Ectropion of the cervix in nursing mothers
Cervical ectropion - A pathological condition of the cervix in which there is an eversion of the mucous membrane of the cervical canal into the vaginal cavity. Clinical manifestations of ectropion develop when an inflammatory or precancerous cervical lesion is attached: it may be whitening, contact bleeding, menstrual dysfunction, pelvic pain. Ectropion of the cervix is diagnosed as a result of a gynecological examination, extended colposcopy, cytological and morphological studies. The treatment of ectropion in case of congenital or minor lesions may include electrocoagulation, laser vaporization and cryodestruction, with pronounced changes - conization or excision of the cervix.
Causes of cervical ectropion
Congenital ectropion of the cervix in young women who have not previously had pregnancies and childbirth, is a consequence of functional dyshormonal disorders. Acquired (post-traumatic) ectropion most often occurs as a result of damage to the tissues of the cervix uteri, which have not been eliminated or were improperly sutured during childbirth. These can be bilateral side ruptures of the cervix during independent labor or after obstetric operations (imposition of special obstetric forceps, extraction of the fetus). Sometimes, cervical injuries lead to the development of ectropion during artificial termination of pregnancy in the later stages of gestation.
The rupture and subsequent scarring of the muscle fibers of the cervix are accompanied by a violation of the microcirculation, innervation and trophism of the tissue structures of the cervical canal, which leads to its deformation - the "gaping" of the external os and the inversion of the endocervix.
Symptoms of cervical ectropion
When ectropion of the cervix complaints may be absent, since the disease has no specific symptoms.
In case of development of inflammatory, dystrophic or atypical processes associated with ectropion of the cervix, there may be increased mucous and milky vaginal discharge, pain in the lower abdomen and in the lower back, irregular menstruation (menorrhagia), contact bleeding.
Diagnosis of cervical ectropion
Recognition of the ectropion of the cervix is carried out according to the gynecological examination using mirrors, extended colposcopy, cytological or histological studies. A gynecological examination allows you to detect cervical deformity: the presence of inversion of the endocervix into the vaginal cavity, cicatricial changes at the site of injury. If necessary, perform material sampling for cytological, bacterioscopic and bacteriological analysis, PCR diagnostics.
To study the nature of the surface and the type of folds of the eversion area of the mucous membrane of the cervical canal, to identify complications of the ectropion of the cervix, an extended colposcopy is performed. In case of congenital cervical ectropion, the folds of the mucous membrane are evenly spaced, when acquired it is chaotic. Detection of abnormal colposcopic signs, transformation zones is an indication for performing targeted biopsy of cervical lesions with histological examination of biopsy specimens. In case of congenital extrapionic cervix, the hormonal status of the patient is examined, functional diagnostic tests are carried out.
Treatment of cervical ectropion
Treatment of ectropion of the cervix consists in its destruction or removal, elimination of concomitant inflammatory process with subsequent correction of the anatomy of the cervix and vaginal microflora, and aims to restore the barrier and reproductive functions of uterine throat, prevention of pretumor and tumor processes in the endocervix. Clinical gynecology approaches the choice of the method of treatment of ectropion of the cervix of the uterus individually, depending on the age, state of the reproductive system of the patient and the identified colposcopic and cytological changes.
Surgical treatment of cervical ectropion includes destructive methods (diathermocoagulation, laser vaporization, cryodestruction) and surgical methods (radio wave conization or cervical excision). Destructive methods of treatment of ectropion are indicated for moderately severe cervical deformity and allow the destruction of pathological tissue. Surgical methods make it possible to conduct a morphological study of remote samples.
Congenital cervical ectropion is destroyed by cryodestruction, and with ineffectiveness, surgical treatment is used. Radioconization or radio excision are performed with a pronounced ectropion, the presence of dysplasia and other precancerous processes and allow you to remove the affected fragment of the cervix and part of the cervical canal. Also prescribed drug therapy used in the treatment of cervical ectopia and including antibacterial, antiviral, hormonal, immunomodulatory drugs.
With significant deformation of the cervix due to ruptures and cicatricial processes perform reconstructive plastic surgery. During the rehabilitation period after the surgical treatment of cervical ectropion, sexual rest for the first 4-6 weeks, limitation of physical exertion, a ban on douching, the use of hygienic tampons, bathing, bath, sauna, swimming pool are shown.
Prognosis and prevention of cervical ectropion
The prognosis for ectropion is favorable, but asymptomatic cervical disease dictates the need for annual preventive examinations at a gynecologist.
