Cervical Erosion (Cervical Ectopy)
Definition:
Cervical Erosion (Cervical ectopy) is a condition where the squamous epithelium of the ectocervix is replaced by columnar epithelium, which is continuous with the endocervix. It is not an ulcer. [1]
Cervical ectopy is the more current medical term used instead of "cervical erosion." However, there are still some related terms you can consider depending on the context:
- Ectocervical transformation zone: This is the most precise and current medical term for the area of the cervix where the type of cells changes from squamous (outer) to glandular (inner). Ectopy simply refers to the presence of glandular cells on the surface of the cervix.
- Physiological cervical appearance: This emphasizes that this is a normal variation in how the cervix looks and isn’t a cause for concern.
Less Common Synonyms:
- Cervical ectropion: This term is very similar to ectopy but can also imply eversion, where the cells are not just present on the surface but also protrude slightly.
Informal Terms (avoid in most contexts):
- Cervical erosion: As discussed earlier, this term is outdated and can be misleading.
Choosing the Right Term:
- Medical Setting: Use "ectocervical transformation zone" for clarity and accuracy.
- Patient Education: "Physiological cervical appearance" or "normal variation in cervical cells" are easier for patients to understand.
Important Considerations:
- "Cervical ectopy" itself is an acceptable term, but using the full name "ectocervical transformation zone" provides more context.
- Avoid informal terms like "cervical erosion" to ensure clear communication.
Remember:
- The most appropriate term depends on the context and audience.
- In a medical setting, prioritize accuracy and established medical terminology.
Overview
Epidemiology
Causes
Types
Risk Factors
Pathogenesis
Pathophysiology
Clinical Features
Sign & Symptoms
Clinical Examination
Diagnosis
Differential Diagnosis
Complications
Investigations
Treatment
Prevention
Homeopathic Treatment
Diet & Regimen
Do’s and Don'ts
Terminology
References
Also Search As
Overview
Overview of Cervical Erosion (Cervical Ectopy)
- Chronic cervicitis often manifests clinically as erosion or as a Nabothian follicle.
- Moreover, The cervical erosion results from the extension of the columnar endocervical epithelium beyond the external cervical os to replace the squamous epithelium covering the portion vaginalis of the cervix.
- Whenever the mouth of an endocervical gland opening gets blocked, it gets distended with inspissated secretion, resulting in a cystic bulge known as the Nabothian follicle. [2]
Epidemiology
Epidemiology of Cervical Erosion (Cervical Ectopy)
Cervical erosion, also known as cervical ectopy, is a common benign condition characterized by the presence of columnar epithelium on the ectocervix. While it is often asymptomatic, it can sometimes cause vaginal discharge or intermenstrual bleeding.
Studies on the epidemiology of cervical erosion in India have reported varying prevalence rates.
A cross-sectional study conducted in Nagpur in 2003 found a prevalence of 22.96% among women in the reproductive age group (15-44 years). This study also highlighted the association between cervical erosion and lower literacy levels. (Role of socio-economic factors and cytology in cervical erosion in reproductive age group women – PubMed, 2003) [6]
A multicentric cross-sectional study in southern India reported a prevalence of 33%. (View of Review of management of Cervical Ectropion using Traditional Ayurvedic Interventions, jaims.in) [7]
The prevalence of cervical erosion is higher in adolescents, with estimates reaching up to 80%. (View of Review of management of Cervical Ectropion using Traditional Ayurvedic Interventions, jaims.in)
It is important to note that cervical erosion is a normal physiological finding in many women, especially during adolescence and pregnancy. However, it can also be associated with certain risk factors, such as early age at first sexual intercourse, multiple sexual partners, and hormonal contraceptive use.
If you experience any symptoms associated with cervical erosion, it is important to consult a healthcare provider for diagnosis and appropriate management.
Causes
Causes of Cervical Erosion (Cervical Ectopy)
Congenital i.e.:
- At birth, in about one-third of cases, the columnar epithelium of the endocervix extends beyond the external os.
- This condition persists only for a few days until the level of oestrogen derived from the mother falls.
- Thus, the congenital ectopy heals spontaneously.
