Often referred to as erosion. But it is not so. Real erosion is something like a sore. Damage to the mucous membrane can occur as a result of exposure to some destructive agents.
Ectopia is the movement of the epithelium lining the cervical canal to the part of the cervix protruding into the vagina. Otherwise, the ectopia of the cylindrical epithelium of the cervix is \u200b\u200bcalled. Meets this pathology often. In more than 40% of women, it is discovered quite by accident during a periodic examination. Most are women under 30.
Not always this disease worries a woman, that is, it is asymptomatic. But with a thorough examination, the gynecologist can make such a diagnosis. For clarification, a cytological examination of the scraping is carried out, and in more complicated cases, a biopsy. But some women experience a certain malaise: pain, bloody issues during sexual intercourse, itching, leucorrhoea and other signs. It is possible that these symptoms are not related to the ectopia of the epithelium of the cervix, but to concomitant gynecological diseases.
Ectopia may be the result of dishormonal disorders. An increased release of estrogen leads to an uncomplicated form of this pathology. Therefore, it is often diagnosed in adolescents, during pregnancy and in nulliparous young women. Pseudo-erosion in this case can be considered as a variant of the norm. Moreover, in almost half of the girls, cervical ectopia is defined as congenital.
Some researchers suggest that it is inflammation that is the main cause of this condition. In addition, injuries after childbirth or abortion, barrier contraception can infect the cervix, which also leads to pathology.
And of course, a decrease in immunity plays an important role in the occurrence of pseudo-erosion.
Many women who have learned about their diagnosis are wondering: how to treat cervical ectopia? You can reassure them: in itself, an uncomplicated form of pseudo-erosion is not dangerous. Therefore, you can limit yourself to a periodic examination by a gynecologist. If, on the background of ectopia, a woman has signs of inflammation, polyps, dysplasia and other pathologies, 
it is necessary to treat these conditions.
Ectopia of the cylindrical epithelium of the cervix is today considered one of the most common pathological phenomena in gynecology. It is characterized by the displacement of the cylindrical epithelium, which covers the inside of the cervical canal, onto the vaginal surface of the cervix. Outwardly, it looks like redness.
Pathology is observed in approximately 40-45% of women of childbearing age, while it does not tend to form during menopause. More than half of the patients are young, nulliparous women under 25 years of age.
Ectopia of the cylindrical epithelium in medical practice is not considered a disease of the cervix, but is recognized as a pathological phenomenon, therefore, it is not included in the International Classification of Diseases (ICD 10).
Attention! Often in practice, ectopia is called the familiar, but outdated today, the term "erosion". You can also find the names: pseudo-erosion, endocervicosis, glandular-muscular hyperplasia - all this relates to this pathological phenomenon.
Based on the clinical form, the division of this pathology occurs into:
In the form of complications, colpitis, cervicitis caused by infection are implied. However, in many cases, an uncomplicated pathology occurs, according to which, in the colposcopic nomenclature adopted today, this form of pathology is regarded as a normal physiological state.
Important! Over time, ectopia heals with the replacement of cylindrical epithelium on the cervix with stratified squamous cells (with the help of germ cells). This phenomenon is called squamous metaplasia, it is against its background that the development of malignant neoplasms in the organ.
According to the histological type, the following forms are distinguished:
Almost all cases of the phenomenon are acquired, but there are some congenital. The first - require mandatory treatment, the second - are considered a temporary phenomenon, do not need therapy.
Doctors identify several causes that can lead to cervical columnar epithelium.
Ectopia of the cylindrical epithelium of the cervix in an uncomplicated form does not show any symptoms and is most often detected when a woman undergoes a gynecological examination.
If we are talking about a complicated form and the development of concomitant diseases, then patients complain about:
To prescribe a course of treatment for ectopic columnar epithelium, the patient undergoes a number of diagnostic procedures, including:
Separately, it should be noted that cytological examination special attention is paid, and it implies a cytogram of endocervicosis, leukoplakia, inflammation, dysplasia, proliferation of epithelial tissue.
For your information! Depending on the characteristics of the pathology and the complications caused by it, the patient may be shown additional diagnostic procedures.
