Development of ectopia of the columnar epithelium of the cervix. What is called cervical ectopia of the cervix. Ectopia of the cervix. How is it treated?

Content:

Ectopia of the cervix is a displacement of the boundaries of the columnar epithelium to the vaginal part of the cervix. If the form of ectopia of the cervix is uncomplicated, no clinical picture may be observed.

If the ectopia of the cervix becomes complicated, there may be abundant discharge from the cervical canal in the form of leucorrhoea, sometimes bloody discharge from the vagina, itching and burning in the genital area. It is possible to detect this disease with a gynecological examination. For an accurate diagnosis, an extended colposcopy, cytological examination of a scraping will be required, sometimes a biopsy is required.

Uncomplicated ectopia of the cervix does not require any treatment, but the complicated form requires etiotropic therapy, destruction of altered foci. Ectopia of the cervix in medicine is otherwise called pseudoerosia, glandular hyperplasia, false erosion, endocervicosis.

In a normal state, the vaginal area of the cervix, which is accessible to examination in gynecological speculums, is lined with a squamous stratified epithelium outside. And the cervical canal from the inside has a lining of columnar epithelium. If ectopia is observed, the border of the transition of the cylindrical epithelium into the flat epithelium is shifted to the area of the external pharynx, being located locally or along its circumference.

This disease is typical for 40% of all women, and 11.5% get it from birth. Very often, ectopia is observed in women under 30 years of age. The disease itself is not capable of turning into a cancer of the cervix, but in the presence of ectopia, the likelihood of developing a malignant tumor only increases.

Ectopia classification

As already mentioned, ectopia can be congenital and acquired. False erosion can become recurrent. In clinical form, ectopia can be complicated and uncomplicated. It is worth saying that the uncomplicated form of ectopia of the cervix in medicine is considered a normal phenomenon and the physiological state of a woman. Ectopia can take on a complicated form as a result of colpitis and cervicitis, which can be caused by an infection.

If there is a violation of the relationship between the stromal and epithelial elements of the neck, then in this case the ectopia is called ectropion.

Based on the histological parameters, papillary and glandular ectopia of the cervix is isolated, as well as false erosion with squamous cell metaplasia.

Glandular ectopia is accompanied by signs of inflammation and accumulation of glands with a branched network of glandular passages.

Papillary ectopia is accompanied by the proliferation of stromal components and the formation of papillary structures, which are covered with cylindrical epithelial tissue.

The healing process of ectopia involves the reverse replacement of the columnar epithelial tissue with cells of mature flat epithelial tissue. In other words, a so-called transformation zone is formed. In this process, reserve cells are also involved, which initially turn into immature, and then mature metaplastic epithelial tissue.

It is possible to distinguish between completed and unfinished transformation zones using colposcopy. Cell metaplasia under adverse effects can break off, which will lead to a recurrence of cervical ectopia. In the event that the cells of the mouth of the cervical glands overlap with a metaplastic layer, the formation of a cervical cyst (nabotov cyst) is possible.

What is the reason for the occurrence of cervical ectopia?

During puberty, as well as in the early childbearing period, ectopia is regarded as a kind of functional feature and quite normal. In these periods, the basis for the ectopia of the cervix is the excessive secretion of the hormone estrogen (relative hyperestrogenism). During pregnancy, false erosion is also the norm and is explained by changes in hormonal levels and ovarian function.

According to various theories, ectopia of the uterus can occur as a result of inflammatory processes, dyshormonal, immunological and traumatic factors.

The occurrence of ectopia of the cervix as a result of inflammatory processes is explained by recurrent endocervitis and vaginitis, which are caused by streptococci, Escherichia coli, various STD pathogens (ureaplasmosis, mycoplasmosis, chlamydia, gardnerellosis and others). Abnormal and even pathological discharge that affects the vaginal part of the uterus causes the so-called desquamation of flat epithelial tissue with the formation of real erosion in its place. In 1-2 weeks, the epithelial tissue of the endocervix also spreads to the surface of erosion, while covering it, in the place of which a site of ectopia is formed.

Various birth trauma, mechanical damage to the cervix during abortions, trauma to the uterus when using spermicidal agents and barrier contraceptives can contribute to the infection of the uterus.