Acquired:
Hormonal:
- The squamocolumnar junction is not static and its movement, either inwards or outwards is dependent on estrogen.
- When the estrogen level is high, it moves out so that the columnar epithelium extends onto the vaginal portion of the cervix replacing the squamous epithelium.
- This state observed during pregnancy and amongst ‘pill users’.
- The squamocolumnar junction returns back to its normal position after 3 months following delivery and little earlier following withdrawal of ‘pill’.
Infection:
- The role of infection as the primary cause of ectopy has discarded.
- However, chronic cervicitis may associate or else the infection may supervene on an ectopy because of the delicate columnar epithelium which more vulnerable to trauma and infection. [2]
Types
Types of Cervical Erosion (Cervical Ectopy)
Describes two types of cervical ectopy:
Congenital Ectopy: This type is present at birth and is considered a normal variant. It is due to the eversion of the endocervical columnar epithelium onto the ectocervix.
Acquired Ectopy: This type develops later in life and can be due to several factors:
- Hormonal: High estrogen levels, as seen in puberty, pregnancy, or with oral contraceptive use, can stimulate the growth of columnar epithelium.
- Inflammatory: Chronic cervicitis can cause the squamous epithelium to be replaced by columnar epithelium.
- Trauma: Childbirth or instrumentation can lead to ectopy.
The book Shaw’s Textbook of Gynaecology, further clarifies that these types are not clinically distinct and are often used interchangeably.[8]
Risk Factors
Risk factor of Cervical Erosion (Cervical Ectopy)
- Use of the combined oral contraceptive pill
- Pregnancy
- Adolescence
- Menstruating age (it is uncommon in post-menopausal women) [3]
Pathogenesis
Pathogenesis
The pathogenesis of cervical ectopy as follows:
The squamocolumnar junction (SCJ), the boundary between the squamous epithelium of the ectocervix and the columnar epithelium of the endocervix, is dynamic and shifts throughout a woman’s life. In utero and during the neonatal period, the columnar epithelium may be exposed on the ectocervix due to maternal estrogen stimulation. This is termed congenital ectopy and usually regresses as estrogen levels decline.
In puberty and during pregnancy, increased estrogen levels again stimulate the columnar epithelium, causing it to proliferate and evert onto the ectocervix. This is physiological ectopy and is considered a normal finding.
Chronic inflammation or trauma to the cervix can also lead to the replacement of squamous epithelium with columnar epithelium. This is known as acquired ectopy and may be associated with certain infections or procedures.[9]
Pathophysiology
Pathophysiology of Cervical Erosion (Cervical Ectopy)
- In the active phase of ectopy, the squamocolumnar junction moves out from the os.
- The columnar epithelium of the endocervix maintains its continuity while covering the ectocervix replacing the squamous epithelium.
- The replaced epithelium is usually arranged in a single layer (flat type) or may be so hyperplastic as to fold inwards to accommodate in the increased area—a follicular ectopy.
- At times, it becomes heaped up to fold inwards and outwards-a papillary ectopy.
- Underneath the epithelium, there are evidences of round cell infiltration and glandular proliferation.
- The features of infection are probably secondary rather than primary.
- The columnar epithelium is less resistant to infection than the squamous epithelium.
- During the process of healing, the squamocolumnar junction gradually moves up towards the external os.
- The squamous epithelium grows beneath the columnar epithelium until it reaches at or near to its original position at the external os.
- Alternatively, the replacement is probably by squamous metaplasia of the columnar cells.
- The possibility of squamous metaplasia of the reserve cells is also likely.
- During the process, the squamous epithelium may obstruct the mouth of the underlying glands (normally not present in ectocervix), pent up secretion, retention cyst, Nabothian follicle.
- Alternatively, the epithelium may burrow inside the gland Lumina.
- This process of replacement by the squamous epithelium is called epidermalization. [1]
Clinical Features
Clinical Features
The clinical features of cervical ectopy as follows:
Asymptomatic: In most cases, cervical ectopy is asymptomatic and is an incidental finding during a routine pelvic examination.
Vaginal discharge: Some women may experience an increased vaginal discharge, which is often described as clear, white, or yellowish.
