is diagnosed with cervical ectropion, then first of all you should undergo a comprehensive diagnosis. After selecting an effective treatment option, and in the future to control the possibility of relapse with the help of preventive measures.
It consists in carrying out surgical plastics according to the method of Emmett or Sturmdorf. Recently, many authors consider these techniques to be the most promising treatment for ectropion, especially when combined with pseudo-arousal, hypertrophied or grossly deformed neck, and also in the absence of the effects of treatment by other methods or the impossibility of their use.
Cervical ectropion and pregnancy
The pathological state itself does not affect the possibility of fertilization, the safe bearing of the fetus and the birth of a healthy child. If a woman has a congenital form of this pathology, then possible infertility or dysfunctional pregnancy is not associated with ectropion, but with significant hormonal disorders already present, which are the cause of the latter.
Is it possible to give birth with cervical ectropion?
The presence of an isolated ectropion is not an obstacle to childbirth. However, the frequent combination of this pathology with inflammatory processes, pseudoerosis, rough cicatricial changes of the cervix are often not only the cause of miscarriage, but also infection of the fetus, rupture of the neck during labor, cesarean section, infectious complications such as metroendometritis in the immediate postpartum period.
Conception and pregnancy after removal of the pathological site and adequate subsequent anti-inflammatory therapy proceed without any negative consequences.
All women diagnosed with ectropion are recommended treatment with one of the surgical methods. A strictly differentiated approach in choosing a surgical technique allows us to avoid complications and frequent cases of exacerbation of the pathological process.
Prognosis and prevention of cervical ectropion
The prognosis for ectropion is favorable, but the asymptomatic course of cervical disease dictates the need for annual preventive examinations at the gynecologist.
Measures to prevent the development of cervical ectropion are rational management of labor, timely and adequate contraception to prevent abortions.
Ectropion - what is it? Such a deviation is as follows: endocervix, that is, the mucous membrane of the cervical canal, penetrates into the acidic environment of the vagina from an alkaline, habitual for him, environment.
This happens due to the inversion of the cervical mucosa in the vagina. The phenomenon can be both acquired and innate. Deviation affects the lower part of the neck.
With this violation significantly increases the risk of vaginal microflora in the uterus, which provokes the inflammatory process. As a result, a bright red hearth appears.
Possible complications - erosive damage, cervicitis, dysplasia. The most dangerous is the degeneration of cells and the development of a malignant process.
Ectropion acquired during pregnancy can cause infection of the fetus in the womb, miscarriage, rupture of the cervix of the body during childbirth.
Pathology can be triggered by the following factors:
- birth injuries that cause rupture of the cervix. They are caused by such reasons as too large a fetus, the use of generic operations, the improper use of drugs that cause labor-stimulating activity. When injuries disrupt the process of contractility of the muscle layers of the uterus,
- frequent abortions,
- cervical ectopia,
- abortions at a later date
- infectious processes of the genital tract (mainly their lower divisions),
- preterm labor,
- endometriosis of the cervix,
- early sexual debut
- multiple births
- use of obstetric syringes.
Erosion and ectropion are interrelated phenomena: the second is a complication of the first. Young girls who have not yet given birth may also have ectropion. This is due to hormonal disorders.
Also, the deviation is often diagnosed in girls whose first menstruation occurred at the age of less than 12 years.
The manifestations of pathology include the following:
- intermittent pain in the lumbar region. The nature of the pain syndrome is not related to the position of the body. The nature of the pain can be both acute and dull. Duration - from several minutes to several hours. The pain often appears in the morning and disappears in the middle of the day,
- rich transparent discharge from the vagina, which in some cases have a white tint. Over time, they may appear traces of pus,
- discomfort and discomfort during or after intercourse,
- menstruation disorders. The nature of discharge during menstruation changes: their duration becomes different, they become scarce or, conversely, too abundant,
- pain and heaviness in the lower abdomen.
The woman also notes general changes in well-being: there is increased weakness, fatigue, constant sleepiness, body aches.
Diseases that may be triggered by a deviation
Deviation can cause the development of such violations as:
- cervicitis - inflammation of the cervix,
- Keratosis - a change in the cells of the vaginal mucosa. Ectropion in combination with keratosis is considered a very dangerous condition, as in this case they are talking about the precancerous stage,
- dysplasia is a phenomenon accompanied by structural changes in the epithelial layer. In this case, atypical cells appear and increase in size. This condition is also precancerous.
The pathologies described are what ectropion is dangerous for. If you experience characteristic symptoms, you should immediately consult a doctor.
For the diagnosis of "Ectropion of the cervix" prescribe the following diagnostic measures:
- gynecological examination,
- history review,
- biopsy of tissues in the place of eversion of the mucous membrane,
- taking a smear from the mucous membrane and bacterial seeding of the material obtained,
- PCR diagnostics,
- blood test to assess the level of hormones.
The results obtained during the research allow to determine the course of treatment.
If the violation has a congenital nature, the treatment is aimed at suppressing infectious diseases occurring on its background.
In this case, these drugs are prescribed:
- vaginal suppositories (Terzhinan, Pimafutsin, Metronidazole),
- anti-inflammatory drugs in pill form (ibuprofen, nurofen, ketoprofen),
- antibacterial drugs (Streptomycin).
If there is an acquired cervical ectropion, surgical intervention is prescribed. How is this deviation treated?