It is believed that the development of ectopia can also provoke ovarian dysfunction. Very often, ectopia occurs in diseases such as endometriosis, uterine fibroma, ovarian stromal hyperplasia, hormonal imbalance and menstrual irregularities, and other conditions caused by increased estrogen secretion.

It is believed that a decrease in immunity can also cause a weakened immune system in the body. Very often, ectopia can be provoked by an early onset of sexual activity, frequent changes in intimate partners, the presence of diabetes mellitus, smoking, multiple births, etc.

Symptoms and diagnosis of cervical ectopia

An uncomplicated form of ectopia of the uterus is not accompanied by any symptoms and is usually detected during a routine examination by a gynecologist. But most often women experience a complicated form of ectopia (in 80% of cases), which is combined with various inflammatory processes and precancerous changes (cervical polyps, dysplasia, etc.). In the presence of colpitis or endocervitis, there is a discharge of leucorrhoea from the cervical canal, dyspaurenia, itching, contact bleeding.

Primary disorders that lead to ectopia of the uterus can cause menstrual irregularities and even infertility.

Diagnosis of ectopia is possible with the usual routine examination by a gynecologist. The presence of congenital pseudo-erosion is established at the first visit to the gynecologist. If acquired ectopia is diagnosed, its formation on the surface of the cervix, which has never changed before, is taken into account.

The gynecologist can make out the ectopia by examining the patient on the gynecological chair. Ectopia is presented in the form of a bright red lesion with irregular outlines in the area of the external pharynx. When lying erosion comes into contact with a gynecological instrument, a slight release of blood is possible.

If an ectopia of the uterus was detected, the doctor prescribes an extended colposcopy, which will reveal an atypical area, represented by cylindrical epithelial tissue and transformation zones. Very often (in 40% of cases) during the iodine test (Schiller's test), an abnormal colposcopic picture is observed: puncture, mosaic, leukoplakia, iodine-negative zones. If such signs are found, the most in-depth examination is required.

Diagnostics involves bacteriological culture, microscopy, PCR studies. In addition, a cytological examination of scraping is considered a mandatory procedure. Such a study will reveal the inflammatory process, the presence of cells of cylindrical and flat epithelial tissue. If an abnormal colposcopic and cytological picture is observed, it is necessary to conduct a biopsy of the uterus or separate diagnostic curettage followed by a histological examination.

Ovarian function can be studied using special functional tests and hormonal status studies. If any hormonal disorders are detected, it is necessary to consult a gynecologist-endocrinologist.

Treatment, prevention and prognosis of ectopia

As already mentioned, the uncomplicated form of ectopia does not require treatment. But nevertheless, dynamic observation is necessary, which will allow timely identification of any deviations in the development of false erosion.

Treatment of complicated pseudo-erosion should be carried out taking into account the existing changes. As a rule, etiotropic anti-inflammatory and antiviral therapy is prescribed, the correct selection of contraceptive means is carried out, and hormonal and immune disorders are corrected. After these procedures, destruction of pseudo-erosion foci is performed using laser coagulation, cryogenic exposure, chemical coagulation, and radiosurgery. When nabotovye cysts of the cervix are detected, they are opened.

How to prevent the appearance of pseudo-erosion? First, it is recommended that you visit your gynecologist as often as possible. The frequency of visits should be at least 2 times a year. Secondly, any genital infections should be treated immediately. Inflammatory diseases also require urgent treatment. Frequent change of sexual partners can only provoke the appearance of false erosion, try to avoid sexual intercourse with different men.

Treatment of pseudo-erosion is carried out for the following purposes:

To eliminate the concomitant inflammatory process;
for the correction of immune and hormonal disorders;
for the correction of vaginal microbiocenosis;
for the destruction of pathologically altered uterine tissue.

Hospitalization is indicated only if a cervical biopsy is necessary. You can resume sexual activity after a biopsy no earlier than after 4 weeks.