Intermenstrual or postcoital bleeding: Bleeding between periods or after sexual intercourse can occur due to the delicate nature of the columnar epithelium.
Dyspareunia: Pain during intercourse can be experienced in some cases.
Contact bleeding: Bleeding may be observed during a pelvic examination when the ectopy is touched with a swab or instrument.[10]
Sign & Symptoms
Sign & Symptoms of Cervical Erosion (Cervical Ectopy)
Symptoms:
- The lesion may be asymptomatic.
However, the following symptoms may be present.
- Vaginal discharge—the discharge may be excessively mucoid.
- It may be mucopurulent, offensive and irritant in presence of infection may be even blood-stained due to premenstrual congestion.
- Contact bleeding especially during pregnancy and ‘pill use’ either following coitus or defecation may be associated.
- Associated cervicitis may produce backache, pelvic pain and at times, infertility.
Signs:
Internal examination reveals:
- Per speculum—there is a bright red area surrounding and extending beyond the external os in the ectocervix.
- The outer edge is clearly demarcated.
- The lesion may be smooth or having small papillary folds.
- It is neither tender nor bleeds to touch.
- On rubbing with a gauze piece, there may be multiple oozing spots (sharp bleeding in isolated spots in carcinoma).
- The feel is soft and granular giving rise to a grating sensation. [1]
Clinical Examination
Clinical Examination
The clinical examination findings of cervical ectopy as follows:
On speculum examination, the ectopy appears as a bright red, granular area around the external os. It is soft, velvety, and bleeds on touch. The margins are well defined, and the extent varies. It may be confined to a small area around the os or may involve the entire ectocervix.
It is important to note that these findings can be similar to other conditions, such as cervical cancer, cervicitis, or vaginal adenosis. Therefore, further investigations like Pap smear, colposcopy, and biopsy may be necessary to rule out these possibilities.[11]
Diagnosis
Diagnosis
Speculum Examination: The characteristic appearance of a bright red, granular area around the external os is often sufficient for a presumptive diagnosis.
Pap Smear: This is done to rule out any abnormal cellular changes or infections.
Colposcopy: This is a more detailed examination of the cervix using a magnifying instrument. It helps to visualize the extent of ectopy and identify any abnormal areas that may require biopsy.
Biopsy: This is usually not necessary unless there are suspicious areas seen on colposcopy or if the Pap smear results are abnormal.
It is important to note that cervical ectopy can often be misdiagnosed as cervicitis or early cervical cancer. Hence, a thorough evaluation is necessary to differentiate these conditions.[11]
Differential Diagnosis
Differential Diagnosis of Cervical Erosion (Cervical Ectopy)
- Syphilitic ulcer
- Tuberculosis of the cervix
- Carcinoma in situ and
- Cancer of the cervix must be ruled out and the case confirmed as erosion of the cervix. [2]
Complications
Complication
Cervical ectopy is usually asymptomatic and has no serious complications. However, it can be associated with:
Increased vaginal discharge: This is usually a clear, white, or yellowish discharge due to the increased mucus production by the columnar epithelium.
Intermenstrual or postcoital bleeding: This can occur due to the delicate nature of the columnar epithelium, which is prone to bleeding on touch or friction.
Dyspareunia: Some women may experience pain during sexual intercourse due to the exposed columnar epithelium.
Increased susceptibility to infections: The columnar epithelium is more susceptible to certain infections, such as chlamydia and gonorrhea, which can lead to cervicitis.
It is important to note that these complications are generally mild and can be managed with appropriate treatment.[11]
Investigations
Investigation of Cervical Erosion (Cervical Ectopy)
- Cervical ectropion is a clinical diagnosis. The main role of any investigation is to exclude other potential diagnoses:
- Pregnancy test
- Triple swabs – if there is any suggestion of infection (such as purulent discharge), endocervical and high vaginal swabs should be taken.
- Cervical smear – to rule out cervical intraepithelial neoplasia.
- If a frank lesion is observed, a biopsy should be taken (note that biopsies are not performed as routine). [3]
Treatment
Treatment of Cervical Erosion (Cervical Ectopy)
Diathermy cauterization: Gives satisfactory results.