The selection methods are as follows:
- chemical coagulation. This intervention is appropriate if the patient has an eroded lesion. In this case, the impact on the problematic formation occurs through the use of a mixture of acids - they carry out cautery. As a result, ectropion becomes crusted. It separates on its own within a week after cauterization. Full tissue regeneration occurs within a month.
- electrosurgical effect. The affected area is cauterized by electric current. The method is suitable if the patient has already given birth and no longer plans a pregnancy, because during the procedure the affected area is removed, and sometimes part of the cervix is removed. Complete healing occurs within 3-4 months,
- laser cautery. High energy laser is used. This is a fairly painless and gentle way: the wound after such an intervention is delayed quickly, the scars do not remain,
- cryosurgery. This is also a minimally invasive method. Tissue-affected tissues are removed by freezing with liquid nitrogen,
- thermocoagulation. The affected area of the cervix is affected by a heated coagulator. As a result, scar tissue is formed - that is why this method is not suitable for the treatment of patients who have not yet given birth,
- radiosurgery. This is a progressive method in which the dissection of the pathological formation using radio waves. Gentle operation: the waves do not destroy healthy soft tissue. The method is almost painless, healing is quick, the risk of bleeding is minimal.
After the operation, it is necessary to limit bathing in ponds and pools, to give up sex, to perform hard physical work and sports, to use hygienic tampons.
The duration of the rehabilitation period depends on the volume of the operation, the presence of complications, and the general well-being of the patient.
How does ectropion manifest
The main clinical manifestations of this pathology:
- Pain in the pelvis, which is aching in nature.
- Failures of the menstrual cycle.
- Frequent bleeding.
As a rule, this disease affects the lower part of the organ, in particular, contributes to the penetration of the vaginal microflora into the cervical canal and, consequently, to inflammation. A prolonged inflammatory process leads to the emergence of various pathologies, including true ectopia and atrophy of the cervical epithelium.
The code of erosive ectropion in ICD - 86.
What are the options for eversion
Most often, cervical ectropion is limited only to the outer part of the canal, which is located closest to the outer cervical throat. However, a more pronounced inversion of the endocervix will be quite real.
Under normal conditions, cervical glands produce mucus secretion with an alkaline reaction. With ectropion, the inverted endocervical surface is affected by an acidified vaginal environment, which provokes the formation of inflammation. In cervical reversal, in the absolute majority of cases cervicitis and endocervicitis occur, which look like a bright red inflammatory surface. Pseudo-erosion is often accompanied by eversion, which is located on the periphery of the ectropion.
Causes of the disease
- Birth injuries
The main causative factor in the occurrence of eroded inversion is any generic cervical injuries. The most common cause is a bilateral traumatic rupture of the cervix during natural childbirth that occurs in the following situations:
- the birth of a big baby
- abnormal presentation of the fetus during labor (extensor head, pelvic),
- reduction of cervical tissue elasticity (rigidity),
- ineffective and improper use of generic-stimulating drugs,
- use in labor delivery operations (childbirth using vacuum extraction or special obstetric forceps),
- postpartum complications (delay or violation of the integrity of the afterbirth, requiring manual surgery to examine the uterus).
- incorrect mapping of tissues when suturing cervical tears, especially in case of deep injuries (tears of 2–3 degrees).
The muscle layers of the neck are composed of longitudinal and circular fibers. Birth trauma disrupts muscle contractility, which causes a gaping of the cervical canal and the formation of an eroded ectropion.
- Abortion cervical damage
The forcible expansion of the cervical canal, which is always performed before artificial termination of pregnancy, leads to multiple minor traumatic injuries of the cervical tissues, vessels and nerves. Severe inversion with subsequent erosion of the cervical surface appears on the background:
- frequent medical abortions,
- long-term induced abortions (12-14 weeks),
- termination of pregnancy in the later period, regardless of the reason
- treatment and diagnostic examinations requiring expansion of the cervical canal (hysteroresectoscopy).
In fact, any violation of the integrity of the cervical muscles can be a cause for the formation of an eroded ectropion.
- Congenital variant
Although it is quite rare, it is quite possible congenital inversion, found in young girls. The reason for this pathology is an abnormality of the muscle tissue of the neck, leading to a gaping external os and the formation of ectropion.
Symptoms of cervical inversion
When eroded ectropion most often no manifestations. Some women may pay attention to the following inflammatory symptoms:
- increase the number of whiter,
- contact bleeding during sexual intercourse,
- slight pulling pain in the perineum or in the lower abdomen.
Some women may have problems with conception or fetal bearing, manifested by infertility or habitual miscarriage. However, this is more due to inflammation in the cervical canal, occurring against the background of eversion and the formation of erosion.
If in identifying an eroded ectropion, nothing is done, the possible consequences will be the following problems:
- chronic inflammatory process in the field of eversion, which will lead to dysplasia and significantly increase the risk of cervical cancer,
- against the background of infection and in violation of the cervical protective barrier increases the risk of penetration of microorganisms into the upper parts of the reproductive organs (endometritis, salpingoophoritis, parametritis),
- cervical changes on the background of eversion and inflammation become the basis for the formation of infertility or habitual miscarriage,
- When pregnancy occurs on the background of eroded ectropion, the risk of cervical insufficiency and untimely discharge of amniotic fluid, which causes premature labor, increases significantly.