Avoiding such a disease will allow regular visits to the gynecologist with subsequent examination, maintaining a healthy lifestyle, proper balanced nutrition and a culture of sexual life. Remember that a weakened immune system makes the body vulnerable to all diseases. Therefore, try to use all the necessary vitamins and minerals, give up bad habits, limit yourself to drinking alcohol. Have sex with a trusted man, avoid promiscuous sex. These simple rules will help to avoid many gynecological diseases, including ectopia. I wish you good health.

Although the term "pseudo-erosion" doctors are trying to replace the more modern "endocervicosis" or "ectopia of the columnar epithelium of the cervix", the disease is still often called the old fashioned way, which gives rise to excessive fears and negative among patients.

You should not be afraid, often the disease does not even need to be treated.

What is it - endocervicosis

The term "ectopia" is used when an organ or tissue is displaced to an atypical place for them.

Normally, the cervix (CM) faces the vagina with a surface covered with squamous epithelium, but with ectopia, the areas around the throat are replaced by cylindrical epithelium, which is in the channel, and not on the surface.

Outwardly, it looks like a red spot.

Increasingly, modern medicine is inclined to consider such physiological manifestations as an ordinary physical state, since around the CM channel, the cylindrical and squamous epithelium periodically displace each other in one direction or in the opposite direction.

Pseudo-erosion up to 25 years of age:

girls during puberty;
young women when using hormonal contraception;
during pregnancy.

In the following video, the gynecologist talks in detail about the ectopia of the cervix:

Differences between true and pseudo-erosion of CMM

True and pseudo-erosion of CM are different diseases.

If, with endocervicosis, there is a displacement of the position of the columnar epithelium (the inner membrane of the cervical canal goes beyond its limits without symptoms of inflammation and violation of the integrity of the tissues), with erosion, thinning of the squamous epithelium occurs 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 outer os of the cervical canal, but also on the anterior or posterior lip of the cervix, manifesting itself there in various sizes and shapes.

The real one appears only around the external pharynx of the cervix, it is the result of inflammation caused by pathogenic microorganisms such as staphylococci, gonococci, etc.

Prevalence in women

The spread in the prevalence 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 of age.

After this age, endocervicosis does not develop. In 40% of cases, the problem occurs in perfectly healthy women.

Causes

Information about the disease is contradictory.

It is classified as dyshormonal, but the role of estrogens, hormones that contribute to the development of fertility in women, is not fully understood.

The roles of birth trauma and inflammatory diseases of the genitals are also poorly understood.

It is noted that the disease can be either congenital or acquired:

the acquired form has many external and internal causes, conventionally they are divided into the consequences of injuries and dysfunction of hormones;
associated with abnormalities in the hormonal function of the ovaries.

Uncomplicated pseudo-erosion develops when the mechanism of hormone synthesis in the ovaries changes. The epithelium reacts to this with pseudo-erosion.

Any irritation of the cervix, infection can also be the cause.

Symptoms

Uncomplicated endocervicosis, if they are formed on the unchanged surface of the CM, do not bother women, 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, cloudy mucus of a yellowish tint is visible in the vagina or the cervical canal. But with all external signs, the final diagnosis is made on the basis of a cytological examination.

Methods for the treatment of foci of cervical epithelium

If endocervicosis is small, 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 an examination once a year. Pathology can disappear as soon as the cause that caused it disappears.

A complicated version of the disease does not go away on its own and, there are many ways.

The choice of the scheme and method depends on the type of pseudo-erosion, the cause that caused it, the type of complications.

If the therapy is selected correctly, the disease is completely eliminated.

The existing methods of treatment are based on elimination of abnormally growing epithelial cells, so that their place is subsequently taken by cells typical of this organ section.

helps in 75–90% of cases, but complications appear in 6–40% of cases. This is a violation of the menstrual cycle, exacerbation of inflammation, bleeding at the site of intervention, fusion of surfaces.
affects the focus of pathology with low temperatures, the session is painless and bloodless on an outpatient basis. Recovery - up to 80–95% of cases, but the regeneration is long.
does not affect menstrual and reproductive function, therefore it is most often used to treat nulliparous women. The efficiency of application reaches 98%.
(the use of an electromagnetic field of ultrahigh frequencies) refers to expensive methods, therefore it is rarely used.
Thermocoagulation allows you to get complete epithelization without complications in a month. Efficiency - 92%.
Chemical coagulation: electrophoresis with zinc, use of other drugs according to indications.