- The tissues of the cervix are coagulated, the columnar epithelium is destroyed.
- The raw area on the vaginal portion of the cervix gets subsequently covered by squamous epithelium.
- In the cervical canal, diathermy coagulation destroys all infection lying in the depths of the racemose glands and in due course healthy epithelium grows down from the upper part of the cervical canal to cover the raw area.
- Endocervical cauterization requires cervical dilatation and general anesthesia, otherwise, cervical stenosis can occur.
Cryosurgery: is now being used in place of cauterization in many centers.
- The refrigerants used in cryosurgery are carbon dioxide (278°C), Freon (281°C), nitrous oxide (288°C) and nitrogen (2186°C). All are equally effective.
- Cryotherapy is safer than cautery as it avoids accidental burns in the vagina and is painless.
- Besides, it does not require anesthesia and is an OPD procedure.
- Its main disadvantage is that the patient develops copious discharge per vaginam and causes potassium loss through extensive destruction of the tissue.
- The patient should be advised to drink plenty of either fruit juice or take potassium salt.
- The area epithelializes also heals in about 6 weeks.
- Repeat cryosurgery is required if any residual area is left untreated.
- Intercourse is prohibited for 6–8 weeks.
Laser therapy:
- Has replaced cautery and cryosurgery in the management of chronic cervicitis also erosion in some centers.
- Advantages of laser are either precision of excision or burning of tissue, absence of infection and haemorrhages and fast healing in 4 weeks.
- However, laser equipment is very expensive.
Conization operation:
- If chronic cervicitis covers an extensive area or is not cured by any of the above methods.
- It may be necessary to perform conization operation, under general anesthesia, using cold knife, diathermy or laser and a cone-shaped piece of cervical tissue. [2]
Prevention
Prevention
There is no specific prevention for cervical ectopy as it is often a normal physiological finding, especially in adolescents and during pregnancy. However, some general measures mentioned in Shaw’s Textbook of Gynaecology,that may help reduce the risk or severity of acquired ectopy include:
Practicing safe sex: Using condoms can help prevent sexually transmitted infections (STIs) that can lead to cervicitis and subsequent ectopy.
Avoiding harsh douching: Douching can disrupt the normal vaginal flora and increase the risk of infection.
Regular gynecological checkups: Regular Pap smears and pelvic exams can help detect early signs of ectopy or any associated infections.
Treating underlying infections: Prompt treatment of any vaginal or cervical infections can prevent the development or progression of ectopy.[11]
Homeopathic Treatment
Homeopathic Treatment of Cervical Erosion (Cervical Ectopy)
Homeopathy treats the person as a whole. It means that homeopathic treatment focuses on the patient as a person, as well as his pathological condition. The homeopathic medicines selected after a full individualizing examination and case-analysis.
which includes
- The medical history of the patient,
- Physical and mental constitution,
- Family history,
- Presenting symptoms,
- Underlying pathology,
- Possible causative factors etc.
A miasmatic tendency (predisposition/susceptibility) also often taken into account for the treatment of chronic conditions.
What Homoeopathic doctors do?
A homeopathy doctor tries to treat more than just the presenting symptoms. The focus is usually on what caused the disease condition? Why ‘this patient’ is sick ‘this way’?.
The disease diagnosis is important but in homeopathy, the cause of disease not just probed to the level of bacteria and viruses. Other factors like mental, emotional and physical stress that could predispose a person to illness also looked for. No a days, even modern medicine also considers a large number of diseases as psychosomatic. The correct homeopathy remedy tries to correct this disease predisposition.
The focus is not on curing the disease but to cure the person who is sick, to restore the health. If a disease pathology not very advanced, homeopathy remedies do give a hope for cure but even in incurable cases, the quality of life can greatly improved with homeopathic medicines.
Homeopathic Medicines for Cervical Erosion (Cervical Ectopy)
The homeopathic remedies (medicines) given below indicate the therapeutic affinity but this is not a complete and definite guide to the homeopathy treatment of this condition. The symptoms listed against each homeopathic remedy may not be directly related to this disease because in homeopathy general symptoms and constitutional indications also taken into account for selecting a remedy, potency and repetition of dose by Homeopathic doctor.
