What it is
Visually, ESM looks like redness around the opening of the cervical canal. The lesion consists of multiple cracks in the mucous membrane, into which epithelial cells penetrate, which are not normally found on the surface of the cervix.
This epithelium is called ectopic. Ectopias often develop on intact mucous membranes. Then patients are diagnosed with pseudo-erosion of the cervix.
Some forms of pseudo-erosion are considered normal when treatment is not required. However, even with this, you should be more attentive to your health, for example, undergo regular preventive examinations with a gynecologist .
The doctor can notice in time possible changes in the condition of the affected area and, if necessary, prescribe treatment.
Diagnostics
As already mentioned, most often erosion is detected completely by accident during a medical examination . Usually it can be seen with the help of special gynecological instruments, which are mirrors on a long handle. If a pathology has been identified, a series of tests . First of all, a woman must undergo smears for sexually transmitted and inflammatory diseases.
In order to establish the exact characteristics of the erosion present, a colposcopic examination is performed. Sometimes a biopsy may be needed. In this case, a small area of the damaged mucous membrane is taken and examined in detail under a microscope.
Causes, symptoms of the disease
One of the reasons for the development of erosions or pseudo-erosions is considered to be disturbances in the formation of organs of the reproductive system during intrauterine development.
In such cases, signs of erosion are detected in adolescence. In addition, the development of ESM can be triggered by :
- endocrine disorders;
- inflammatory processes;
- viral, bacterial diseases of the reproductive system;
- surgical interventions for diseases of the pelvic organs;
- promiscuity;
- Navy;
- abortions.
The development of gynecological pathologies is indicated by:
- pain after or directly during sexual intercourse;
- profuse, incessant leucorrhoea;
- colored discharge, including blood-stained discharge.
In many patients, ESM is detected upon treatment for recurrent candidiasis.
Diagnosis is carried out by colposcopy during a standard examination by a gynecologist.
A smear is taken from the woman for microflora; to identify possible infectious and inflammatory diseases, the patient is sent for a blood test.
If examination reveals a focus of erosion, a biopsy is performed - a cytological examination of a tissue fragment to exclude malignant processes.
ESM itself is not a dangerous condition, but is a risk factor for the development of various gynecological diseases, complications of pregnancy and childbirth. In 20% of cases, ESM turns into cancer.
Extensive erosion is a place for the vital activity of microorganisms, including pathogenic ones. Through the cervical canal, the infection spreads into the uterine cavity and, in advanced cases, reaches the appendages.
ESM, complicated by inflammatory processes, can lead to infertility . Among the most dangerous infections that develop against the background of erosion are herpes, HPV and chlamydia.
A very dangerous complication is bleeding of the eroded area, which is considered a precancerous condition.
As the disease develops, the possibility of degeneration of the normal epithelium of the mucous membrane of the cervix into an unusual squamous epithelium and its replacement by scar tissue cannot be excluded.
The scar prevents the normal opening of the cervix during childbirth, which can lead to ruptures and even asphyxia of the fetus. Women with ESM have an increased risk of developing isthmic-cervical insufficiency during pregnancy and, accordingly, miscarriage.
Another unpleasant feature of the disease is the high risk of complications after treatment with traumatic methods based on the destruction of the ectopic epithelium.
Relatively recently, when erosion was detected in nulliparous patients, doctors recommended refraining from treatment until delivery.
Similar recommendations can sometimes be heard today. In most cases, the lesion is located around the opening of the cervical canal and careless cauterization of the erosion may damage healthy tissue.
When an injury heals, a scar is formed with all the possible consequences.
In difficult cases, complete fusion of the cervical canal and infertility are possible.
Due to the high risks of complications, electrocoagulation, electro- or cryodestruction methods are not recommended for patients planning to have children.
The rehabilitation period after treatment with any of the methods involving physical destruction of the lesion can last up to three months.
At this time, the woman is recommended to have sexual rest, limit physical activity and take a bath.
Causes and symptoms of cervical erosion:
Signs and symptoms of cervical erosion
In most cases, the pathology does not have pronounced symptoms and is diagnosed during a gynecological examination. Rarely do women seek help themselves due to minor bleeding not related to menstruation.
Clinical manifestations:
- nagging pain in the lower abdomen;
- erosion bleeds after sex;
- pain during intercourse;
- burning, itching;
- leucorrhoea
The general condition of the woman remains unchanged.
