Cervical erosion – symptoms, diagnosis, treatment

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An erosion of the cervix is ​​a loss of the epithelium. When we hear at the gynecologist that we have an erosion, what do we do? we panic. Is it cancer or just a mild change? Heal, cut, burn, freeze or wait and observe? Lots of questions, and the answers are not easy at all.

What is cervical erosion?

An erosion is an irregular red area on the cervix called erythroplakia. This area is formed when the epithelium from the vaginal part displaces the cylindrical epithelium from the cervical canal. The erosion is a tiny wound with an uneven surface, and at first glance it seems inconspicuous. The occurrence of erosions is quite a common problem that affects every third or fourth woman.

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Real and alleged erosion

There are two types of erosions:

1. True erosion (ectopy) is an area with a crater-like defect in the protective cover of the multilayer squamous epithelium. Such a change is mainly observed in clinically advanced cases of cervical cancer.
2. Pseudo-erosion (erythroplakia) is the area resulting from the replacement of the multilayered flat epithelium covering the outer surface of the vaginal part of the cervix with the glandular epithelium lining the cervical canal. It is this area that is often incorrectly referred to as pathological, but it can be

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How to recognize a real erosion?

In order to distinguish between true and pseudo-erosions, the patient should be referred for additional cytological and colposcopic examinations. Only after recognizing the results, analyzing the history of past ailments and conducting a clinical interview, the doctor may decide on the next stage of diagnosis: histopathological assessment of the affected areas.

Cervical erosions – causes

Erosions appear in women who:

1. ignore inflammation of the vagina and vulva, do not spend time on their proper treatment,
2. sustained mechanical injuries, e.g. during intercourse,
3. are after childbirth, when the cervix is ​​weakened,
4. past miscarriage,
5. have given birth many times,
6. use an intrauterine contraceptive (e.g. IUDs cause inflammation)
7. have / have multiple sexual partners (higher risk of infection).

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Cervical erosion – symptoms

Erosion is not associated with specific symptoms that can clearly indicate a diagnosis. There may be a foul-smelling vaginal discharge that irritates the vulva area, causing infections. Women may complain of burning and itching of the intimate body parts. Patients also see a doctor because of bleeding during sexual intercourse and between menstruation.

With such symptoms, which may indicate erosion, you should see a doctor – most of these symptoms require observation, not treatment. However, not all of the above-mentioned symptoms immediately indicate the presence of erosions, they may also indicate other diseases. Women should have a gynecological examination every six months to prevent unwanted diseases.

Cervical erosion – diagnosis

Before the examination diagnosing erosion, women should not: two days before the examination, have intercourse, wait 3-4 if vaginal preparations were taken. In order to diagnose erosions, gynecologists use the following methods:

1. Cytology: the doctor takes the material for examination from the cervix, he does it with the use of a brush, which carefully collects a sample from the cells of the mucosa. The material is then transferred to the appropriate slide and then sent to the laboratory. The cytologist observes the size of the collected cells, their structure and shape under the microscope. The results of the research include cytological groups, the lower this group the better. Cytology is a simple examination in the diagnosis of erosions, but not only because with it the doctor assesses the condition of the cervix and detects inflammation and even early cancer.

2. Seeds: consists in collecting mucus from the cervix and vagina with a spatula. This examination allows the gynecologist to assess what type of infection (viral, bacterial, fungal) caused the inflammation.

3. Colposcopy: the gynecologist inserts an instrument into the vagina that looks like a microscope connected to a computer (a coloscope). Due to the fact that the doctor can see everything on the monitor, there is a chance of a large magnification of the image, and thus a thorough analysis of the changes. During the examination, the doctor may perform a biopsy of suspicious tissue to confirm or rule out the existence of cancer cells.

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Cervical erosion – treatment

The choice of erosion treatment depends on the diagnosis and the result of cytological, colposcopic, virological or histopathological examination, the extent of the lesion and its etiopathogenesis, the woman’s age and obstetric history.

Ways of treating erosions

1. Pills or globules: they are used when the erosion is small and there are no disturbing changes in the cytology. Pills and globules are anti-inflammatory drugs that heal erosions.

2. Chemical coagulation: it is a painless treatment that causes scarring. Special measures are applied to small erosions to destroy the damaged epithelium and replace it with a new, healthy one. It is said that this type of treatment is not very effective and must be repeated. The big disadvantage of this therapy is the prolonged healing time.