Measures to prevent the development of cervical ectropion are rational management of labor, timely and adequate contraception to prevent abortions.
One of the most common complications of the ectropion of the cervix are various infectious diseases, since the mucous membrane of the cervix is turned outward and comes into contact with the acidic environment of the vagina. Thus, the vaginal microflora can enter the sterile uterus and cause inflammation there. Also complications include the following diseases:
- Cervical cancer or a precancerous condition
- Endometritis and endometriosis, andexitis
- Thrush, which can very often occur due to damage to the mucous membrane of the cervix
- Inability to follow pregnancy and childbirth
However, if during the treatment of this disease, to burn ectropion and erosion, then the prognosis for later life and reproductive function is favorable.
What can you do
After giving birth, a nursing mother can douche with antibacterial solutions or use special sprays for intimate hygiene and disinfection. If during childbirth a woman was stitched to the cervix, then this procedure is mandatory so that the inflammation of the cervix does not go away.
What the doctor does
After the diagnosis is made by the gynecologist, the expectant mother will be prescribed the following treatment:
- The use of various drugs for the correction of vaginal microflora
- If any associated diseases are detected, antibacterial therapy is applied. However, it is contraindicated when breastfeeding, so a nursing mother will need to temporarily stop lactation.
- Radiosurgery It is the most painless and effective treatment. After it, no consequences remain and the nursing mother can lead a normal life without indulging in anything. The treatment of the affected part of the cervix with an electric current. However, this method is very painful. After it comes a long recovery period. There are contraindications.
- Chemical coagulation. This method is a treatment of ectropion with chemical preparations that cauterize it. After this, a crust remains, which falls off after 3-4 weeks.
- Thermocoagulation. This method is characterized by the effect of a hot point-on temperature on ectropion. However, this method should be used only if the nursing mother does not plan pregnancy yet.
- Cauterization of ectropion with liquid nitrogen. It freezes and after a while the cervical canal comes to its normal appearance and condition.
- Cauterization laser. It is one of the most common methods, is effective and inexpensive. The ectropion is cauterized by a laser, a crust remains, which quickly falls off.
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 a mucous (epithelial) membrane, and in the channel itself the epithelium cells are cylindrical in 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 canal 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 that are consonant with the 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 squamous 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 of the fetus. This happens as a result of a certain hormonal shift in the body of the future mother. 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 extract a child,
- carrying out artificial childbirth 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 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 can 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, so conception occurs quite successfully.
If a woman with a pathology such as ectropion, infertility is observed, then the cause of it is not 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 exacerbation 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, and pregnancy proceeds without complications.
Usually, doctors recommend that women who are 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 with the help of mirrors, cervical 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.
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 is carried out by 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.
When conducting medical treatment of inflammatory and infectious complications, antiviral and anti-inflammatory tablets (ciprolet, acyclovir, virolex) are used, as well as suppositories (suporon, depantol, hexicon). 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.
Anomaly ectropion is a gynecological phenomenon, which is described by inversion of the mucous membrane of the cervical canal inside the vagina. Гинекологами это явление характеризуется как утяжеленная форма заболевания эктопией, которая, в свою очередь, совмещает псевдоэрозию и проявления в виде рубца.
Что происходит при эктропионе? Слизистая шейки матки обитает в щелочной среде. When ectropion she is in the vagina in an unusual acidic environment. Because of this, the secretion is violated and there is a risk of maturation of infectious diseases.
This pathology leads to a violation of the vaginal microflora, which would entail such diseases:
- in extreme cases, cancer of the uterus.
The image of ectropion is shown below.
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 difficult 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 an abortion at a late period, at which the cervix is artificially expanded.
- The reason associated with impaired hormonal levels. This problem can occur even in non-giving birth girls.
- Causes of ectropion, which are caused by infections and pathologies. Often, this problem may occur 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 that 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.
- At 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, it is necessary to cure the concomitant disease and the woman can 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 generic 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 is not complicated by itself and does not need treatment. You need to treat the pathology that is acquired over time. Ectropion cure is possible in two ways. Consider each of the methods in more detail.
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, the disease affects the lower part of the body, in particular, contributes to the penetration of the vaginal microflora into the cervical canal and, consequently, to inflammation. A long-term 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.
Possible complications of cervical ectropion
What is the danger of this disease? In the absence of timely treatment, there is a risk of complications, including:
- Narrowing of the cervical canal.
- Cancer degeneration.
- Inflammation of the pelvic organs.
- Secondary infection.
Infertility is one of the most severe complications of the disease. In the absence of medical care possible re-development.
