Ectropion

Ectropion is an eversion of the mucous membrane of the cervix, which can occur due to primary or secondary causes. This disease has an unfavorable prognosis in terms of oncopathology, so it is necessary to identify it in time and determine the main clinical symptoms. Some clinical features affect the treatment of each case of the disease, so an individual approach is needed.

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Causes ectropion

When talking about the causes of such a pathology as ectropion, it is necessary first of all to know the structural features of the cervical canal in the norm. The anatomical features of the internal female organs are as follows: the vagina passes into the cervix, which begins with the external os, then the cervical canal of the cervix begins, which ends with the internal os and passes into the uterine cavity. Thus, the cervical canal has the form of an elongated tube, which is limited on both sides by the os. Ectropion is a pathology in which such a normal structure is disrupted, and the external os with part of the cervical canal descends or prolapses into the vaginal cavity.

There are several main causes of ectropion formation. First of all, it is necessary to distinguish primary ectropion, which is congenital, as well as secondary - the cause of which can be many factors. Congenital ectropion occurs infrequently and its main cause is hormonal disorders with a combination of congenital anomalies in the structure of the internal genital organs.

Secondary or acquired ectropion develops most often after trauma or surgery. Often, such pathology is preceded by trauma after childbirth with a large fetus or surgery on the uterus and cervix. In this case, the normal structure of the uterine canal is disrupted, and the stitches can change the configuration of not only the mucous membrane, but also the muscle. This disrupts the contraction and structure of the entire cervical canal, after which eversion of the mucous membrane can occur. Another common cause is termination of pregnancy at a later stage with trauma to the uterine tissues - which leads to secondary changes in the mucous membrane.

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Risk factors

For timely diagnosis and medical examination of such patients, it is necessary to identify the main risk factors for this pathology, which include:

1. more than three births in the anamnesis with a large fetus;
2. the presence of surgical interventions on the cervix or uterus;
3. repeated termination of pregnancy, especially at later stages;
4. birth canal trauma after childbirth;
5. obstetric pessary;
6. congenital anomalies in the structure of the internal genital organs.

These factors increase the risk of developing ectropion, especially at later stages, when there is a physiological disorder of muscle tone and ligamentous apparatus of the internal genital organs. Therefore, medical examination of this group of patients is very important to prevent advanced cases.

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Pathogenesis

The pathogenesis of ectropion and its changes is caused by the primary influence of the etiologic factor. Under the influence of trauma to the mucous and muscular membranes, the trophism of the tissues of the cervical canal is disrupted. In this case, the blood supply and nervous regulation of the mucous membrane are disrupted, which provokes dystrophic changes in the cells, and this in turn ends in dystopia of the endocervix and prolapse of the mucous membrane. The longer such changes are expressed, the more difficult it is to treat and correct such a condition. After all, further pathogenetic changes consist of deepening dystrophic changes in cells and their metaplasia. The histological structure of the cervical canal of the cervix has its own characteristics. The vagina, which is also called the exocervix, is lined with multilayered flat non-keratinizing epithelium, and the cervical canal, or endocervix, is built of a single-layer cylindrical epithelium. Between these zones there is normally a small border, which is called the transition zone, and it is normally located at the level of the external os. When the mucous membrane is everted with ectropion, this structure is disrupted, and the risk of metaplasia increases significantly, which increases the likelihood of malignant transformation of such endothelium.

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Symptoms ectropion

Speaking about the clinical signs of ectropion development, it is necessary to note that the clinical picture differs depending on the type of pathology. Therefore, specific symptoms are not distinguished, and the course can be asymptomatic for a long time.

Based on the clinical course and the main morphological picture, the following types of ectropion can be distinguished:

• inflammatory;
• erosive;
• ectropion with keratosis.