3. Electrocoagulation: with the help of electric flashes, the erosion is burnt. This method is so effective that it allows the doctor to reach every affected area. When performing electrocoagulation, an unpleasant odor may be emitted, which is not very comfortable for a woman. Too much current during surgery can cause permanent scarring of the cervix, which ultimately leads to very painful periods and difficulty opening during labor. There may be an unpleasant odor discharge during the healing process (about 3-5 weeks).

4. Freezing: with the help of a special electrode, the doctor freezes the tissues of the cervix. The procedure is short, as it takes 4-6 minutes, while the treatment is highly effective and painless. For erosions that are larger in size, freezing is carried out with several tips. There may be a watery discharge during the healing process (up to 40 days). The procedure should be performed after menstruation.

5. Photocoagulation: the erosion is removed with the tip, which emits great waves, the treatment is not painful and leaves no scars. This method is very effective in the case of small lesions, healing after photocoagulation usually takes about 2 weeks

Cervical erosion – post-operative procedure

After the treatment of erosions (while the cervix is ​​healing), sexual intercourse should be refrained fromand especially from deep penetration and the use of condoms. After the procedure, the cervix must regenerate, and this is made difficult by its constant irritation with the penis and semen, which can only lead to further damage and cause bleeding.

Cervical erosion – cancer prevention

Erythroplakia can develop into a cancer of the cervix. The essence of cervical cancer prevention is the treatment of precancerous and neoplastic lesions:

1. screening of healthy asymptomatic patients in order to identify a group of women at risk of cancer;
2. diagnostics of existing lesions on the cervix;
3. treatment of precancerous lesions and cervical cancer.

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Not only in the case of cervical erosions, it is worth performing a hormonal analysis based on 8 hormones, including estradiol, prolactin and TSH>

Cervical erosion and the threat to pregnancy

An erosion in its advanced form causes discomfort during intercourse and makes it difficult to get pregnant, which means that the diagnosed erosion should be treated before pregnancy. If an erosion is detected during pregnancy, pharmacotherapy is used in most cases. When it comes to surgical procedures, they are rather postponed until after delivery.

However, it should be noted that the erosion itself does not pose a threat to pregnancy, but it is different with the pathogens responsible for it. In the event of an erosion, you should consult a doctor who will conduct the appropriate tests, because you need to know that each case is different and requires careful diagnosis.

Cervical erosion and exfoliative vaginitis

Exfoliative vaginosis is a poorly understood chronic vaginosis that occurs in 8% of women with chronic vaginosis and occurs most frequently in perimenopausal women, although it is recognized over a wide age range.

There was a case of a patient (34-year-old woman) who had a profuse yellowish discharge and dyspareunia for 4 years. Upon reporting of symptoms, laboratory findings met the criteria for exfoliative vaginosis, but standard treatment did not provide long-term relief. As a last resort, cryotherapy (cryosurgery) of the cervix was performed in order to heal the erosion of the cervix, which ensured complete relief of all symptoms.

Researchers at the Wayne State University School of Medicine in Detroit reported a case series of 98 women with exfoliative vaginitis who had a high rate of improvement for symptoms after one of three treatments: 2% vaginal clindamycin cream, 10% vaginal cream, 25% vaginal hydrocortisone or vaginal suppositories containing XNUMX mg of cortisone acetate.

Researchers reported that 86% of the women initially improved their symptoms after using these methods, but that the patients relapsed within 6 weeks of stopping treatment, and that more than 58% of the women required long-term maintenance therapy. Researchers concluded that exfoliative vaginitis is a chronic condition that requires long-term maintenance treatment in most patients.

The goal of treating symptomatic cervical erosion is to destroy the glandular columnar epithelium, thereby inducing squamous metaplasia, leading to the resolution of vulvovaginal itching, irritation, yellowish discharge and dyspareunia. Reported treatments include laser ablation, microwave ablation, concentrated ultrasound, platelet-rich plasma injections, herbal therapies, and cryosurgery. Most studies reported very high cure rates, for example a case series of 50 patients in English hospitals where the cure rate was 98% in patients treated with cryotherapy.

In conclusion, although erythematous spots on the cervix are common in patients with exfoliative vaginitis, no simultaneous occurrence of cervical erosion and exfoliative vaginitis has been reported. However, as the reported case indicates, it is possible that some patients with exfoliative vaginitis may have accompanying, but not necessarily causal, cervical erosion. Therefore, taking into account the minimal risks associated with cryotherapy, physicians should consider such treatment in patients with concomitant exfoliative vaginosis and cervical erosion in whom standard therapy for exfoliative vaginitis has failed.

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