So, here we describe homeopathic medicine only for reference and education purpose. Do not take medicines without consulting registered homeopathic doctor (BHMS or M.D. Homeopath).
Medicines:
Kali Bichromicum:
- Nymphomania; during puerperal state.
- Moreover, Sterility from excessive sexual indulgence.
- Ovarian neuralgia from ungratified sexual desire.
- Cystic tumours of ovaries.
- Flooding in young women, with sexual desire.
- Menorrhagia, from strong sexual desire.
- Besides, Subinvolution.
- Sexual feeling lost, aversion to coition.
- Lastly, Aggravation Sexual excess, Puberty, Unsatisfied sexual desire.[4]
Hydrastis Canadensis:
- Erosion of cervix.
- Thick; acrid, yellow; ropy leucorrhoea.
- Pruritus vulvae, with profuse leucorrhoea, with sexual excitement.
- Cancer of breast, nipples, retracted, sore, cracked, in nursing women.
- Menorrhagia and metrorrhagia, with fibroids.
- Removes the tendency to habitual adherent placenta.
- Vagina sore, during coition, bleeding after.
- Pain in breast (especially, right) on sneezing.
- Hot, watery, discharge from uterus. [4]
Alumina:
- Menses, too early, short, scanty, pale followed by great exhaustion.
- Leucorrhoea; acrid profuse, runs to feet, worse during daytime; before menses better by washing with cold water.
- Intolerable bearing down pain.
- Tickling and itching in genitals; with strong desire for embrace.
- Nipples itch, burn, looks angry (especially, during pregnancy).
- It takes a woman all her time to recuperate from one menstrual period to the next. [4]
Argentum Nitricum:
- Coition painful, followed by bleeding.
- Prolapsus, with ulceration of os or cervix uteri.
- Metrorrhagia, with nervous erethism at the change of life; also of young widows and childless women.
- Ovaries painful, with pains radiating to sacrum and thighs.
- Menses; irregular, too soon, too late or last one day only.
- Pain in stomach and spasmodic contraction in chest before menses.
- Menses scanty, with Dyspnoea.
- Infants die early after delivery.
- Leucorrhoea; profuse, with erosion of cervix. [5]
Kreosotum:
- Menses; profuse, lumpy; intermittent; worse lying; better sitting, or walking.
- Leucorrhoea, gushing, like bloody water, offensive, corrosive, causing itching, staining the linen yellow; with accompanying complaints; white, having odours of green corn.
- Violent pain during coition; burning in parts, followed by discharge of dark blood; next day.
- Violent itching of vulva and vagina worse during urination. Lochia, lumpy, offensive, intermits.
- Cancer, erosion of cervix.
- Dwindling of mammae with small hard painful lumps in them.
- Menses worse lifting, over exertion.
- Stitches in vagina, make her start. [5]
Diet & Regimen
Diet & Regimen of Cervical Erosion (Cervical Ectopy)
- Wear cotton underwear.
- Wash the genital area with warm water also mild soap.
- Avoid vaginal [5]
Do’s and Don'ts
Do’s & Don’ts
While there are no specific do’s and don’ts for cervical ectopy mentioned explicitly in medical textbooks, based on the information in Shaw’s Textbook of Gynaecology and general medical advice, here are some recommendations:
Do’s:
Attend regular gynecological checkups: Regular Pap smears and pelvic examinations are essential for early detection of any changes in the cervix, including ectopy or related infections.
Practice safe sex: Using condoms can help prevent sexually transmitted infections (STIs) that may worsen ectopy.
Maintain good hygiene: Keep the genital area clean and dry to minimize the risk of infection.
Follow your doctor’s advice: If you are diagnosed with cervical ectopy, follow the treatment plan recommended by your doctor.
Don’ts:
Panic if diagnosed: Cervical ectopy is a benign condition in most cases and does not usually require treatment unless it causes symptoms or complications.
Ignore symptoms: If you experience unusual vaginal discharge, bleeding, or pain during intercourse, consult your doctor.
