Cervical Erosion - Cervical Ectopy

What is a cervical erosion?

The cervix is the lowest part of the uterus (womb) and is the part that can be felt at the top of the vagina.

A cervical erosion is a raw-looking granular appearance on the cervix. It occurs when the inner lining of the cervical canal (columnar epithelium) comes out onto the part of the cervix that can be visualised with a speculum. It appears as a red, velvet-like area. 

Cervical erosion is related to the hormone called oestrogen and is common in young girls, during pregnancy and in women on the contraceptive pill. It should not be regarded as a sign of disease because it is frequently found in perfectly healthy women.

Gynaecolgists now tend to use the term cervical ectopy and at one time it was called a cervical ectropion. The cervix is not eroded and there is no ulceration - it is simply that the columnar epithelium is much thinner than the squamous epithelium and so the underlying blood vessels show through more clearly, making the area look red and raw.

Cervical erosion is a completely benign condition and it does not lead to cancer.

The vaginal surface of the cervix has a covering of layers of flat cells (squamous epithelium) (Figures 21.1 and 21.2). The cervical canal is lined by columnar cells that produce mucus. The squamo-columnar junction is where the squamous and columnar epithelia meet.

Cervix Cervical Epithelium

Figure 21.1 - In a cervical erosion, the squamo-columnar junction moves out onto the cervix and the columnar epithelium is more red.

 
Cervical Erosion

Figure 21.2 Cervical Erosion (Ectopy)

During puberty, when taking the pill and during pregnancy, the cervix enlarges and the columnar epithelium from the cervical canal seems to move out (almost like a flower opening) to cover part of the vaginal cervix. The clinician looking at the cervix sees a deep pink velvet-like appearance, which has been called erosion, ectropion or an ectopy (Figure 21.3). The majority of women with cervical erosions have no problem but some are troubled by excessive discharge or bleeding after intercourse (post-coital bleeding).

During childbirth or miscarriage, the surface covering of the cervix can be damaged and become inflamed (cervicitis). Evidence of this inflammation can still be found even many years later. Sometimes small mucus filled cysts form on the cervix (Nabothian follicles). Chronic cervicitis may be associated with discharge or bleeding after intercourse. Cervical ectopy and cervicitis are not pre-malignant or malignant conditions.

What symptoms may occur with a cervical erosion?

Most young women, particularly if they are taking the combined oral contraceptive pill, have a cervical erosion.

Most women with a cervical erosion have no symptoms. The cervical erosion is observed during routine pelvic examination. If there are no symptoms there is no reason to offer treatment for a cervical erosion.

It follows that many women with symptoms including vaginal discharge without evidence of infection will have a cervical erosion.

Another symptom that can sometimes be attributable to a cervical erosion is bleeding after intercourse - postcoital bleeding. In these circumstances, your doctor may offer to treat the cervix by destroying the surface. No guarantee can be given that this treatment will reduce or alleviate symptoms.

Bleeding in early pregnancy can be related to cervical erosion

Treatment of Cervical Erosion

Usually cervical ectopy causes no symptoms and needs no treatment. Sometimes it can cause a vaginal discharge or lead to slight bleeding after intercourse - postcoital bleeding. If these symptoms are troublesome then a simple treatment either freezing (cryotherapy) or cauterising (diathermy) the cervical erosion will stop the problem. Cervical erosion is treated by minor surgery. These treatments can be usually be done quite painlessly as an out-patient. Tampons should be avoided for a couple of weeks after these treatments to allow the cervix to heal.

It is essential to ensure that there is no pre-malignant change in the cervix before destroying the surface. This is not because a cervical erosion is pre-malignant but it is important to be certain that there is no pre-malignancy that is being inadvertently and perhaps inadequately treated. A pap smear and / or colposcopy may be indicated if there is postcoital bleeding.

Cervical Erosion

Figure 21.4 Cryotherapy probe applied to the cervix to treat a cervical erosion.

A twenty-five year old lady presented with vaginal discharge, intermenstrual bleeding (bleeding between periods - intermenstrual bleeding), post-coital bleeding (bleeding after sexual intercourse) and occasional deep dyspareunia (pain with intercourse -  painful sex). On examination she had florid cervical ectopy. Her PAP test (cervical smear) showed no abnormality and swab tests for infection were negative. There was some noticeable improvement following a course of Acijel (a mildly acidic jelly) but she still had some symptoms. The cervix was treated by cryotherapy and five months later she remains asymptomatic.

It used to be thought that cervical erosion could lead to cervical cancer but this is now known not to be true. Cervical erosion is a completely benign condition and that does not lead to cancer.



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