True cervical erosion.

True erosion of the cervix is a benign pathology of the vaginal part of the endocervix, accompanied by significant changes on the surface of the cervix in the form of obvious bright red or pink spots.

This disease today occupies one of the leading places among gynecological diseases in women.

Causes true cervical erosion.

The causes of true cervical erosion are somewhat varied, and in order to prescribe effective therapy, a specialist must have a complete clinical picture of the disease, this is the only way to determine the "provocateur" of the disease. Doctors distinguish between acquired and congenital cervical erosion. As is clear from the name, congenital pathology is a disease with which a person is already born. But on the pages of this article we will try to understand in more detail the acquired (true) cervical erosion during life.

So what can lead to true cervical erosion?

• A consequence of inflammation caused by such invasive microorganisms as streptococci, gonococci, herpes virus, chlamydia, ureaplasma, yeast fungi, human papilloma, staphylococci, trichomonas.
• This pathology can also be provoked by trauma to the cervix (cervix uteri, cervix), received during obstetrics, abortion or surgery. Trauma can also be received as a result of too young or too late birth. Other factors can also initiate trauma.
• Endocrine diseases.
• The cause of the disease may be a history of colpitis (inflammation of the mucous membrane of the vaginal walls, of various origins).
• Early or, conversely, fairly late onset of sexual activity.
• Irregular sexual relations.
• Multiple, frequently changing partners.
• Vaginal dysbacteriosis.
• Hormonal imbalance in a woman’s body: ovarian dysfunction, menstrual cycle failure, and so on.
• Immune disorders.
• Endocervicitis is an inflammation of the mucous membrane of the cervical canal of the uterus, accompanied by increased functioning of the secretions of the glands of the cervical epithelium.
• Endometritis is an inflammation of the inner layer of the uterus. As a result, discharge begins from the cervical canal. If this process takes a long enough time, the outer layer of the epithelial lining begins to soften and peel off. This process has a specific name - desquamation. During these changes, after the peeled section of the epithelium, a wound remains on the mucous membrane.
• Collapsing polyps. The process of erosion formation is similar to the previous one. When collapsing, dead cells exit the uterine cavity in the form of pathological discharge. Erosion is essentially an "open gate" that allows pathogenic microorganisms to freely enter the body.
• Myoma nodes.

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Symptoms true cervical erosion.

True or, as it is also called, acquired pathology is visually determined as a reddened point, which is clearly differentiated on the pink surface of the healthy mucous membrane of the vaginal part of the cervix. When palpating the affected area, bloody discharge begins from erosive wounds.

Mostly (about 90%), clinical symptoms of true cervical erosion are extremely rare (latent). Therefore, in the vast majority of cases, the disease can only be diagnosed during a preventive examination.

But pathological manifestations may still appear. And then the woman herself rushes to see a gynecologist. Her complaints are often voiced by the following symptoms:

• Discomfort and heaviness in the lower abdomen.
• The appearance of bloody discharge regardless of the phase of the menstrual cycle. They can especially appear or intensify after coitus.
• During intercourse, a woman may feel pain in the genitals.
• If the disease progresses and the inflammatory process develops, mucopurulent leucorrhoea may be observed. Sometimes these symptoms are incorrectly attributed to thrush, and if the woman is pregnant, they may be confused with the threat of miscarriage.

Diagnostics true cervical erosion.

A qualified obstetrician-gynecologist can make a primary diagnosis of true cervical erosion after a visual examination of a woman using a gynecological mirror. However, to be completely sure of the correctness of the diagnosed disease, one examination is not enough. To confirm the specialist's suspicion, a more thorough diagnosis of true cervical erosion is necessary.

After a visual examination, the gynecologist makes a preliminary diagnosis - pseudo-erosion of the cervix. To confirm or refute his suspicions, the doctor usually prescribes:

A smear is taken to differentiate the microflora of the vaginal mucosa.