Is the development of the disease dangerous

The lower part of the CM, protruding into the vagina (ectocervix), is normally covered with stratified squamous epithelium, which protects the 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 decreases significantly or completely disappears.

This gradually leads to chronic inflammation of the CM of varying severity, affecting not only the outer part of the canal, but also the surrounding space or the inner part.

Later, the inflammatory process can go to the uterus, fallopian tubes, lead to infertility or ectopic pregnancy.

Chronic cervicitis is the cause:

miscarriages;
premature birth;
postpartum inflammation.

After all, the cervix is a barrier to infections, and its inflammation opens the way for all kinds of microbes.

conclusions

Pseudo-erosion is not a dangerous pathology and passes 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 the inflammation, the attending physician draws up an individual therapy regimen and chooses the most effective of the existing methods of exposure.

You can avoid the disease.

Preventive measures:

refusal to abortion;
choosy sex life;
using safe contraception;
non-traumatic sex.

Preservation and strengthening of reproductive health is the main task of modern gynecology, therefore, girls begin to undergo regular examinations from adolescence. In this way, it is possible to identify most diseases even during puberty. Special attention is now paid to the diagnosis of a variety of uterine pathology, which occurs in almost 50% of women of reproductive age.

But you should not be intimidated by this figure, since the lion's share of them is occupied by benign diseases of the cervix. The most famous pathology from this group is cervical ectopia. Having learned such a diagnosis from a doctor, a woman is immediately frightened - what is it? The first thought is standard - this is some kind of malignant tumor, which will inevitably require immediate surgery.

Therefore, myths need to be dispelled - cervical ectopia of the cervix has nothing to do with neoplasms. Although it is currently considered one of the risk factors that increase the likelihood of developing cancer. The difficulty also lies in the fact that ectopic transformation is almost always asymptomatic. Therefore, its accidental detection serves as an indication for additional examination, after which the question of the need for its treatment is decided.

Concept

Before moving on to the issues of diagnosis and management of such patients, it is necessary to fully characterize the ectopia of the cervix - what is this disease? It is based on quite simple mechanisms - the movement of the epithelium lining the cervical canal of the cervix behind its external pharynx (to the vaginal surface). And since these tissues differ in their structure, outwardly the changes resemble erosion.

But in fact, there is no damage area there. The simple columnar epithelium has a red color, which stands out sharply against the background of the vaginal mucosa. Also, the disease has several features that distinguish it from the background of another pathology of the cervix:

Ectopia is always detected at a young age, and is characterized by a persistent and stable course. Over time, there is no significant change in its shape or size, in contrast to true erosion.
The disease takes only the reproductive period in a woman's life, disappearing on its own after 40 years. Therefore, when such changes are detected at an older age, the oncological nature of the changes is already suspected.
The disease is rarely accompanied by any subjective manifestations. Only occasionally do girls report vaginal itching or discomfort, or bloody discharge - usually associated with intercourse. If there are severe symptoms, then one should rather think about true erosion.

These signs are characteristic of one of the forms of ectopia - congenital, which has the most benign course. Now the acquired variant of the disease is also distinguished, associated with the outcome of various inflammatory diseases of the cervix.

Congenital

The detection of this form indicates a relatively favorable prognosis - if there are no other risk factors, then the likelihood of complications is minimal. The development of changes is currently associated with a transient violation of the processes of maturation of the genital organs:

Normally, in girls until adolescence, there is a physiological ectopia, which is due to the general immaturity of the reproductive system.
Around the external os of the cervix, they have a bright red corolla with a velvety surface. It stands out sharply against the background of the relatively pale, smooth and shiny surface of the vaginal mucosa.

Normally, during puberty in girls, there is an increase in the number of muscle fibers in the cervix.
Due to this, it is rounded, becoming more pronounced. And the ectopic area should shift into the cervical canal, forming a border with the mucous membrane a little deeper than the external pharynx.
If for some reason this does not happen, then the zone of the columnar epithelium remains for the entire reproductive period in a woman's life.
Only closer to the age of 40, ectopia gradually begins to be replaced by the stratified squamous epithelium of the vagina, which is associated with hormonal changes in the body.