How is it treated
The gynecologist chooses the method and tactics of treatment after examination.
Additionally, you may need to consult with specialists of another profile, for example, an endocrinologist, and preliminary treatment of concomitant pathologies.
Alternative methods of treatment with sea buckthorn oil or other herbal preparations, hirudotherapy, dietary supplements can be used as an addition to the main treatment and only in consultation with a doctor.
Methods used
For those planning to have children in the future, more gentle methods are recommended:
- Laser vaporization.
- Radio wave destruction.
- Chemofixation.
Treatment methods for cervical erosion:
Laser vaporization
This is a relatively new method , recognized as the most effective. The use of a combination of helium-neon and CO2 lasers provides complete relief from erosion.
Under the influence of high-frequency laser radiation, the affected tissue is destroyed and evaporated. The procedure is performed under video colposcopic control.
A wound surface remains in the area of exposure, completely healing within a month. The fundamental difference between laser therapy and classical methods of destruction is the almost complete absence of the risk of scar formation at the site of the lesion.
The procedure is performed on an outpatient basis, takes 15-20 minutes, hospitalization is not required. Laser treatment is the most expensive method, not yet available to everyone.
Radio wave destruction
The impact on the affected area is carried out without contact. Radio waves destroy the lesion , the destroyed tissue evaporates, as with laser therapy.
There is no scarring of the tissue; when the affected area of the mucous membrane heals, normal epithelium is formed within a month.
In the first time after exposure, bloody discharge is possible.
Chemofixation or chemical coagulation
Recommended for eliminating small lesions. The lesion is treated with potent mixtures of acids (Solkovagin, Vagotil), which destroy the abnormal epithelium.
Unlike methods of physical influence, which are used once, chemofixation is carried out in a cycle of up to five procedures.
The treatment regimen and drug are selected individually, depending on the characteristics of the clinical case.
The healing period is individual. The ESM chemical coagulation technique does not guarantee a 100% result .
Let's tell you more:
- about methods of cauterization of erosion;
- does it hurt;
- what kind of discharge occurs after the procedure;
- what complications and consequences are possible;
- useful recommendations after cauterization.
Causes of erosion in nulliparous girls
The formation and development of the genital organs in girls occurs while still in the womb. In a newborn girl, columnar epithelium predominates on the vaginal part of the cervical canal. This condition is natural and persists until puberty.
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When the level of estrogen in the body increases and the gonads begin to work, a change occurs in the epithelial layer of the cervix. Congenital erosion gradually disappears, and the integrity of the epithelial tissue is restored
. Usually this process goes unnoticed for the girl, since in virgins it is problematic to examine the condition of the cervix.
Doctors call other causes of cervical erosion in nulliparous women:
- Hormonal disbalance. During puberty, the formation of hormonal levels occurs
. the balance of estrogen and progesterone ensures the correct function of the gonads and the natural state of the epithelial layer of the cervix. Hormonal imbalances provoke a shift in the boundary between the endocervix and exocervix. - Taking hormonal drugs. Shifting of the epithelial border in nulliparous girls occurs under the influence of certain drugs. These include oral contraceptives and means of emergency protection against pregnancy
. Most often, the problem appears if the medicine is taken without a doctor's prescription or is chosen incorrectly. - Infections of the genital organs. Cervical erosion in nulliparous women is often detected against the background of an inflammatory process
. The cause is sexually transmitted diseases or changes in the vaginal microflora due to reduced immunity. - Mechanical damage. Large cervical erosion can be detected in a nulliparous woman if she leads a stormy intimate life
. Damage to epithelial tissue can cause instrumental interventions.
The risk group includes girls who have bad habits, often change sexual partners, and begin intimate life too early.
Autoimmune diseases, chemotherapy and unfavorable ecology also increase the likelihood of changes in the boundaries of the cervical epithelium. There is a version about hereditary predisposition
. If mother and grandmother suffered from ectopia of the cervix, then with a high probability the problem may appear in their daughters and granddaughters.
Conservative methods
If the patient has a concomitant disease, drug treatment may include a course of specific or nonspecific drugs of the following groups:
- antibiotics;
- antimycotics;
- antiviral;
- hormonal;
- immunomodulators;
- restorative.
The choice of dosage form is made depending on the cause of the pathology and the general condition of the patient.
