What is Cervical Erosion
It is the development of a reddened area on the portio vaginalis around the external os. Pathologically, it is the replacement of the stratified squamous epithelium of the portio vaginalis by the columnar epithelium of the endocervix. The condition is often described to the patient as ulcer but an erosion is never ulcerated unless it is malignant.
More than three-fourths of adult women suffer from this condition.
Types. 1. Congenital; 2. acquired(a) simple flat; (b) papillary ; (c) follicular with Naboth’s follicles.
Causes of Cervical Erosion
- (i) physiological. During puberty, pregnancy and puerperium sex hormones cause coluinnar epithelial overgrowth beyond external os; then retrogressing spontaneously
- (ii) Pathologicalsex hormonal hyperplasia, oral contraceptive hyperplasia, and chronic inflammatory hyperplasia following chronic cervicitis.
Cervical Erosion | Congenital Erosion
At birth, in some newborn female babies, columnar epithelium of the cervical canal may extend to some extent over the .vaginal portion of cervix. The condition persists for a few days after birth as a result of maternal oestrogen in the newborn,’ On withdrawal of hormone, the erosion retrogresses.
Acquired erosion. It was postulated by Robert Meyer, 1910 that the interplay of columnar and squamous epithelium of the cervix leads to various types of erosion as follows.
(a) Simple flat type. During early stage of established cervicitis, desquamation and shedding out of the epithelium round the external os occur due to (i) loosening of the epithelium by the underlying inflammation and (ii) constant bathing of the epithelium by irritating discharge. The denuded area is being covered by the proliferating columnar epithelium of the endocervix. The epithelial lining forms a straight line on the surface.
(b) Papillary type. Due to proliferation of the columnar epithelium, it gets folded and forms papillary projections on a granulation tissue base in chronic cervicitis. On the surface, pseudoglands or crypts form in between the papillae.
(c) Follicular type. It is considered that in the healing stage, the endocervicitis and chronic discharge get abated, the squamous epithelium regrows towards the external os replacing the columnar epithelium which is made to atrophy and disappear. Alternativelybasal cells of columnar epithelium proliferate and be metaplastic to form stratified epithelium. The mouths of the glands may be blocked with the regrown squamous epithelium and such glands may produce retention cyst-like elevations on the surface of the portio vaginalis and these are calledNabothian follicles.
In noninflammatory type as in sex hormonal hyperplastic or OC erosion, columnar epithelium under stimulus of sex hormones overgrow beyond external Os and shows features as in simple and papillary erosion.
Cervical erosion is chiefly a disease during reproductive age and after menopause, it tends to retrogress spontaneously.
Cervical Erosion | Microscopic View
This may show the following:
1. Erosion area around the external os on the portio vaginalis shows the covering of columnar epithelium with the formation of new glands.
2. In follicular type, the surface is covered with stratified epithelium with underlying retention cysts.
3. The endocervix and cervical stroma show the picture of chronic inflammation, round cell infiltration and fibrosis in inflammatory type.
In follicular stage, histological picture may be mistaken for carcinoma.
Cervical Erosion | Signs
Signs of Cervical Erosion
1. Patient commonly a parous woman during the child-bearing period. This can be rarely seen in young virgins and in women within a year or two after menopause.
2. General health may be below normal; there may be slight
3. Vaginal examination. Speculum examination per vaginum is a diagnostic procedure. A red granular surface with well-defined margin is visible on the vaginal cervix around the external os. Both lips of the cervix are commonly involved. The surface is commonly seen smeared with white discharge. In follicular erosion, the surface of the portio vaginalis shows multiple small pearly white translucent nodular elevations and vaginal cervix also appears bulky. A few of these cases may be of tubercular origin; clinical features of this type are described later.
The affected area on the portio vaginalis may be felt smooth, velvety soft or thesmall hard Naboth’s follicles may be felt scattered over the surface. Cervix may be normal or bulky, firm and elongated with lacerations especially at the lateral angles.
The uterus may be fixed due to associated chronic parametntis; in these cases, the movements of the cervix may elicit pain.
Cervical Erosion | Symptoms
Symptoms of Cervical Erosion
1. Persistent white discharge per vagina; the dischargevaries in character from clean mucus (in hyperplastic erosion) to mucopurulent(in inflammatory erosion-).
2. Metrorrhagia specially after sexual intercourse in a vascularerosion is seldom a symptom; this is the symptom of cervical neo-plasia ratherthan that of cervical erosion.
3. There may be backache atthe lower part of the sacrum.
4. There may be frequency of micturition and dysuria perhapsdue to spread of infection around the bladder wall.
5. Chronic ill health and metastatic infectionarthritis, muscularpains.
6. Infertility may bepresent.
7. Pruritus vulva does not ordinarily be the symptom but it maybe present in profuse mucopus discharge.
8. Psychological upsets due to persistent vaginal discharge since it is believed by lay public that white discharge is ‘white blood’.Consequently she develops palpitation, sense of unwell.
9. There is commonly nosymptom at all
Cervical Erosion | Treatment
Treatment of Cervical Erosion
Symptomless cervical erosion needs no local treatment but needs PAP stain cytology, repeated followup clinical checkup and cytology. Cervical erosion is treated in various ways depending on the cause. If an infection is present, antibiotics are necessary. When cervical erosion is caused by trauma to the cervix, either by injury or a chemical such as vaginal douches, avoiding the cause and time to heal are the only treatments. Sometimes cervical cauterization is used to treat cervical erosion. Your health care provider may also prescribe vaginal estrogen cream to help thicken the outer surface of the cervix.