What treatment will be shown for ectopia of the cylindrical epithelium of the cervix depends on the results of the diagnosis and the type of pathology. If a congenital uncomplicated form is found, then it does not require special therapy, but is subject to constant monitoring. In other cases, one of the modern methods can be chosen:
In many cases of ectopic columnar epithelium of the cervix, the patient is shown drug therapy, which is aimed at eliminating inflammation and microbiocenosis, supporting the immune system and correcting hormonal abnormalities.
Ectopia of the cervix or cylindrical epithelium, pseudo-erosion - with this concept, medicine refers to the same pathology. Currently, 40% of women know firsthand about this disease, which proves its widespread prevalence.
The cervix is covered with the so-called squamous epithelium, and the adjacent cervical canal is cylindrical. The physiological norm is a condition in which the boundaries between the cervix and the cervical canal are not violated. Ectopia is diagnosed if the columnar epithelium grows into the cervical region and replaces the squamous epithelium.
When examined by a gynecologist, ectopia looks like a different appearance mucosal area. Ectopia can also be an independent phenomenon, but mainly acts as a consequence of other gynecological problems.
Ectopia is characterized as a benign process, but it has been proven that ectopia exacerbates cancerous processes in the cervix. Comprehensive diagnosis of ectopia is necessary due to its ability to mask cancer. Also, the statement about the identity of ectopia and outwardly similar cervical erosion is also incorrect. Ectopia is called pseudo-erosion, but in fact it only shifts the boundaries of the epithelium of the cervical canal, while true erosion involves damage to the mucous membrane of the cervix.
Ectopia is congenital and acquired. Congenital ectopia is regarded as the norm. Acquired ectopia is more often detected in progressive stages due to the asymptomatic course of the initial stages.
Depending on the nature of the growth of cylindrical epilethium, ectopia is classified as follows:
The cells of the cylindrical epithelium are capable of secretion, and therefore it belongs to the glandular structures. Glandular ectopia is characterized by a large volume of glandular structures of the subepithelial layer with infiltrative zones.
With this type of ectopia, the cylindrical epithelium consists of papules, or nipples, at the end of each of which there is a vascular loop.
The structure resembles glandular ectopia, but there are areas of normal squamous epithelium on the formation. In this case, special treatment is not required, since the surface of the cervical os is self-healing, when the cylindrical epithelium is gradually replaced by areas of mature squamous.
The class of ectopia practically does not affect the treatment strategy, but it allows you to determine the nature of the lesion of epithelial areas.
About half of the cases of ectopia occur in nulliparous young women, so it should not be attributed to the usual postpartum disorders. Another common misconception that ectopia can occur as a result of the onset of sexual activity is also incorrect. Diagnose ectopia if present hymen quite difficult, since the use of a mirror during the inspection is impossible. But this does not prove a direct connection between the development of ectopia and the onset of sexual activity.
The causes of ectopia are not completely known, but modern medicine has identified certain patterns. Acquired ectopia can occur for the following reasons:
Ectopia of the cervix often occurs at puberty and during pregnancy as a reaction to hormonal changes in the ovaries. This process is caused by estrogen deficiency. During the formation of the genitals (at puberty), there is the possibility of self-healing after the normalization of the hormonal background.
Infections can affect the condition of the cervix. Specific microflora damages the squamous epithelium, especially Trichomonas and gonococci contribute to this. Subsequently, the regeneration of the cervical epithelium may be incorrect. Ectopia in the vast majority of cases occurs precisely as a result of infectious and inflammatory diseases caused by specific microflora.
A significant factor in the occurrence of ectopia can be injuries resulting from childbirth and multiple abortions, as well as other incorrect and / or traumatic gynecological manipulations.
Ectopia can occur as a result of a decrease in the functions of the body's immune system, which, in turn, has various causes: smoking, early childbirth and early sexual life, etc.
Ectopia at the initial uncomplicated stage is not felt and is detected only during a visual gynecological examination. Complicated ectopia in 80% of cases is combined with inflammation and precancerous conditions (cervical polyps, dysplasia, leukoplakia).
During the course of ectopia with endocervicitis, symptoms such as leucorrhoea and itching, contact bleeding, dyspareunia are observed. Also, the symptoms of ectopia include menstrual irregularities.
Diagnosis of cervical ectopia is carried out in the gynecological departments of hospitals and medical centers using special equipment. Ectopia can be diagnosed by several methods.