After preliminary treatment, the following drugs are prescribed in the form of vaginal suppositories:
- Clotrimazole;
- Hexicon;
- Depanthol;
- Livarol.
Conservative treatment is permissible only for mild lesions of a small area.
Treatment of erosion
Before treating cervical erosion in nulliparous women, a specialist assesses in detail the condition of the epithelial tissue, studies the results of a biopsy (if one has been performed) and takes into account the patient’s complaints. The more information is obtained about the disease, the more accurately the likelihood of adverse consequences and the need for therapy can be assessed.
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For a nulliparous patient, there are three options that the doctor can offer:
- Take a wait-and-see approach and delay treatment until delivery, but constantly monitor changes in epithelial tissue.
- Carry out drug treatment and then regularly examine the cervix.
- Perform cauterization of the erosion followed by drug treatment.
Waiting attitude
Gynecologists suggest postponing cauterization of cervical erosion for nulliparous women if:
- the area of damage is small, and the results of the PAP test did not show the presence of atypical cells;
- colposcopy did not reveal dangerous areas prone to malignancy;
- the patient does not have any complaints;
- It was possible to establish what caused the erosion - inflammation or hormonal imbalance.
A wait-and-see attitude involves regular monitoring by a gynecologist.
The patient is prescribed therapy to eliminate the cause of erosion. It is also recommended to follow the rules of intimate hygiene, use barrier contraception, and maintain a healthy lifestyle.
. If, over time, the size of the cervical erosion in a nulliparous girl begins to increase in size, it is recommended to do cauterization.
Drug treatment
Conservative treatment of cervical erosion in nulliparous women is resorted to in the initial stages of the disease. The patient is prescribed drugs for topical use that accelerate tissue regeneration
. It is recommended to take hormonal medications to eliminate the imbalance. Immunomodulatory substances are also prescribed, since one of the common causes of damage to the cervical mucosa is the activity of the human papilloma virus.
Surgery
Many women doubt whether it is possible to cauterize erosion for nulliparous women and whether the operation will cause problems in the future. Surgical treatment is indicated in the following cases:
- the area of the pathological area increases;
- there is no effect from drug therapy;
- the patient has characteristic disturbing symptoms;
- there is a high probability of degeneration into cancer.
Modern techniques for cauterizing erosion in nulliparous girls allow the operation to be performed without negative consequences in the future. Taking into account age and the desire to further realize reproductive function, the doctor selects the most gentle cauterization method
. Traditionally, laser or radio wave treatment is prescribed. Treatment with chemicals is less common.
Selection of treatment regimen
There is no universal treatment regimen for ESM. When choosing treatment methods, the anatomical features of the structure of the reproductive organs in nulliparous and parous patients, the stage of the lesion, and the woman’s plans for the future are taken into account.
After examination , nulliparous patients are prescribed conservative treatment .
For minor lesions identified during pregnancy planning, the doctor may recommend postponing therapy until the birth of the child, since the disease sometimes goes away after childbirth.
The treatment regimen for patients who have given birth includes preparation for cauterization of cervical erosion and the procedure for its elimination itself.
Cervical erosion is a potentially dangerous disease. The sooner it is identified, the easier it is to get rid of it. Treatment should be prescribed and carried out only by a gynecologist.
What procedures are needed to make a diagnosis?
How is cervical erosion diagnosed in nulliparous girls? Reviews from doctors indicate that in most cases the disease is discovered completely by accident, during a routine gynecological examination. When examined using mirrors, the doctor may suspect the presence of erosions, which is a reason for further tests:
- Colposcopy is considered an informative diagnostic method. Using a special device (colposcope), the doctor must carefully examine the walls of the vagina and part of the cervix. To obtain more information, the tissue is treated with iodine solution or acetic acid - this way the doctor has the opportunity to see the boundaries of the erosion areas.
- The specialist also takes a smear from the vagina, because it is important to determine the composition of the microflora. The same procedure allows you to determine the presence of bacterial pathogens.
- Sometimes PCR diagnostics are also necessary, especially if there is a possibility of activation of herpes or papilloma viruses.
- It is necessary to take urine and blood samples for analysis, and also determine the level of hormones in the blood.
- A cervical biopsy is performed if there is suspicion of malignant tissue degeneration.
During diagnosis, it is important not only to determine the presence of erosion in the cervix, but also to identify the causes of the development of pathology.