If the congenital nature of the disease is confirmed, then no specific treatment is required - the woman should only be regularly observed by a gynecologist.

Acquired

Transformation in the area of the external pharynx sometimes has a secondary character, when a cylindrical epithelium grows in place of the damaged mucous membrane. Such a process is considered pathological, and is characterized by the following features:

Acquired ectopia is almost always the outcome of true erosion of the cervix caused by a viral, bacterial or fungal infection. For some reason, not complete healing occurs, but replacement with a neighboring type of tissue.

Special attention is now being paid to the infection of a woman with the human papillomavirus of oncogenic types. Their existence ensures the maintenance of chronic inflammation in the area of erosion, interfering with the normal regeneration processes.
An additional factor for the development of the disease is hormonal disorders leading to an imbalance of the vaginal microflora.
The disease also occurs predominantly in young patients, but does not appear at an early age. The maximum frequency is observed in patients from 20 to 30 years old.
Much more often there are subjective manifestations - itching, discomfort in the vagina, spotting, mucous or bloody leucorrhoea.
The disease under the influence of pathological factors can easily transform again into true erosion.

Regardless of the initial form of the disease, all women with ectopia of the columnar epithelium of the cervix are subject to regular examination, including extended colposcopy.

Observation

Any disease to a certain extent affects reproductive function, so even benign ectopia requires constant monitoring. Once a year, women should visit a gynecologist who conducts special studies to assess the course of the disease:

Initially, a standard examination is performed - examination of the cervix in the mirrors. In this case, the doctor evaluates its appearance, shape, as well as the size and nature of the ectopic area. This is important for determining the dynamics of growth, or changes in the parameters of the focus.
Then the usual colposcopy is performed - examination of the cervix using a system of magnifying lenses. The gynecologist directly examines the area of ectopia - its color, clarity of boundaries, uniformity, and the nature of the surface.
Then a colored green filter is placed on the colposcope. It allows you to clearly see the vasculature in the mucous membrane of the cervix, which is necessary for differential diagnosis with tumors.
At the end, an extended colposcopy with chemical tests is performed. The neck is sequentially processed using a solution of acetic acid and iodine, and after each time it is examined. It helps in the diagnosis of leukoplakia, dysplasia (precancerous disease).

If, as a result of the diagnosis, there is a doubt about the good quality of ectopia, then it is recommended to immediately treat it using the methods available at the institution.

Treatment

Thanks to the advent of modern minimally invasive methods, it was possible to simplify as much as possible the procedure for removing altered areas of the cervix. Previously, everything was much more complicated - there were only surgical methods for treatment, which were a full-fledged operation. The intervention led to a temporary loss of reproductive function associated with the need to create a rehabilitation period.

Now the procedure for eliminating ectopia, which occurs against the background of true erosion, is increasingly limited to an outpatient link - a antenatal clinic. And there are only three successive stages in providing assistance:

At the first, a smear from the cervical canal is additionally examined to determine the presence or absence of cellular atypia. This sign indicates the formation of dysplasia or cervical cancer in the area of erosion.
Then the actual intervention is carried out, the volume of which depends on the previous study. Now the most common is conization - mechanical, thermal or chemical destruction of the focus with the help of special nozzles.
After a short period of recovery comes - during it, artificial erosion should fully heal. For this, medications are prescribed that improve the regeneration processes.

Each individual method has advantages and disadvantages, but surgical options for conization are now gradually fading into the background, giving way to physical and chemical procedures.

Surgical methods

Usually, direct excision of the affected area is performed when significant dysplasia is detected. This allows you to remove a specific area of the cervix under visual control. Currently, three options for intervention are common:

The Schroeder operation involves a wedge-shaped removal of the ectopia. Usually it is chosen in relatively adult women who do not plan further pregnancy. This is due to the inevitable narrowing of the cervical canal after healing.
The Emmett operation involves excision of erosion with a crescent-shaped marginal incision. Removal is more gentle, practically without affecting the shape of the cervix.
Sturmdorf's operation is indicated only for large areas of ectopia, covering almost the entire circumference of the external pharynx. In this case, removal is performed according to the type of a cone, after which additional neck plastic is performed.