It is carried out in a gynecological chair using a mirror. The gynecologist sees ectopia or pseudo-erosion as a bright red focus of the epithelium with indefinite outlines. Touching the instrument to the site of ectopia may cause minor bleeding. Ectopia resulting from infectious and inflammatory diseases is characterized by severe redness and may have a purulent coating, but its borders are difficult to see due to redness and swelling of closely located tissues.
This study is necessary to accurately identify atypical areas with columnar epithelium and transformed zones. More accurate readings are given by colposcopy with a Schiller test, which shows iodine-negative zones, leukoplakia, puncture and mosaic. Colposcopy allows you to identify areas of ectopia that cannot be determined during a routine medical examination. In 40% of cases, after colposcopy, the patient requires a more detailed study.
To diagnose and study cervical ectopia, the doctor must do a scraping, which reveals cells of the cylindrical epithelium, an uncharacteristic microflora. In addition to microscopy, bacterial culture and PCR analysis are used for accurate diagnosis.
Histological studies with biopsy and separate diagnostic curettage are performed when an abnormal clinical picture is obtained as a result of standard tests. Studies on cytology reveal the features of the disease at the cellular level, therefore, they are the most reliable and accurate diagnostic method.
At this stage, the hormonal status is examined, therefore, a consultation with a gynecologist-endocrinologist is necessary. Also, functional tests to confirm ectopia are done with diagnosed true erosion or cervical cancer.
Ectopia does not always need treatment, but the doctor's attention to the abnormal condition of the cervix is required. Treatment methods are selected according to the characteristics of a particular case and are usually implemented according to the following scheme:
It is carried out with uncomplicated forms of ectopia, as well as with congenital pathology: the patient is monitored to monitor possible changes in her condition. Actually, treatment is started only with negative changes.
More complex and advanced forms of ectopia are treated depending on the type of epithelial changes and their causes. The doctor can prescribe anti-inflammatory and antiviral drugs, help you choose the right contraceptives and eliminate immune and hormonal abnormalities. If an infection has become the cause of ectopia, treatment begins with antibiotic therapy, since otherwise it makes no sense to treat ectopia.
After the treatment prescribed by the doctor has yielded results and the infectious process has been stopped, the ectopic foci are destroyed.
As a result of the diagnosis of ectopia, concomitant abnormal conditions may be detected: nabothian cysts, polyps, dysplasia, leukoplakia, endometriosis. For them, appropriate methods of treatment are used.
Reduces the risk of ectopia stable sex life, properly performed gynecological interventions, timely treatment of sexually transmitted infections, correction of hormonal and immune abnormalities.
Mandatory preventive measure- scheduled visits to the gynecologist, guaranteeing the detection of almost any disease in the early stages.
Pain is a sign of trouble in the human body, signaling that its tissues and organs need special attention. Pathologies of the cervix in most cases are asymptomatic, because there are no pain receptors in this section of the reproductive system.
When an unsuspecting woman visits a gynecologist, she is sometimes surprised to learn that her health is threatened by a serious illness. Such pathologies that occur for a long time without pain include cervical ectopia, or false erosion of the cervix.
This disease occurs in women of childbearing age from 14 to 37 cases per 100 people. Symptoms of pathology - pseudo-erosion or false erosion of the cervix, glandular-muscular hyperplasia, endocervicosis.
Approximately one third of patients with a similar diagnosis have a congenital form of ectopia. Up to half of the patients are in the age group of 18-30 years.
The connection with reproductive function suggests that the pathology is based on an imbalance of hormonal processes occurring in the female body.
In itself, this disease is not dangerous, but it has been proven that the ectopia of the outer part of the cervix is the background for the onset of the oncological process.
According to the international classification of diseases of the 10th revision, the disease belongs to the interval N80-N98 (Non-inflammatory diseases of the female genital organs), has ICD code - N86(Erosion and ectropion of the cervix).
Normally, the part of the cervix that extends into the vagina is covered with squamous stratified epithelium. The cervical canal leading to the uterus is lined with a cylindrical single-layer epithelium. By definition, cervical ectopia of the outer part of the cervix is the replacement of the squamous epithelium with a cylindrical one.
With the reverse growth of the squamous epithelium, it overlaps the cylindrical cells and glands characteristic of this layer. This process forms the transformation zone. Since the glands are clogged with plugs from cells atypical for them, mucus cannot come out.