Uterine rupture leads to scarring, which causes damage to the nerve fibers and blood vessels.
Cytology - an effective way to diagnose ectropion
Causes of erosive ectropion
As a rule, the reasons for which erosion and ectropion occur are associated with impaired mucosal integrity.
- The birth of a large fetus. The uterus can be injured during the process of labor, while a large fetus is released through the vagina, a uterine rupture may occur. Also, pathology often occurs if the cervix is not ready for labor.
- Premature birth. In this case, rupture of the neck occurs due to its insufficient disclosure during labor.
- Application during the birth process obstetric forceps. Erosion can be triggered by the use of obstetricians and gynecologists to extract a child. It is also provoked by improperly stitched seams on tears after childbirth.
- Diagnostic and therapeutic measures (for example, abortion or diagnostic curettage).
- The risk group includes women who have an abortion late (16 weeks later). However, if the operation did not use tools that could lead to an accidental rupture, there will be no pathology.
- The rotation of the body leads to the open mouth of the external channel. This injury is expressed in violation of the tissue integrity of the uterine mucosa.
- The development of deformity often provokes poorly performed hysterorrhaphy. It is performed for women in the early postpartum period.
- In rare cases, the development of an eroded cervical ectropion can be caused by an impaired hormonal balance of functional origin.
Takes its formation in the womb, due to the influence of estrogen, often persists until puberty. In this case, it is not considered an anomalous phenomenon, but rather a physiological state that passes on its own. It is classified as a functional disorder caused by hormonal imbalance. As a rule, not observed in patients who have not had a pregnancy.
Gynecologists prefer to call acquired uterine ectropion "traumatic type." In the course of the instrumental study, its occurrence is taken into account in the previously unchanged mucous membrane area. This type of illness is often accompanied by other gynecological pathologies, such as endometritis.
There are a number of unpleasant symptoms that do not depend on the type of pathological process. In the congenital type of the disease is accompanied by a violation of the relationship between the epithelium and the main organ - the stroma.
The symptomatology of a pathological condition depends on its type, therefore it is not customary to single out specific signs. For a long time, the process can be asymptomatic, only with the addition of inflammation or infection, changes in the vaginal discharge can be noticed.
In gynecological practice, according to the morphological picture, the following subspecies of inversion are distinguished:
- deformation with keratosis.
The inflammatory type suggests the presence of a pronounced inflammatory process, which is localized in the region of the prolapsed mucous membrane of the uterus. The first signs are characterized by a change in the vaginal discharge. Their color, consistency, smell change. They may be yellow or greenish with a specific smell.
Concomitant symptoms appear: itching, nagging pain in the lower abdomen and lower back, menstrual abnormalities, worsening of general well-being. An increase in central body temperature and the development of an intoxication clinic are possible.
In the case of an erosive course of the disease, unlike the first one, it manifests itself in a brighter symptomatic course. Accompanied by the formation of erosive lesions on the mucosal surface. This subspecies is more common, because when inversion, the cervix is exposed to increased exposure to the weakly acidic environment of the vagina, due to which the irritating effect is much stronger.
With this pathology, such erosion is much pronounced ordinary - extensive and deep. Such injuries are accompanied by an appropriate clinic: bleeding in the non-period of menstruation, pain during intercourse, nagging pain in the lower abdomen.
If it delays with a therapeutic effect, the chance of infection is very high and reaches almost 90%. As a result, the normal functioning of the cervix is disrupted, leading to infertility. This is due to its anomalous structure and a change in the secret that prevents sperm from moving normally. Often infertility is the only symptom of the disease.
In case of discharge, consult a doctor immediately.
Inversion with keratosis. It requires an immediate therapeutic action, as it is regarded as a precancerous condition. Here it is customary to refer the neglected cases, where the vaginal secretion on the cervical mucosa has been affected for a long time. Such action provokes the restructuring of cells and starts the process of their change - thickening, keratinization.
The main danger lies in the uncontrolled and rapid development of atypical cells. At the earlier stage it is almost impossible to suspect the process, the course is asymptomatic. Only the painful sensations at the moment of sexual intercourse or specific discharge can guard.
Treatment methods for cervical ectropion
When an ectropion of the cervix is detected, the treatment involves a whole range of therapeutic measures, in particular:
- Removal of deformed areas of the mucosa,
- Relief of inflammation (drug therapy),
- Anatomical correction of the genital tract to restore reproductive functions.
- Prevention of malignancy.
In clinical gynecology, the choice of treatment tactics is individual, the method of treatment is selected taking into account the patient's age, the state of her reproductive system, and laboratory and instrumental data.