Inflammatory ectropion is a very conditional concept, since in any case, when the mucous membrane falls out, there is also a minor inflammatory reaction. But when it comes to inflammatory ectropion, it means pronounced inflammation of the part of the fallen mucous membrane of the cervix. This is very important not only for diagnosing the pathology, but also for treatment tactics. Symptoms of inflammatory ectropion often begin with the appearance of pathological vaginal discharge. In this case, green, yellow or white discharge appears, with an unpleasant odor, which causes itching and discomfort. Then there may be a suspicion of an infectious process. With a pronounced inflammatory reaction, there may be manifestations of intoxication syndrome (increased body temperature, body aches, decreased appetite and performance).

Erosive ectropion often has a more pronounced clinical picture due to the fact that there is erosion of the mucous membrane of the cervix and its integrity and protective function are disrupted. This form is most common, since the eversion of the mucous membrane is exposed to the slightly acidic environment of the vagina and this contributes to irritation of the cells with membrane disruption. Such erosions are most often quite significant, both in size and depth. This is manifested by various symptoms - bloody discharge outside of menstruation, pain and bleeding during intercourse, dyspareunia (lack of orgasm in women). If the process is too prolonged, then infectious agents may join. Infertility is also a common symptom of erosive ectropion. This occurs due to the fact that the normal function of the cervix is disrupted, its structure and secretion do not allow normal movement of sperm. If fertilization has occurred, then the movement of such a zygote is difficult and implantation is impossible. Therefore, infertility may be the only symptom of ectropion, especially in combination with erosion.

Cervical ectropion with keratosis is one of the cases that is precancerous and requires immediate action. As a rule, these are advanced cases, in which there is a long-term effect of vaginal secretion on the mucous membrane. This is a factor under the influence of which there is a restructuring of cells and dysplastic processes in them - this is how keratosis develops - thickening and keratinization of the mucous membrane. This is a dangerous condition, since the initial metaplastic processes in such cells have already begun, and then uncontrolled cell growth may develop. This type of ectropion is often asymptomatic, the only changes may be during sexual intercourse - pain or discharge.

The first signs of ectropion often develop when changes are already pronounced, which is why timely preventive examinations are so important, which allow the disease to be detected at an early stage.

Ectropion and pregnancy is a widely discussed issue in terms of future pregnancy and in terms of predicting the course of pregnancy, if it already exists. Although this disease is dangerous in terms of infertility, if a woman is treated in time, she may well carry a pregnancy and give birth to a normal child. If pregnancy develops against the background of ectropion, the risk of postpartum complications increases in terms of trauma to the birth canal and aggravation of existing changes. At the same time, the risk of developing an ectopic pregnancy and premature termination of pregnancy due to a short cervix (this happens after correction of ectropion) also increases. Therefore, the issue of pregnancy with concomitant ectropion should be carefully studied and planned. It is better to treat an existing pathology before pregnancy in order to reduce the risk of complications during pregnancy and postpartum complications.

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Complications and consequences

Advanced ectropion can be very dangerous in terms of developing complications in the future. After all, a change in the topic of the mucous membrane and the constant effect of vaginal juice on the eversion of the mucous membrane can cause epithelial metaplasia, and in the future, this entails the development of cervical cancer. Therefore, one of the complications of eversion can be considered oncopathology. Also, the consequences of untimely correction of this pathology in young women can manifest themselves in the form of infertility. This occurs due to a violation of the normal structure of the cervical canal and its reproductive function, which does not allow normal implantation of the egg.

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Diagnostics ectropion

Anamnesis data are very important in diagnosing ectropion, and especially in identifying its causes. It is very important to know the number of pregnancies and births in the anamnesis, their course, the presence of surgical interventions. Such data make it possible to determine the risk of developing certain complications associated with ectropion. It is difficult to suspect this pathology based only on complaints or anamnesis data. The most informative and simple method is to examine the woman in mirrors. This allows you to identify visual changes not only in the eversion of the mucous membrane, but also to verify the type of ectropion. You can see a slight swelling in this area, redness of the mucous membrane, as well as the presence of inflammatory plaque on the external os of the cervix. You can also visually assess the degree of changes and the scope of intervention that needs to be performed. If we are talking about erosive ectropion, then you can see with the naked eye a violation of the integrity of the mucous membrane at the site of eversion. Ectropion with keratosis has the appearance of a mucosal area that is raised above the surface level and has a darker color and keratinization.