Use harsh douches or vaginal washes: These can disrupt the normal vaginal flora and increase the risk of infection.
Self-medicate: Do not use over-the-counter medications or herbal remedies without consulting your doctor.[11]
Terminology
Terminology
Cervical Erosion:A condition where the cells lining the inside of the cervix (columnar epithelium) extend to the outer surface.
Squamous Epithelium: The flat, protective cells that normally cover the outer surface of the cervix.
Columnar Epithelium: The glandular cells that line the inside of the cervix and produce mucus.
Ectocervix: The visible part of the cervix that extends into the vagina.
Endocervix: The canal inside the cervix that connects the uterus to the vagina.
Transformation Zone: The area where the squamous and columnar epithelium meet.
Congenital Ectopy: Cervical ectopy present at birth.
Acquired Ectopy: Cervical ectopy developed later in life due to hormonal changes, inflammation, or trauma.
Homeopathy: A system of alternative medicine based on the principle of "like cures like."
Homeopathic Remedies: Natural substances used in diluted form to stimulate the body’s healing process.
Miasm: A predisposition to certain types of diseases in homeopathic theory.
Repertory: A reference book listing symptoms and their corresponding homeopathic remedies.
Materia Medica: A collection of descriptions of homeopathic remedies and their therapeutic effects.
References
References
- D.C. Dutta Textbook of Gynecology
- Gynecology by Padubidri
- https://teachmeobgyn.com
- Materia Medica of Homoeopathy By Phatak
- www.drelist.com
- Role of socio-economic factors and cytology in cervical erosion in reproductive age group women – PubMed, 2003.
- View of Review of management of Cervical Ectropion using Traditional Ayurvedic Interventions, jaims.in.
- Shaw’s Textbook of Gynaecology, 16th Edition (2019), by Shaw, Konar,Publisher: Elsevier India.
- Comprehensive Gynecology, 7th Edition (2017), by Lobo, Gershenson, Lentz, and Valea,Publisher: Wolters Kluwer.
- Clinical Obstetrics and Gynaecology, 3rd Edition (2020), by Sheila Balakrishnan, Chitra Ramamurthy, and Nandhini Balakrishnan,Publisher: Jaypee Brothers Medical Publishers.
- Shaw’s Textbook of Gynaecology, 16th Edition (2019), by Shaw, Konar,Publisher: Elsevier India.
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Frequently Asked Questions (FAQ)
What is Cervical Erosion?
Cervical ectopy is a condition where the squamous epithelium of the ectocervix is replaced by columnar epithelium, which is continuous with the endocervix. It is not an ulcer.
Is cervical erosion a sign of cancer?
No, cervical erosion is not cancerous. However, it’s important to have regular checkups to monitor any changes in the cervix.
What are the 3 causes Cervical Erosion?
- First, Congenital
- Secondly, Hormonal
- Lastly, Infection
Can homeopathy treat cervical erosion?
Yes, homeopathy offers a holistic approach to treating cervical erosion, focusing on individual symptoms and underlying causes.
What are the main symptoms of Cervical Erosion?
- Vaginal discharge
- Mucopurulent, offensive also irritant
- Contact bleeding
- Backache
- Pelvic pain also at times, infertility.
Homeopathic Medicines used by Homeopathic Doctors in treatment of Cervical Erosion?
Homeopathic Medicines for Cervical Erosion
- Kali Bichromicum
- Hydrastis Canadensis
- Alumina
- Argentum Nitricum
- Kreosotum
Can homeopathy cure cervical erosion?
Homeopathy aims to stimulate the body’s self-healing mechanisms to address the underlying cause of cervical erosion. While some individuals report positive outcomes, it’s crucial to have realistic expectations and continue conventional medical follow-up.
How long does homeopathic treatment take to work?
The duration of treatment varies depending on individual factors and the severity of the condition. It may take several weeks or months to observe significant improvement.
Are there any side effects of homeopathic remedies?
Homeopathic remedies are generally considered safe when used appropriately. However, some individuals may experience a temporary aggravation of symptoms at the beginning of treatment.