The resulting cysts provoke inflammatory processes, ending in the appearance of atypical cells. A progressive violation of the cellular structure stimulates the development of such complications of cervical ectopia as malignant neoplasms.
There are various bases for classification of pathology.
Types of pseudo-erosion according to histological features:
Glandular ectopia.
Accumulations of glands, the presence of an inflammatory process are diagnosed.
papillary ectopia.
The appearance of papillary structures, the growth of the stoma are diagnosed.
Epidermis ectopia.
Or the displacement of the cylindrical epithelium by squamous cells, when spontaneous restoration of the pharynx of the cervical canal occurs.
By etiology:
According to the clinical picture:
Complicated.
Provoked by infectious colpitis and cervicitis.
Uncomplicated.
It may be a variant of the norm.
If for some reason the natural restoration of the epithelium is interrupted, a relapse of the disease occurs.
There are several theories suggesting that cervical ectopia can be caused by inflammatory, immunological factors, hormonal imbalance, cervical trauma.
Possible causes of the development of the disease:
These reasons become more significant in the presence of provoking factors - a history of somatic diseases, endometriosis, fibroids, hyperplasia, ovarian pathology, early formation of the menstrual cycle. Frequent change of sexual partners, smoking can also negatively affect the formation of ectopia.
There are no specific manifestations characteristic exclusively for this disease. In most cases, pathology is discovered by chance during a preventive visit to the gynecologist. Most often, cervical ectopia is accompanied by signs of concomitant pathologies of the reproductive system - colpitis, endocervicitis.
Possible signs of cervical ectopia:
In complicated cases, true erosion, cervical dysplasia, and leukoplakia are simultaneously diagnosed.
Visually, the doctor notes such characteristic symptoms pathology, such as the presence of a red spot of an oval or irregular shape around the pharynx of the cervical canal. When touched by a gynecologist's instrument, pseudo-erosion of the mucous membrane of the cervix begins to bleed.
The most informative diagnostic study at the initial stage is extended colposcopy. With the help of the Schiller test, the doctor easily determines the area of \u200b\u200bthe atypical structure, an abnormal colposcopic picture.
Before starting treatment for any form of cervical ectopia, an in-depth diagnosis is carried out, which includes:
When diagnosing, differentiation of ectopia with cervical cancer, true erosion is carried out.
To eliminate the site of an atypical structure, modern gynecology seeks to use non-traumatic and minimally invasive methods. If earlier ectopia was preferred to be treated surgically, now modern innovative technologies have come to the fore, minimizing the rehabilitation period.
Methods of surgical intervention:
Operation Schroeder. Wedge-shaped excision of part of the neck, the method prevents the normal flow possible pregnancy due to narrowing of the cervical canal.
Operation Emmett.
Sparing technique of excision of the neck in the form of a crescent.
Operation Sturmdorf.
Cone-shaped excision of the neck with its subsequent plasty.
Methods of chemical influence are becoming a thing of the past - lubricating the neck with Solkovagin or Vagotil. After protein coagulation, the affected area is spontaneously removed.
How is cervical ectopia eliminated - modern physical treatment:
Thermocoagulation.
Cauterization of the transformation site with high-frequency current.
Cryodestruction.
Exposure to abnormally low temperatures using liquid nitrogen.
A combination of the above methods.
Allows you to control the depth of impact on the focus of pathology.
laser surgery.
It has a minimum of relapses, a reduction in the rehabilitation period, and a complete restoration of reproductive function.
These methods guarantee a complete recovery. At the same time, medical support for the body of a woman suffering from ectopia is carried out.
Groups medicines used in conservative therapy:
When diagnosing comorbidities, their treatment is carried out simultaneously. To prevent ectopia, it is necessary to treat inflammatory diseases of the reproductive system in a timely manner, regularly visit a gynecologist. The prognosis for recovery in this pathology is favorable.
Although doctors are trying to replace the term "pseudo-erosion" with more modern "endocervicosis" or "ectopia of the cylindrical epithelium of the cervix", the disease is still often called the old fashioned way, which gives rise to excessive fear and negativity among patients.
You should not be afraid, often the disease does not even need to be treated.
The term "ectopia" is used when an organ or tissue is displaced to an atypical place for them.