• Smear examination for the presence of atypical cells (cancerous neoplasms). As a result of this analysis, the level of proliferation of cuboidal cells of the integument is determined, a cytogram of the inflammatory process is constructed, signs of dysplasia (structural change in the structure of the cervical mucosa, related to precancerous diseases) or leukoplakia (keratinization of the integumentary epithelium of varying severity) are identified.
• Blood test to exclude HIV infection (the presence of these antibodies is determined) and syphilis.
• If necessary, blood tests for hormones.
• Polymerase chain reaction (PCR diagnostics) is a highly accurate examination method that allows identifying a pathogenic infection affecting a woman's genitals. Primarily, it is the human papilloma virus.
• Colposcopy. Thanks to this procedure, using a special biocular with a built-in microscope, the obstetrician-gynecologist has the opportunity to perform a thorough examination of the mucous membrane of the cervix. During colposcopy, a number of tests are carried out: treatment of the mucous membrane with 3% acetic acid (blood vessels in a normal area narrow under the influence of acid), treatment of the mucous membrane with Lugol's solution (healthy epithelium acquires a brownish tint, while erosive inclusions remain uncolored). This technique is informative and has no contraindications.
• Removal of biomaterial for biopsy to exclude malignant neoplasm.
• Ultrasound examination of the pelvic organs. Allows to detect the presence of diseases based on hormonal imbalance and/or inflammatory process.

Based on the color of the discharge, the gynecologist can fairly accurately guess the cause of the pathology:

• If a woman has brownish leucorrhoea, this may indicate mechanical trauma to the mucous membrane. This is also an expression of an inflammatory process affecting the endometrium, which is quite often a consequence of progressive true erosion of the cervix.
• The appearance of yellowish discharge when the integrity of the mucous membrane is compromised signals the addition of an infection to the inflammation (of various origins - streptococci, staphylococci, ureaplasmosis, and others).
• The release of a whitish liquid may indicate the presence of a disease such as candidiasis (thrush), caused by a fungus belonging to the genus Candida.

Only after confirming the suspected diagnosis, the doctor makes a diagnosis. The disease is established - you can begin therapy designed to stop this problem.

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Treatment true cervical erosion.

The principle of any therapy is the elimination, if possible, of the primary source of pathological manifestations. Treatment of true cervical erosion also meets this postulate. That is, if the disease was caused by damage to the mucous membrane by invasive negative microflora, the task of therapy is to destroy the infection and provide anti-inflammatory therapy.

In such a situation, antibiotics and antiviral drugs are introduced into the treatment protocol, for example, the following:

Antibiotics, macrolides: pefloxacin, roxithromycin Lek, rovamycin, abactal, doxycycline and others.

Roxithromycin Lek is prescribed by the attending physician for oral administration. For adult patients and children who are already 12 years old and weigh more than 40 kg, the daily dosage of the drug is determined by the figure of 0.3 g twice during the day (0.15 g every 12 hours) or once a day at a dosage of 0.3 g.

If the patient suffers from severe liver and kidney dysfunction (creatine clearance below 15 ml/min), the dose of the administered drug is halved and is 0.15 g once a day (every 24 hours). The duration of the therapeutic course is determined by the doctor depending on the severity of the lesion. On average, it takes from one to two weeks.

Contraindications to Roxithromycin Lek include individual intolerance to the components of the drug, porphyria (a hereditary disorder of pigment metabolism with an increased content of porphyrins in the blood and other tissues of the patient's body) or the first trimester of pregnancy.

Pefloxacin should be taken during meals. The tablet is swallowed whole. For adolescents over 15 years of age and adult patients, the drug is prescribed in a dosage of 0.8 g per day, divided into two doses. In case of therapeutic necessity, the amount of the administered drug can be doubled - 1.6 g per day. During the period of pefloxacin therapy, it is worth avoiding exposure to ultraviolet rays (reduce exposure to direct sunlight).

The drug should not be prescribed if the patient has a history of glucose-6-phosphate dehydrogenase deficiency, liver dysfunction, hypersensitivity to the components of the drug, as well as if the woman is pregnant or breastfeeding a newborn, children under 15 years of age.