Surgical treatment is carried out using minimally invasive destructive methods - laser vaporization, cryodestruction and diathermocoagulation.
The laser is most often used for congenital uterine pathology. This procedure is absolutely painless, it does not leave scars and contributes to the rapid healing of injuries.
Surgical methods are presented:
- Radio wave conization (impact on the modified mucous membrane of the high-frequency alternating current). The positive effect of conization is achieved due to the removal of damaged tissue within the cone, the top of which is turned towards the inner throat.
- Excision of the cervix. This procedure is characterized by layer-by-layer excision of the affected tissue. Excision does not result in the removal of healthy tissue.
It is advisable to prescribe the use of destructive techniques in the presence of moderately severe deformation, which allows you to completely eliminate the pathology.
Surgical interventions are more acceptable with significant lesions, in particular pretumor ones, since they allow morphological examination of the obtained tissue samples.
It is mandatory prescribed drug therapy, as a rule, it is prescribed in the presence of the inflammatory process, as well as before and after surgical treatment, for example, immunomodulators, antibacterial, antiviral and hormonal agents.
The final stage is cosmetic correction. This is an endocervical procedure. The purpose of this operation is to restore the reproductive and barrier function of the female body.
Can I get pregnant with cervical ectropion?
An unequivocal answer to this question can not be given. On the one hand, in the majority of patients, with eversion and ectopia, the reproductive function was impaired, and they could not get pregnant. On the other hand, the presence of ectropion in the past and pregnancy are comparable things. The fact is that the presence of this pathology is not an objective reason to argue about the impossibility of pregnancy.
According to gynecologists, the eroded type of the disease does not in the direct sense prevent conception.
Why do many women suffering from this disease, impaired reproductive function? The inability to conceive in such patients is not associated with erosion, but with the complications to which it leads.
Favorable pregnancy is possible with timely contact with your doctor
Even treated ectropion may entail the risk of postpartum complications (as a result of trauma to the birth canal and the progression of existing changes).
Patients with this disease increase the risk of ectopic pregnancy and miscarriage. This is due to a decrease in the length of the cervix (this is possible after correction).
Only those women whose insignificant parts of the mucous membrane have undergone pathological deformities can become pregnant and bear a healthy fetus.
If the area of deformity is significant, there is inflammation and there is a violation of the menstrual cycle - this is the medical reason for the prohibition of conception.
It is contraindicated to plan the birth of a child to those patients in whom atypical cells were revealed during a biopsy of the uterine cervix.
Only a healthy woman can become pregnant and make a healthy baby. That is why each woman is recommended to undergo a gynecological examination annually and, if any changes are detected, immediately begin treatment.
Causes and types
The disease is formed against the background of various factors. Cervical ectropion can be congenital, then the treatment is not carried out, since this condition goes away on its own through time if there is no infection or inflammation. Acquired forms are traumatic.
If the 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 in the later 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 fruit, 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, because 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. For the treatment of 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 comorbidities 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 the cells, from which they may 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 complex 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.
Eroded cervical ectropion 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 immunomodulating drugs, after which an operation 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 the 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 cervical ectropion directly 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 drawbacks: too deep an impact, causing healthy tissues, as well as long-term healing, many complications, no histological examination for cancer,
- Electro excision - layer-by-layer excision of pathological tissues within healthy ones. 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 operation - 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 does not occur 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, often there are ruptures of the cervix during labor, infectious complications, such as metroendometritis, caesarean section is prescribed. Pregnancy and ectropion of the cervix - a very versatile concept.
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 for pregnancy is better to be postponed until the pathological area is removed and adequate anti-inflammatory therapy is carried out.
In 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, prevention of ectropion is the regular visit to the doctor. In addition, women 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 you give birth without negative consequences.
What are the options for eversion
Most often, cervical ectropion is limited only to the outer part of the channel, which is located closest to the outer cervical pharynx. However, a more pronounced inversion of the endocervix will be quite real.
Under normal conditions, cervical glands produce mucous 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. Often, pseudo-erosion, located on the periphery of the ectropion, accompanies eversion.
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, which occurs in the following situations:
- the birth of a big baby
- incorrect presentation of the fetus during labor (extensor head, pelvic),
- reduction of cervical tissue elongation (rigidity),
- ineffective and improper use of generic-stimulating drugs,
- use in labor delivery operations (birth of a child 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).
- improper juxtaposition of tissues when suturing cervical tears, especially in case of deep injuries (breaks 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
- therapeutic 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 cervix, leading to a gaping external os and the formation of ectropion.