Rehabilitation after surgical interventions necessarily includes the prevention of inflammatory complications in order to prevent infection of the postoperative wound.

Physical methods

Modern technologies have made it possible to develop innovative equipment that simplifies the conduct of minor gynecological operations. At present, almost all physical factors of influence are used to eliminate ectopias:

Thermocoagulation - the destruction of the altered area with the help of high temperature, became the ancestor of the entire group. The method immediately gained an advantage over the operation, due to the reduction in the healing time of erosion. The only drawback is the difficulty of direct control over the depth of impact on the tissue.
Another option is cryodestruction using a liquid nitrogen probe. It was installed exactly above the ectopic zone, after which a cooling agent was supplied to destroy the altered area.
Combined options are now common - electrosurgery and cryosurgery. They provide simultaneous controlled removal of ectopia, combined with thermal effects on the surrounding tissue.
The most modern method is laser destruction, which immediately showed advantages over its predecessors. It is characterized by a minimal incidence of complications, a short recovery period, and the absence of a possible effect on reproductive function.

This group of interventions now occupies a leading position in the elimination of cervical ectopia - treatment with them is almost 100% effective.

Chemical methods

This group of interventions is based on the direct destructive effect of substances or drugs applied to the area of erosion. Now they are rarely used in their pure form, in combination with other methods of treatment. All chemical methods are divided into two groups - pharmacological or chemical destruction:

The first option, implying the use of a drug, is characterized by low efficacy, but high safety. Therefore, its use, in combination with a physical method, can become an alternative for surgical intervention (with existing contraindications).
Chemical coagulation itself gives good results and can therefore be used alone. Special substances (Vagotil or Solkovagin) are applied directly to the cervical region and removed after a certain time.

Chemical methods are most suitable for women with uncomplicated variants of the disease, in which the lesion occupies a small area.

Recovery

After any treatment method, a wound surface remains on the cervix, for which optimal conditions for healing must be created. Therefore, all women are advised to follow certain recommendations that reduce the likelihood of developing inflammatory complications:

During the first week, local administration of antiseptics into the vagina is mandatory. The form of the preparations is not important - it can be gels or creams, suppositories, douching solutions.

Then the woman for about 4 more weeks needs to carefully monitor the hygiene of the genitals. Clean regularly with soap, change your underwear daily, and avoid using panty liners.
To improve wound healing, local forms of drugs are prescribed, which accelerate the processes of epithelial regeneration. Prescribed drugs Actovegin or Solcoseryl in the form of a cream, as well as suppositories with methyluracil.
Additionally, vaginal eubiotics are used - agents that normalize the microflora in the vagina.

After performing the therapeutic intervention, the woman continues to be monitored by the gynecologist, who assesses the recovery process. When the defect has completely healed, follow-up examinations are carried out to show the effectiveness of the treatment.

Ectopia of the cervix or columnar epithelium, pseudo-erosion - with this concept, medicine means 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 nearby 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 section of the mucous membrane that is different in appearance. Ectopia is also 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 aggravates cancer processes in the cervix. Comprehensive diagnosis of ectopia is necessary due to its ability to mask cancer. Also, the statement about the identity of the ectopia and the erosion of the cervix, which looks like it, 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.

Types of ectopia

Ectopia is congenital and acquired. Congenital ectopia is considered normal. Acquired ectopia is more often detected at progressive stages due to the asymptomatic course of the initial stages.

Depending on the nature of the growth of the cylindrical epileticus, ectopia is classified as follows:

Glandular

The cells of the columnar 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.

Papillary (papillary)

With this type of ectopia, the columnar epithelium consists of papules, or nipples, at the end of each of which there is a vascular loop.

Epidermal (healing)

In structure, it resembles glandular ectopia, but areas of normal squamous epithelium are found on the formation. In this case, special treatment is not required, since self-healing of the surface of the cervical pharynx occurs, when the cylindrical epithelium is gradually replaced by areas of the mature flat.

The class of ectopia practically does not affect the treatment strategy, but it allows you to determine the nature of the lesion of the epithelial areas.