Antiseptics and antimicrobials used in the treatment of true cervical erosion: Candide, Atsilakt, Clindacin, Metrovagin, Nystatin, Clotrimazole, Trichopolum, Delacin and many others. The prescription of a specific drug largely depends on the recognition of a specific pathogen.

Vaginal tablets Candid are used locally and are inserted deeply intravaginally. The preparation is inserted into the vagina while lying on your back and bending your knees. A single injection of 0.5 g of the preparation is recommended, which corresponds to one tablet. Candid is inserted into the cervical canal in the evening, just before bedtime.

Contraindications for the use of this drug include hypersensitivity to clotrimazole or other components of Candida, the time of the menstrual cycle, as well as the first trimester of pregnancy and with special caution during lactation.

Oral tablets of Atsilakt are taken two to three times a day. To increase the effectiveness of treatment, it is better to administer the drug 30 to 40 minutes before meals. Teenagers and adult patients (with acutely developing pathology) are prescribed five tablets. The duration of administration is seven to eight days. This drug can also be administered in the form of suppositories. Contraindications for this drug are individual intolerance to the components of the drug or vulvovaginal candidiasis.

After completion of anti-inflammatory and anti-infective therapy, the obstetrician-gynecologist determines the method of cauterization of erosions. The selection of the stopping process is based on the patient's age, the need for her to give birth in the future, the size of the lesion, and many other factors are taken into account.

Not so long ago, if a young girl subsequently wanted to carry and give birth to a child, this procedure was postponed indefinitely.

Modern methods of cauterization:

• Electrocoagulation – stopping electric shock. The effectiveness of the procedure is about 92%. In case of deep tissue damage by erosion, the doctor has to resort to local or general anesthesia during electrocoagulation. It is a rather traumatic method, after which colloid scars remain on the cervix. They can become a problem during obstetrics. It is used quite often due to its availability and cheapness.
• Cryocauterization or cryodestruction. This treatment method is used for a fairly large lesion. Its area should be at least 3 cm. If the affected surface is deformed, this method is not recommended, since it is difficult to achieve the necessary contact of the tube with liquid nitrogen and the affected mucosa. After the procedure, coarse scars do not form, which removes the cause that prevents the fetus from passing through the birth canal. This technique is absolutely painless, just a little unpleasant. After cryodestruction, complications can very rarely be observed, such as bleeding, but watery leucorrhoea can be observed for a month after the procedure.
• Radio wave coagulation is the least traumatic method of treating the mucous membrane of the cervix. A painless procedure that does not require anesthesia. After its use, there are practically no complications, and colloid scars do not form. But due to the high cost of the procedure, it is used quite rarely.
• Laser coagulation makes it possible to act only on the affected areas of the cervical mucosa without damaging the adjacent tissues. The treatment is carried out using a laser beam. This is a contactless method of affecting the affected area. Local anesthesia is used during the procedure. The lesion should be larger than 3 cm. Quite often, such a complication as uterine bleeding can be observed. The effectiveness of this technique is more than 98% of complete recovery. No scar formation is observed on the cervix after this procedure. During the treatment, a small area of healthy tissue is also exposed to the laser beam.

Any of these procedures is carried out immediately after the end of menstruation - in the first phase of the menstrual cycle. Before it is carried out, the woman must undergo certain preparation: the affected area is first treated with acetic acid. This is done in order to obtain a spasm of blood vessels - this will prevent bleeding to some extent. After this, the surface is treated with iodine solution - such treatment makes it possible to contrast the contours of erosions.

After the therapy (whatever method is used), it is necessary to adhere to a number of rules:

• It is not recommended to have sexual intercourse until the wounds are completely healed. This result can be achieved on average six weeks after cauterization.
• Reduce physical activity during this period and limit the weight of the load lifted.
• During the healing period, you should not visit a swimming pool, public beaches, saunas or baths, or swim in open water.
• Water procedures should be limited to showers (you should wait before taking a bath).