More detailed examination methods are needed to confirm the diagnosis and clarify the extent of changes. Tests are performed to exclude or confirm an infectious process, as well as to identify the degree of dysmetabolic changes in the cells of the mucosa at the site of ectropion. For this purpose, a smear from the vagina and cervix is examined for pathological flora, as well as a smear from the cervical canal for cytological examination. If ectropion is accompanied by an inflammatory reaction, then a specific pathogen can be identified with subsequent targeted treatment. It is very important to conduct a histological examination, since dysplastic processes in the cells at the site of ectropion require a different scope of intervention, so it is necessary to determine these data. It is also important to know about changes in the cells to predict complications. The results of such a study may indicate a high degree of metaplasia or only inflammatory changes.

Instrumental diagnostics is also carried out for the purpose of differential diagnostics. A very important diagnostic method is colposcopy. This examination allows you to insert a special sensor into the vagina and see the cervix in several times greater magnification. It is possible to see altered areas of the mucous membrane, as well as erosions that cannot be seen with the naked eye. You can use special dyes - iodine or Lugol's solution, which will allow you to distinguish the boundaries of the normal mucous membrane from keratosis or erosion with ectropion. Also, with colposcopy, it is possible to take a sample for biopsy, which will allow you to accurately determine the degree of changes and the depth of the pathological process.

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Differential diagnosis

Ectropion must be clearly differentiated from many pathologies. First of all, it is necessary to conduct a thorough diagnosis of erosion and the erosive form of ectropion. Erosion and ectropion often accompany each other, but erosion alone is a more favorable form. Therefore, it is necessary to differentiate these two pathologies, and if there is eversion of the mucous membrane, then we can already talk about ectropion.

It is also necessary to differentiate ectropion and cervical prolapse. These two pathologies have a similar clinical picture and the anamnesis contains data on surgical intervention or trauma. But the distinctive feature of cervical prolapse is the prolapse of all layers - both mucous and muscular, whereas with ectropion only the mucous membrane is involved in the pathological process. This can be checked by simple probing - with prolapse this can be done with difficulty. Also, when palpating with a fingertip in the case of cervical prolapse, tension of the muscular layer will be felt, which should not be the case with ectropion.

If the ectropion is significant in size and extends to the cervical canal and deep into the uterus, it must be differentiated from uterine fibroids. Bimanual palpation will help in this case, which allows you to identify an increase in the volume of the uterus and the presence of a nodular structure of the uterus or its increased density. This is the main diagnostic feature. It is also important in this case to conduct an ultrasound, which will help to identify an increase in the uterus itself and the size of the fibroid. With ectropion, the ultrasound data will be unchanged due to the fact that the process affects only the inner layer of the cervix.

Treatment ectropion

During the treatment of ectropion, it is necessary to take into account the type of pathology, as well as its etiology. There are cases when drug treatment is indicated as the main type of treatment, and in some cases it is preoperative preparation. The main directions that the treatment of pathology provides for are correction of eversion of the mucous membrane, elimination of the inflammatory process or erosion, as well as normalization of pH and microflora of the vagina and cervical canal. It follows from this that with inflammatory ectropion, it is necessary to first conduct anti-inflammatory therapy, and then, with a significant defect of the mucous membrane, it is necessary to complete the treatment surgically. Normalization of the anatomical structure of the cervix is mandatory, as this prevents the development of complications.

As anti-inflammatory agents, it is recommended to use complex agents that act on bacteria, fungi, and also have antiseptic activity.

1. Neotrizol is a combination product that contains two antibacterial drugs (neomycin and ornidazole), an antifungal drug (miconazole) and a hormonal drug (prednisolone). Due to this composition, it has a wide spectrum of action and, through a course of therapy, allows you to get rid of many problems at the same time. In case of inflammatory ectropion, Neotrizol relieves the inflammatory reaction of the cervix and helps reduce symptoms with subsequent drug therapy. The drug is available in tablet pharmacological form and the dosage is one tablet at night for an eight-day course. Method of application of the drug - one vaginal tablet must be inserted into the applicator and inserted into the vagina with the applicator at night. After this, you need to lie down in a horizontal position for some time for the drug to work better. Precautions - during pregnancy, treatment with this drug is not recommended due to the hormonal agent it contains. Side effects are rare due to the predominantly local action of the drug, but dizziness and headache may occur, as well as local burning and itching in the vaginal area.