Symptoms of cervical inversion
With eroded ectropion, most often no manifestations. Some women may pay attention to the following inflammatory symptoms:
- increase in the number of whiter,
- contact hemorrhage during intercourse,
- slight pulling pains in the perineum or in the lower abdomen.
Some women may have problems with conception or bearing a fetus, manifested by sterility 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.
Diagnosis of eroded ectropion
- Inspection on the mirrors
On a medical examination or during a preventive visit to a gynecologist, a doctor with a standard examination will pay attention to pathological changes in the cervix. The visual signs of eroded ectropion include:
- gaping neck with eversion,
- severe redness of the mucous, sharply distinguished on the background of a pale pink outer cervical part,
- thick puffy and hyperemic folds,
- the appearance of areas of defects of the epithelium,
- the presence of turbid mucus-milky secretions.
Unlike conventional or pseudo-erosion, the doctor will not see an eroded inversion when moving on the mirrors when approaching (folding) the anterior and posterior cervical lips.
When an eroded ectropion is detected, the doctor will necessarily perform an examination for oncocytology (taking cytobrush smears or using liquid cytology).
Special microscopic examination is used for accurate detection of inversion and detection of associated pathological problems. Colposcopy with eroded inversion allows you to:
- to distinguish erosion and pseudo-erosion from post-traumatic cervical inversion,
- to identify normal and pathological changes of the cervical epithelium during eversion,
- assess the risk of dysplasia and pre-invasive cervical cancer.
As a rule, extended video-colposcopy is used, in which, in addition to microscopic examination, special solutions are used to accurately diagnose cervical diseases.
Usually no additional examinations, except for inspection and colposcopy, are required. However, when identifying suspicious areas on the inverted part of the cervix (leukoplakia sites, suspected dysplasia), it is necessary to take material for histological examination from the outer and inner surface of the ectropion.
All therapeutic measures for eroded ectropion imply several main objectives:
- restoration of natural cervical protection, protecting the inner surface of the uterus from infection,
- improvement of childbearing ability,
- prevention of dysplasia and cervical cancer.
With a slight inversion and a moderate cervical defect, diathermocoagulation can be used. A cautery cautery around the ectropion helps to form cicatricial structures narrowing cervical inversion. The closure of the anterior and posterior cervical lips ensures the elimination of the ectropion.
The use of liquid nitrogen for cryodestruction of the eroded surface of an inverted cervix creates conditions for the healing of the pathological portion of the cervical canal and the formation of a normal external os. In addition, cryotherapy is an excellent prevention of precancerous changes in the cells of the cervical epithelium.
- Radiosurgery and laser vaporization
Modern high-tech methods of treating cervical problems are most optimal in the presence of an eroded surface and a high risk of pathological changes in the cellular structures of the cervix. In some cases, even a simple removal of erosion provides restoration of cervical structures, creating conditions for getting rid of inversion.
- Plastic surgery
A pronounced puerperal cervical defect with the formation of an ectropion can be a cause for surgical reconstructive plastic surgery. Before surgery, an examination should be carried out to exclude oncological processes. Be sure to perform all operations for the treatment of cervicitis and colpitis. Correction of anatomical disorders in the muscle layers of the cervix helps to get rid of pathological inversion.
- Conization of the cervix
At the slightest suspicion of dysplasia or preinvasive cervical cancer, surgery will be required. Usually, the doctor performs a cone-shaped excision of the problem area within healthy tissue. As a rule, during conization, most of the inverted and eroded cervix is removed.
If an oncological process is detected that accompanies eroded neck reversal, a radical operation will be required to remove the entire organ. Extirpation of the uterus in cervical cancer is the only option to preserve the health and life of a woman.
Effective measures to prevent the formation of eroded ectropion are:
- absolute rejection of induced abortion,
- mandatory theoretical and practical preparation of a pregnant woman for childbirth,
- complete examination at the end of pregnancy for the timely detection of complications that may cause birth injuries,
- respect for the birth canal during childbirth in compliance with all the rules for the protection of the perineum and cervix,
- correct layering sutures on the neck with birth injuries and tears,
- use for the diagnostic examination of the inner surface of the uterus mini-hysteroscopy method that does not require the forcible expansion of the cervical canal.
Detection of eroded ectropion in women in the postpartum period is a reason for examination and subsequent treatment. The main goal of therapy is the restoration of the cervical canal and the prevention of precancerous changes in the eroded area. With infertility and habitual miscarriage, surgery may be necessary to help a woman re-experience the happiness of motherhood.