After the cauterization, the doctor prescribes medicinal ointments or suppositories to his patient that have a wound-healing effect. This can be sea buckthorn oil or levomekol. These medications make it possible to soften the scab, which prevents rough scarring and reduces the likelihood of bleeding at the time of rejection of the scab tissue.

It should be known that folk medicine methods are not used in this case. Alternative medicine recipes can only be used as an additional therapy to increase the body's immune forces, which are necessary to fight the disease.

It is worth emphasizing that sea buckthorn oil does not treat true cervical erosion. If you try to treat pathology with oil, it will not solve the problem, on the contrary, it will only contribute to the growth of epithelium (proliferation), therefore, the focus of erosive damage will expand. Using sea buckthorn oil after cauterization will allow the "postoperative" wound to heal much faster.

Sea buckthorn oil suppositories are inserted into the vagina once a day, in the evening, just before bedtime, and left there until the morning. Most of the suppository will dissolve during this time, absorbed into the layers of the body, and only a small amount will come out in the morning. The duration of the treatment course is ten days. These suppositories have a tinting effect, so it is advisable to use daily pads during the treatment period - this will protect the woman's underwear from contamination.

After going through all the stages of treatment of true cervical erosion, the patient may well begin planning a pregnancy. In any case, if a woman plans to become a mother, it is advisable to undergo a full examination of the body and treat the pathology before conception, especially regarding the organs of the reproductive system, including stopping the foci of infection and affected mucous membrane, if any.

It is absolutely necessary to treat this disease. After all, although it is insignificant (in 3% of women with this pathology), there is a possibility of its degeneration into malignant neoplasms.

If true cervical erosion was diagnosed during pregnancy, then the obstetrician-gynecologist postpones all treatment measures until after the delivery. Since if cauterization is performed during the gestational period, it will be somewhat more difficult for the woman to give birth. After cauterization, the elasticity of the cervical tissue will be impaired (reduced), which can lead to problems with the opening of the cervix and stretching of the tissues during the passage of the baby through the birth canal.

Prevention

It is always better to prevent pathology than to fight it later. Prevention of true cervical erosion includes a number of simple recommendations that will not complicate, but will protect the life and health of a woman:

• A woman should undergo a preventive examination by a gynecologist once every six months.
• If any disease is detected, treatment should be undertaken immediately.
• Don't stop halfway, treat the disease completely, and not just until the obvious symptoms disappear.
• Prevent early sexual activity and childbirth at a young age.
• It is necessary to carefully observe the rules of personal hygiene. In this case, this mainly concerns the care of the genitals. For a woman, it is advisable to shower twice a day: after waking up and before going to bed. This is especially true during the menstrual period.
• A woman will have to adjust her sex life:
  • There must be one sexual partner.
  • A woman must be sure of his sexual health (the absence of a sexually transmitted infection).
  • Ensure safe and secure sexual intercourse using condoms.
• Before sexual intercourse, it is advisable for the woman’s partner to also take a hygienic shower.
• Reduce the risk of needing abortions by using modern effective methods of non-traumatic contraception.
• A mother of teenage girls should not miss the moment of her daughter's first period and monitor the establishment of a normal menstrual cycle. This will make it possible not to miss a hormonal imbalance in the child.
• Minimize trauma to the cervix, which can occur both during an abortion and as a result of surgical intervention affecting the pelvic organs, including the genitals. And also during childbirth.
• You should give up bad habits.
• It is advisable to undergo a colposcopy once a year.

Only a healthy lifestyle and compliance with all preventive measures will allow you to protect yourself from this not entirely pleasant, and potentially cancerous, and dangerous pathology.

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Forecast

If the pathology is detected in time and effective treatment is carried out, the prognosis for true cervical erosion is favorable. There is only a small percentage of probability of the pathology transitioning into a malignant tumor due to its untimely detection and ignoring adequate therapy. But even in this case, if the process is caught at an early stage and adequate therapy is carried out, a woman can live a fairly high-quality life.

Even minor discomfort in the genital area, a nagging pain in the lower abdomen is a reason to come for a consultation with a gynecologist. After all, true cervical erosion is most effectively treated at the initial stage of the disease.

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