In the erosive form of ectropion, anti-inflammatory treatment can only be carried out using a local antiseptic, since bacterial inflammation has not been confirmed.

2. Hexicon is a topical anti-inflammatory drug, the main active ingredient of which is the antiseptic chlorhexidine. It inhibits the work of bacterial cells by acting on their membranes and disrupting DNA synthesis. The drug is available in the form of a solution and vaginal suppositories and the dosage is one suppository vaginally once a day with a course of treatment of ten days. The method of using the drug is the same as any suppositories - it is better to use suppositories at night after hygiene procedures. Precautions - do not use the solution internally. Side effects are possible in the form of itching, dry skin and mucous membranes of the vagina and perianal area.
3. Flamax is an anti-inflammatory suppository recommended for use in cases of severe inflammation of the mucous membrane in the area of ectropion with severe pain. The active ingredient of this drug is ketoprofen, which relieves swelling of the mucous membrane, inflammatory reaction and has a bacteriostatic effect. The drug reduces the severity of pain, erosive changes in the mucous membrane and inflammation, which contributes to a better effect in preparation for surgical treatment of ectropion. Flamax is used in the pharmacological form of rectal suppositories in a dosage of 100 milligrams. Method of application - insert into the rectum twice a day after washing the genitals. The minimum treatment period is a week. Precautions - not recommended for use in bronchial asthma, gastritis with high acidity and gastroesophageal reflux disease. Side effects may be in the form of action on the mucous membrane of the digestive system and the formation of erosions and ulcers in the form of drug-induced esophagitis and gastritis. Suppression of hematopoiesis and a decrease in the number of formed elements in the peripheral blood are also possible.
4. Vagilak is a product that helps normalize vaginal microflora and can be used in the preoperative and postoperative periods. The main active ingredient of the drug is lactobacilli of different strains, which normally populate the vagina and help normalize the pH and inhibit the proliferation of pathogenic flora. The dosage of the drug is one vaginal tablet per day, the course of treatment is ten days. Method of administration of the drug - it is necessary to use vaginal suppositories, but only in the absence of an active inflammatory process. Side effects are possible only in the form of unpleasant burning or itching in the vagina.

Vitamins and physiotherapy treatment of ectropion provide for the active use of such means in the period of remission, especially in the early postoperative period. The use of laser therapy and electrophoresis prevents the development of adhesions of the cervical canal and fallopian tubes. Vitamins can be used seasonally, which increases local immune mechanisms of vaginal protection and prevents the development of secondary bacterial processes.

Surgical treatment of ectropion is based on the destruction of the pathological eversion of the mucous membrane and a method is used taking into account individual characteristics. The main methods of surgical intervention are the use of a laser, high and low temperatures.

Diathermocoagulation is a treatment method in which an electric current is applied to a special scalpel, which is capable of acting on tissue and cutting off the eversion of the mucous membrane.

Laser vaporization is a method using a laser to correct pathology, which involves using a laser as a means that simultaneously removes tissue and cauterizes the pathological process in the form of erosion.

Cryodestruction is the cauterization of ectropion with nitrogen, which can be used for small defects without significant harm to surrounding tissues. This is the most gentle method, which is recommended for use in young women.

Folk treatment of ectropion

Traditional methods of treating ectropion are not the main type of treatment, since they will not be able to correct anatomical changes. But treatment is possible using herbs that relieve the inflammatory reaction and prevent the development of complications, and also act on erosive changes. The main recipes for traditional treatment are as follows:

1. A solution of alder and birch bark helps to normalize metabolic processes in the cells of the endocervix. To prepare, take one hundred grams of dry bark of both trees, pour boiling water over them and boil for half an hour. Then, when the solution cools down, take 100 grams of this infusion instead of tea twice a day.
2. White acacia flowers should be mixed with chamomile leaves and poured with boiling water, then, when the solution has cooled, douching or sitz baths should be done for fifteen minutes.
3. Birch mushroom should be poured with a liter of boiled warm water, infused in a dark place for three days, and then taken a tablespoon three times a day, adding three drops of lemon juice.