Causes of the disease

About half of cases of ectopia occur in nulliparous young women, so it should not be classified as a common postpartum disorder. Another common misconception that ectopia can occur as a result of the onset of sexual activity is also incorrect. It is quite difficult to diagnose ectopia in the presence of a hymen, since the use of a mirror during the examination 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 fully understood, but modern medicine has revealed certain patterns. Acquired ectopia can occur for the following reasons:

Hormonal changes in the body

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

Infections can affect the condition of the cervix. Specific microflora damages the squamous epithelium, especially Trichomonas and gonococci. Subsequently, the regeneration of the cervical epithelium may be incorrect. Ectopia in the overwhelming majority of cases occurs precisely as a result of infectious and inflammatory diseases caused by a specific microflora.

Reproductive trauma

Injuries resulting from childbirth and multiple abortions, as well as other incorrect and / or traumatic gynecological manipulations, can become a significant factor in the onset of ectopia.

Decreased immunity

Ectopia can occur as a result of a decrease in the functions of the body's immune system, which, in turn, has different causes: smoking, early childbirth and early sexual activity, etc.

Ectopia symptoms

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).

When ectopia proceeds with endocervicitis, symptoms such as leucorrhoea and itching, contact bleeding, and dyspareunia are observed. Also, symptoms of ectopia include menstrual irregularities.

Diagnosis of pathology

Diagnosis of cervical ectopia is carried out in gynecological departments of hospitals and medical centers using special equipment. Ectopia can be diagnosed in several ways.

Visual inspection

It is carried out in a gynecological chair using a mirror. The gynecologist sees ectopia or pseudo-erosion as a bright red epithelial focus with indefinite outlines. Touching the ectopic site with the instrument may cause minor bleeding. Ectopia resulting from infectious and inflammatory diseases is characterized by severe redness and may have a purulent plaque, but its borders are difficult to see due to redness and swelling of closely spaced tissues.

Colposcopy

This study is necessary to accurately identify atypical areas with columnar epithelium and transformed zones. More accurate indications are given by colposcopy with Schiller's 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 examination.

Analyzes

To diagnose and study the ectopia of the cervix, the doctor necessarily makes a scraping that reveals cells of the columnar 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.

Functional tests

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 when diagnosed with true erosion or cervical cancer.

Treatment of ectopia of the cervix

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:

Observation

It is carried out with uncomplicated forms of ectopia, as well as with congenital pathology: the patient is monitored in order to track possible changes in her condition. The actual treatment begins only with negative changes.

Elimination of causes

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 choose the right contraceptives and eliminate immune and hormonal abnormalities. If the cause of ectopia is an infection, treatment begins with antibiotic therapy, since otherwise it makes no sense to treat ectopia.

Treatment of foci

After the treatment prescribed by the doctor has yielded results and the infectious process is stopped, the destruction of the foci of ectopia is performed.

Diathermocoagulation (or cauterization) is the destruction of abnormal areas using special electrodes. As a result, a scab forms, under which there is a healthy epithelium. After rejection of the scab, a scar remains, therefore diathermocoagulation is recommended for women who do not plan to give birth.
Cryodestruction is the destruction of the columnar epithelium with nitrous oxide, followed by the formation of a scab. Cryodestruction is less traumatic and leaves no scars.
Laser destruction - the laser beam evaporates the cylindrical epithelium, leaving in its place a thin film of tissue instead of a scab.
Radio wave destruction is an innovative method of treatment, minimally traumatic, but so far not widespread and expensive.

Treatment of concomitant diseases

As a result of the diagnosis of ectopia, concomitant abnormal conditions can be found: nabotovy cysts, polyps, dysplasia, leukoplakia, endometriosis. Appropriate treatment methods are used for them.

Preventive actions

The risk of ectopia is reduced by a stable sex life, properly performed gynecological interventions, timely treatment of sexually transmitted infections, correction of hormonal and immune abnormalities.

An obligatory preventive measure is planned visits to the gynecologist, which guarantee the detection of almost any disease in the early stages.

