Cervical Erosion – Symptoms, Treatment, Causes
What is Cervical Erosion?
Cervical Erosion or medically known as cervical ectropion (ectropy) is a condition wherein the endocervix protrudes out through the external os. The outer portion of the cervix is lined by simple squamous epithelium, whereas the inner part is lined with columnar epithelium. The protrusion of the columnar epithelium marks cervical erosion. Cervical cells also undergo squamous metaplasia and changes from simple squamous into stratified squamous epithelium. In more simple terms, changes happen in cell characteristics of the cervix making the cervix appear protruded.
Cervical erosion is not a form of cervical cancer, but the symptoms are similar to early stage of cervical malignancy. Cervical erosion is a normal change in the cervix, but may appear inflamed, red and seems eroded although there is no actual erosion of the cervix. The term erosion is only used to describe the change in the cervix.
Because it is likened to cervical cancer, further tests should be done to rule out any malignancy.
Pathogenesis of Cervical erosion
At a young age, the cervix is lined by simple squamous epithelium. Increase in estrogen during puberty, intake of contraceptive pill and pregnancy opens the cervical os and exposes the endocervical columnar epithelium on the cervical opening. When this happens, the endocervix is exposed to the acidic environment of the vagina, causing the cells to undergo metaplasia and changes it into stratified squamous epithelium.
Symptoms
Most women do not have symptoms of cervical erosion. As discussed, cervical erosion is not an abnormality, but is sometimes associated with the following symptoms:
- Excessive, non-purulent discharge from the vagina because of exposure of mucus secreting glands located in the columnar epithelium
- Post-coital bleeding or bleeding after sexual intercourse because of trauma to the blood vessels located in the columnar epithelium. Pregnant women complaining of vaginal spotting or bleeding should be asked for sexual intercourse for the past twelve hours. Bleeding may be a result of injury to the ectropion and not actually a sign of threatened abortion.
- Bleeding between periods
- Non-foul smelling, clear to yellowish, slippery vaginal discharge
- Some women may experience backache
- Internal examination may reveal a bright red external os and soft to granular texture upon palpation.
These symptoms are not of any concern. However, during infection of the reproductive organs, a woman may experience foul-smelling and purulent discharges not associated with cervical erosion.
Causes of cervical erosion
Cervical erosion is not an abnormal condition. Reasons for ectropy are due to increase in estrogen levels as seen in:
Puberty
Puberty starts the menstrual cycle of a young woman. During this time, estrogen levels increase leading to changes in cervical characteristics.
Oral Contraceptive Pill Intake
Contraceptive pills contain small amounts of progesterone and estrogen to prevent ovulation. The presence of estrogen leads to erosion.
Pregnancy
Estrogen levels increase dramatically during pregnancy for the growth and protection of the fetus. Cervical erosion usually disappears six months after delivery.
Hormone Replacement Therapy
Estrogen administration during menopause may also lead to cervical erosion because of high levels of estrogen in the body.
However, some reasons not associated with increased estrogen levels also lead to cervical erosion such as:
Fetal exposure to estrogen
Persistence of squamous columnar epithelium and squamous epithelium junction happens during intrauterine life because of exposure of the fetus to high levels of maternal estrogen. About 30% of female babies may experience it. It disappears while the child is growing up. But puberty again increases the risk of developing it.
Trauma
Sexual intercourse causes trauma and scarring to the cervix leading to cervical ectropy. Frequent use of tampons may also irritate the external cervical os.
Mucopurulent Cervicitis
Excessive secretion of discharges due to inflammation of the cervix increases the size of the cervical ectropion.
Infection
Presence of sexually transmitted diseases such as syphilis or herpes may lead to cervical metaplasia. However, recent studies have shown that infections do not lead to erosion; rather, cervical erosion increases the risk for infection because the cells in the cervix are more sensitive than before.
Diagnosis of cervical erosion
To rule out presence of malignancy, certain tests such as Pap smear and cervical biopsy can be done. Pap smears and biopsies determine the characteristics of the cells in the cervix and may show stratified squamous epithelium as a sign of cervical erosion. Colposcopy is also done to visualize the cervical area. In addition, physical examination of the cervix such as palpation is done to further characterize the texture of the cervical erosion.
Treatment of cervical erosion
Since cervical erosion is not a disease, it does not require treatment. However, bleeding after sexual intercourse or presence of mucopurulent discharge may be disturbing to some women. In these cases, certain managements can be done. The following outlines the most common management for cervical erosion:
Discontinue Oral Contraceptive Pills
Managing the cause involves removing the underlying cause such as the use of estrogen pills. Other forms of contraception may be used according to client preference and suggestion of the gynecologist.
Ablation Therapy
Ablation therapy focuses on destroying the columnar cervical cells. This will allow the simple squamous cell to grow in replacement of the destroyed cells. This treatment involves the use of a heated probe to destroy up to four mm of the stratified epithelium. Local anesthetics are placed prior to the ablation.
Ablation therapy may include the following procedures:
1.Electrocautery
The cervical cells are destroyed by using high temperature produced by electricity on a needle-like instrument.
2.Diathermy
The cervical os is exposed to high temperatures to damage the cells.
Cryocautery
The cervix is exposed to extremely cold temperatures to destroy the cells. Application of cold nitrous oxide gas is usually performed.
Antibiotics
In the presence of infection, antibiotic therapy is prescribed.
In cases of any malignancy, conization of the cervix and removal of the uterus (if affected) is done. These procedures are for presence of malignancy only and it should be known that cervical erosion is not a malignancy.
Post-operative Management of Cervical Erosion
The site of cautery or ablation heals at an average of five to eight weeks. During this time, the patient should be advised to avoid sexual contact until the surgical site has completely healed. Use of tampons and vaginal douches should also be avoided. The patient is also advised to return for follow-up check-up for re-assessment.