What is cervical erosion?
When we hear at the gynaecologist that we have an erosion, what do we do? We are in a panic. Is it already cancer or just a benign lesion? Should we treat it right away, cut out, burn out, freeze out or wait and watch? All questions will be answered by Joanna Szymkowiak- Gołębiowska, MD, from the Medfemina Hospital in Wrocław.
What is cervical erosion?
So-called „erosion” is a commonly and incorrectly used term for ectopia . It is when the vaginal part of the cervix that is seen in the speculum is not pale pink but red over a varying area. This condition is caused by the „displacement” from the cervical canal of the columnar epithelium (thin epithelium with translucent blood vessels), which naturally occurs there, to the cervix, where the stratified squamous epithelium is usually present (thicker, the vessels are barely visible and therefore pale pink in colour). Quite rarely the boundary between these epithelia runs near the mouth of the external cervical canal, usually the glandular epithelium to a greater or lesser extent passes to the surface of the cervix giving an ectopic picture. It is a condition most commonly seen during sexual maturity, pregnancy, childbirth, and after miscarriage. Both the image of the epithelial borders running near the outer mouth of the cervical canal and shifted to the cervix are considered normal. Cervical ectropion (the real erosion), on the other hand, is a fairly rare epithelial defect resulting from chronic inflammation, precancerous conditions, cancer, mechanical trauma or estrogen deficiency. Both of the above conditions can produce a different sized red spot on the neck referred to as erythroplakia. The finding of such a condition requires further diagnostics – a pap test and colposcopy examination. Ectopia, unless symptomatic, does not require treatment and usually resolves on its own after a variable length of time by indirect metaplasia (replacement of glandular epithelium with new squamous epithelium). An indication for treatment is symptomatic ectopia leading to recurrent inflammation, in which case an appropriately selected vaginal treatment works. In the case of erosion (ectropion) caused by inflammation, it makes sense to treat the infection vaginally, in the case of estrogen deficiency their local application, while in the case of mechanical trauma erosion usually resolves spontaneously provided that the normal vaginal flora is present. Erosion (ectropion) associated with the presence of precancerous conditions or cancer is removed by surgical excision (so-called cold knife – the most recommended, but also phototherapy, cryotherapy, CO2 laser).
What are the causes of cervical ectopia and erosion?
Ectopia is caused primarily by hormonal changes (sexual maturity, pregnancy, state after childbirth, miscarriage, quite rarely infections) Usually the cause of its occurrence is natural, physiological changes. The causes of erosion are:
- chronic inflammation;
- precancerous or cancerous lesions;
- mechanical injuries;
- hormonal disorders, estrogen deficiency.
What are the symptoms of a true cervical erosion?
- spotting between periods or after intercourse;
- noticeable pain in the sacro-lumbar region and pain in the lower abdomen;
- white discharge (sometimes yellow or greenish, sometimes blood-coloured) with an unpleasant odour.
How to detect cervical erosion?
Cervical erythroplakia is diagnosed by examination in a speculum. The nature of the lesion should then be confirmed by cytological examination (a pap smear) and colposcopy. Results of a pap smear are reported on the Bethesda scale.
Is cervical erosion in pregnancy dangerous?
Very often, cervical erythroplakia is not diagnosed until pregnancy, when a woman visits her gynaecologist for a routine examination. Ectopy as written above is not a threat. Erosion itself is not a danger to the baby, but intimate infections are often responsible for or accompany it. These are already a potential risk (miscarriage, premature amniotic fluid outflow, preterm labour) and therefore require treatment, usually vaginal, after the smear result is obtained.
Erythroplakia of the cervix vs. cancer
Any cervical erythroplakia requires further diagnosis as described above: pap smear + colposcopy. It is worth remembering that cytological examination should be performed regardless of the presence of erosions (sometimes oncologically suspicious lesions occur in apparently normal cervices). Every woman should remember that erythroplakia and even confirmed cervical erosion does not immediately mean cancer. However, regular check-ups are crucial.