Speaking about the ectopia of the columnar epithelium, they mean its displacement to the outer (vaginal) surface of the cervix. In a normal state, it lines only the inner cavity of the cervical canal, and its cells, tightly adjacent to each other, are laid out in one layer. The outer covering is made up of the tissues of stratified squamous epithelium (similar in structure to the vaginal mucosa), here the cells form several layers. With ectopia, the inner layer of the columnar epithelium is displaced and partially replaces the outer (flat), forming a bright red ring around the pink throat (from the side it looks like inflammation).

Such pathology in most cases is acquired in nature, i.e. occurs due to the influence of external factors. There is also a congenital form, but it is about 10-11%.

The displacement of the epithelial layer of the cervical canal does not pose a danger to the health and life of a woman. Moreover, the process is often complicated by various diseases and pathological processes (these can be polyps, cervicitis), which requires medical intervention. In rare cases, having got into an unfamiliar environment for themselves, the cells of the columnar epithelium during ectopia can begin active division, increasing the focus of the neoplasm. The process remains benign but requires the removal of excess tissue. On this basis, there is a division into the form:

recurrent;
non-recurrent.

Important! Ectopia never transforms into cancer, but it can create a favorable background for the development of a malignant process.

According to the histological structure, there is also a division of the anomaly into subspecies:

glandular;
papillary;
mixed.

Reasons for the onset of the abnormal process

There are many reasons that can lead to ectopia of the columnar epithelium on the cervix. The most common version is considered to be injuries that can be obtained during abortion, difficult childbirth, from intrauterine devices.

The next group of reasons includes infectious, inflammatory diseases and viruses. The causative agents of the abnormal process can be chlamydia, staphylococcus, streptococcus and other bacteria.

Hormonal imbalance is also considered no less dangerous than the previous ones. Against its background, cell division may fail, the menstrual cycle, accompanied by bleeding, may be disrupted - all this contributes to the development of ectopia.

Doctors identify several more separate factors that can lead to the onset of pathological changes:

multiple pregnancies;
early onset of sexual activity;
chronic inflammation;
numerous sexual partners;
weakened immunity.

What symptoms accompany the pathology

There are no specific signs characteristic of ectopia of the cylindrical cervical epithelium. It is asymptomatic, and a woman finds out about her only after being examined by a gynecologist. This is typical for congenital pathologies and for forms uncomplicated by other diseases.

In 80% of cases, it is precisely complicated ectopias that occur, then the complaints of the patients indicate the appearance of:

profuse vaginal discharge, leucorrhoea;
itching in the genital area;
pain during sexual intercourse;
bleeding after the act.

Modern methods included in diagnostics

If there is a congenital ectopia of the columnar epithelium, then the patient learns about it during her first gynecological examination. With the development of an acquired form of pathology, diagnostics include:

physical examination (examination of the vagina using gynecological mirrors, palpation, collection of anamnesis);
colposcopy (special examination of the pathological area using an optical device - a colposcope);
collection of scrapings from an atypical surface for cytological examination;
biopsy or diagnostic curettage with further histological examination of the material;
hormone tests.

What treatment methods are provided

Treatment of ectopia of the columnar epithelium of the cervix is carried out only if we are talking about its acquired, complicated form. Congenital anomalies of the epithelium are subject to observation (periodic monitoring of their condition). In a complicated form, therapy always begins with the elimination of the concomitant disease. For this, a course can be assigned:

hormone therapy;
anti-inflammatory drugs;
antibiotics;
immunotherapy;
vitamins.

After that, the method of treatment of ectopia of the columnar epithelium is chosen, aimed at the destruction of the atypical area. One of the most commonly used methods is cryotherapy. The method is based on burning tissues with liquid nitrogen, as a result of which the abnormal part of the columnar epithelium is destroyed.

Chemical coagulation is popular today. Its essence is to apply special drugs to the abnormal surface, which lead to the death of its constituent cells and the destruction of atypical tissues.

The modern and most gentle method of removing ectopia of the columnar epithelium is laser destruction (it is also called coagulation, laser treatment). In this case, the removal of the affected area is performed using a laser beam directed at it.

The procedure is characterized by high precision, efficiency, it allows excision of only the required segment, without affecting healthy tissues.

Attention! All methods of treatment are organ-saving, they do not threaten fertility.