Herbal solutions and tinctures are also widely used:

1. Erosive ectropion can be successfully treated with an infusion of medicinal herbs that normalize cell proliferation and restore the mucosal defect. To do this, take chamomile, valerian and mint leaves, pour water over them and leave for ten minutes. Drink a glass of this solution twice a day.
2. Viburnum berries should be poured with 500 milliliters of boiled hot water, then infused and drunk in a glass once a day, adding a slice of lemon.
3. Barberry should be infused in hot water and taken one tablespoon four times a day. It is especially effective for vaginal bleeding, and also with additional treatment in sitz baths.
4. Sweet clover herb is effective for ectropion in case of long-term treatment. For medicinal tinctures, take one hundred grams of the herb and add one hundred grams of alcohol, then leave for a week. This tincture should be taken one tablespoon in the morning on an empty stomach.

Homeopathic treatment can be used in the postoperative period for better tissue regeneration and restoration of hormonal balance. For this purpose, it is possible to use drugs that affect not only tissue trophism, but also the level of hormonal changes.

1. Ruta Plus is a combined homeopathic remedy recommended for the treatment of inflammatory ectropion. The drug is available in the form of homeopathic granules, and its dosage is eight granules per dose three times a day. Method of administration - under the tongue, dissolving until completely dissolved after meals. Side effects are rare, only allergic reactions are possible. Precautions - it is necessary to take into account the amount of glucose for patients with diabetes.
2. Sepia Plus is a combined homeopathic remedy in liquid form. It is available in the form of drops and the dosage of the drug is eight drops per dose. Directions for use: drip the solution into 100 milliliters of boiled water and drink half an hour before meals. The course of treatment is at least three months. Precautions: use with caution in case of recent traumatic brain injury and cerebral vascular pathology. Side effects are rare, allergic skin reactions are possible.
3. Cinchona is a single-component homeopathic preparation, the main active ingredient of which is the bark of the cinchona plant. The drug is recommended for the treatment of ectropion, which is accompanied by bloody discharge and pronounced erosivity of the mucous membrane. The drug is released in the form of standard homeopathic granules and its dosage is ten granules three times a day. Method of administration - under the tongue after meals after half an hour. Precautions - do not use if you are allergic to conifers. Side effects can be in the form of menstrual irregularities, which disappear after dose adjustment.
4. Thuja is a homeopathic single-component remedy used to correct hormonal imbalances after treatment of ectropion, especially in young women. The drug is available in the form of drops and granules. Method of administration and dosage - seven granules three times a day or ten drops per glass of warm water. Side effects are rare, dyspeptic disorders are possible.

Traditional methods of treatment and homeopathic preparations can be used in combination with local antibacterial agents, as well as against the background of surgical intervention.

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Prevention

The role of not only timely diagnosis of such pathology, but also prevention of ectropion development is very important. The main preventive measures are non-specific and imply avoidance of premature termination of pregnancy, frequent surgical interventions by treating chronic inflammatory diseases of the genital organs. Correct tactics of labor management with avoidance of birth canal injuries are necessary. For timely detection of ectropion, it is necessary to undergo all scheduled preventive examinations by a gynecologist, especially if there are risk factors in the anamnesis.

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Forecast

The prognosis for ectropion with timely surgical correction and complex drug treatment is favorable; in the case of metaplasia, it is necessary to conduct the most extensive examination and urgent treatment possible, then the prognosis for recovery is favorable.

Ectropion is a pathology of the cervix, which is characterized by eversion of the mucous membrane with subsequent changes in cells of an inflammatory or dysplastic nature. Often the pathology develops against the background of trauma during childbirth, but there may be other causes of this pathology. Symptoms may first appear only when complications arise, so it is very important to prevent the disease through timely examinations.