Normally, the cervix (CC) faces the vagina with a surface covered with squamous epithelium, but with ectopia, the areas around the pharynx are replaced by a cylindrical epithelium, which belongs in the channel, not on the surface.
Outwardly, it looks like a red spot.
Increasingly, modern medicine is inclined to consider such physiological manifestations as a normal physical condition, since around the cervix canal, the cylindrical and squamous epithelium periodically shift each other in one direction or in the opposite direction.
Pseudo-erosion up to 25 years of age:
In the following video clip, the gynecologist talks in detail about cervical ectopia:
True and pseudo-erosion of CMM are different diseases.
If during endocervicosis there is a shift in the position of the cylindrical epithelium (the inner shell of the cervical canal goes beyond its limits without symptoms of inflammation and violation of tissue integrity), erosion causes thinning of the squamous epithelium lining the cervix from the outside, i.e. in the vaginal part of the organ.
Later, cracks and sores appear in these areas.
Endocervicosis can be located not only around the external pharynx of the cervix canal, but also on the anterior or posterior lip of the cervix, manifesting itself there different sizes and forms.
The real one appears only around the external pharynx of cervix, is the result of inflammation caused by pathogenic microorganisms such as staphylococci, gonococci, etc.
The range of prevalence rates of pseudo-erosion of the cervix is wide - from 10 to 25 percent.
Some sources indicate the appearance of pathology in almost every 2nd woman under 40 years old.
After this age, endocervicosis does not develop. In 40% of cases, the problem occurs in perfectly healthy women.
Information about the disease is contradictory.
It is classified as dishormonal, but the role of estrogens - hormones that contribute to the development of women's reproductive abilities, has not been fully elucidated.
The roles of birth injuries and inflammatory diseases of the genitals are also poorly understood.
It is noted that the disease can be either congenital or acquired:
Uncomplicated pseudo-erosion develops when the mechanism of hormone synthesis in the ovaries changes. The epithelium reacts to this with pseudo-erosion.
The cause may also be any irritation of the cervix, infection.
Uncomplicated endocervicoses, if they form on the unchanged surface of the cervix, do not bother women, they are asymptomatic, and are detected only during examination.
But if inflammation develops in parallel, it can be accompanied not only by secretions, but also other signs corresponding to the disease that caused the inflammation.
Occasionally, contact bleeding occurs (appearing after vaginal intercourse).
On examination, the ectopia of the cervix looks like a red area located around the exit of the cervical canal. The epithelium in this place seems velvety.
If the problem is accompanied by inflammation, in the vagina or CMM canal, cloudy yellowish mucus is visible. But with all external signs, the final diagnosis is made on the basis of a cytological examination.
If endocervicosis is small in size, proceeds without complications, it is not classified as a gynecological disease, but is considered a physiological condition not associated with pathology.
Treatment in this case is not required, it is enough to visit a doctor for examination once a year. Pathology can disappear as soon as the cause that caused it disappears.
A complicated variant of the disease does not go away on its own and, of which there are many ways.
The choice of scheme and method depends on the type of pseudo-erosion, the cause that caused it, the type of complications.
If the therapy is chosen correctly, the disease is eliminated completely.
The existing methods of treatment are based on elimination of abnormally proliferating epithelial cells so that their place is subsequently taken by cells typical of this part of the organ.
The lower part of the cervix protruding into the vagina (ectocervix) is normally covered with a stratified squamous epithelium that protects tissues from the contents of the vagina, which (even its opportunistic part) is aggressive in the microbiological sense.
If, during pseudo-erosion, any area is replaced by a single-layer epithelium, protection is reduced significantly or completely disappears.
This gradually leads to chronic inflammation of the cervix. varying degrees severity, affecting not only the outer part of the canal, but also the space surrounding it or the inner part.
Later, the inflammatory process can go to the uterus, the fallopian tubes, lead to infertility or ectopic pregnancy.
Chronic cervicitis - cause:
After all, the cervix is a barrier to infections, and its inflammation opens the way for all kinds of microbes.
Pseudo-erosion is not a dangerous pathology and disappears over time, as soon as the cause that caused it disappears.
If the disease is complicated by inflammation, then self-healing is impossible. Depending on the cause of inflammation, the attending physician draws up an individual therapy regimen and chooses the most effective of the existing methods of exposure.
The disease can be avoided.
Prevention measures:
