Uterus neck pseudo-erosion
The uterus neck pseudo-erosion – a state at which the cylindrical epithelium of the tservikalny channel settles down on the vaginal surface of a neck of a uterus is normal the covered multilayered epitelialny fabric. In most cases proceeds asymptomatically and incidentally comes to light at gynecologic survey. Unusual allocations, morbidity at sexual intercourse can take place. Apply a kolposkopiya, scrape or a biopsy of a neck of a uterus, cytologic researches to diagnostics. Treatment at an asymptomatic current is not required, appointed observation and periodic inspection, in case of complications make cryodestruction, electrothermic coagulation, laser or chemical cauterization.
Uterus neck pseudo-erosion
The pseudo-erosion of a neck of a uterus is known also as an ektopiya of an epithelium or . Terms capture the essence of the process leading to such state – penetration of a tservikalny single-row epithelium on a vaginal part of a neck. Actually the erosion (destruction or damage of an epitelialny cover) does not occur. Experts of World Health Organization do not consider such phenomenon pathological process, it is regarded as physiologically variable state. Practically always the ektopiya is registered at women 35-40 years are younger, more than a half of persons are in age of 20-23 years. Endotservikoz arises at the vast majority of pregnant women and spontaneously disappears in 1-2 years after the delivery. Correlation between this process and use of the combined oral contraceptives is noticed – the last promote an epithelium ektopiya.
Anomaly of formation of female genitals is considered a prerequisite of a pseudo-erosion of a neck of a uterus during an embryonal development. The single-row cylindrical epithelium at a pre-natal stage covers an internal surface both a uterus, and vaginas. Shortly before the birth such cover is replaced with a multilayered flat epithelium, normal remaining only in the tservikalny channel, but at some women it remains also on the insignificant site of a vaginal part of a neck of a uterus. The sizes of this zone can change under the influence of various factors over time:
- Hormonal background. Cages of an epithelium of genitals of the woman are gormonochuvstvitelny, differently reacting to work of endocrine system. Frequent detection of a pseudo-erosion during puberty is explained by it, at pregnancy or use of hormonal contraceptives.
- Infectious factors. Diseases, sexually transmitted, or a nonspecific inflammation of female genitals (colpitises, tservitsita) provoke expansion of a zone of a tservikalny ektopiya.
- Chemical factors. The irritation of a neck of a uterus the chemical compounds which are a part of vaginal suppositories, lubricants, lubricants for condoms can become the reason of development of this state.
- Mechanical irritation. Emergence of a cylindrical epithelium is noted when traumatizing a vaginal part of a neck of a uterus – frequent sexual contacts, use of barrier methods of contraception, childbirth can be the cause.
The question of purely acquired character of this state and its development without congenital prerequisites in gynecology remains debatable. There are no convincing proofs that factors of the external environment are capable to cause without existence of predisposition to it. Supporters of a hypothesis of the acquired nature of a pseudo-erosion of a neck of a uterus consider that inflammatory, immunological and endocrine violations participate in its development.
The pseudo-erosion of a neck of a uterus arises at a combination of the congenital and acquired factors. If at the birth there is such feature of distribution of an epitelialny cover in genitals, then during the different periods of life of the woman the area of a zone of an ektopiya will constantly fluctuate. Expansion happens under the influence of female sex hormones as the tservikalny epithelium is more sensitive to them and reacts to their influence by growth. At reduction of concentration of hormones there is a restoration of a multilayered cover at the expense of growth cages.
Therefore the woman during the different periods of life can have an ektopiya as pronounced, not to be defined at all. Though this state is not recognized pathological, it can be potentially dangerous as the cylindrical epithelium possesses smaller barrier function. It increases risk of penetration of infectious agents. Continuous activization of reserve growth cages of a multilayered epithelium creates risk of their abnormal growth and division that further it is fraught with uterus neck cancer. Formation of various clinical types of a state is connected with accession of an inflammation or influence of other factors.
At the moment there is no conventional side dividing physiological feature of a female body from the state demanding medical intervention. Allocate several types of an ektopiya differing on the histologic structure.
- Papillary form. Epitelialny fabric forms the sosochkovy growths and tyazh representing inflammatory infiltrates. Arises under the influence of an infection or other factor causing an inflammation.
- Ferruterous form. The small follicles and cysts covered with a multilayered epithelium are formed. The reasons of development are not clear, suspect influence of hormones or cellular changes.
- The mixed form. The Epitelialny cover forms both nipples, and cystous growths.
In addition allocate or the beginning to live forms at which normal restoration of a multilayered cover of a vaginal part of a neck is observed. Some experts criticize such classification, carrying above-mentioned types to pathological complications of an ektopiya.
In most cases the ektopiya proceeds asymptomatically, noticeable manifestations arise only at accession of an infection or abnormal growth of multilayered epitelialny fabric. For example, at emergence of a tservitsit emergence of transparent or whitish allocations from a vagina, sometimes with an unpleasant smell is registered. Some women note morbidity at sexual intercourse, sometimes after it there are small bloody allocations. Rare symptoms are also pains in the bottom of a stomach, a vagina itch, feeling of burning. Duration of manifestations can make months and even years without tendency to progressing, their disappearance or, on the contrary, accession of complications is possible.
Because of the lowered resilience of a cylindrical epithelium at this state there is an inflammation under the influence of infectious agents, chemical and mechanical irritants easier. Change of a consistence and volume of tservikalny slime leads to reversible infertility – the secret forms a barrier on the way of penetration of spermatozoa. Chaotic sex life, non-compliance with rules of personal hygiene can become a cause of destruction of covers of a neck of a uterus and development of a true erosion. Ektopiya is not carried to precancer diseases of a neck of a uterus, however the chronic inflammation on its background is capable to cause a dysplasia of cages that is the first step to their malignant regeneration.
Diagnosis of a pseudo-erosion of a neck of a uterus is important for differentiation of a state from the precancer states, inflammatory defeats and other pathologies demanding treatment. It includes consultation of the gynecologist who develops the scheme of further researches and analyses:
- Survey on a chair. Signs of an ektopiya it is possible will reveal at simple visual survey of a neck of a uterus in mirrors. For confirmation of the diagnosis the doctor carries out inquiry of the patient and appoints the list of additional procedures.
- Expanded kolposkopiya. Aim studying of the changed site of a neck under repeated increase is necessary for definition of structure of an epitelialny cover. During the research carry out Schiller test.
- Tservikalny scrape. The research of samples of fabrics allows to define character of cages in abnormal area. Also it is necessary for an exception of a dysplasia and inflammatory changes. Apply cytology of scrape of a neck of a uterus (PAP test).
- Determination of level of sex hormones. Studying of a hormonal background of the woman will help to define the reasons of an ektopiya and to specify the forecast of a state. For example, at pregnancy such phenomenon is considered absolutely normal.
In addition the doctor can appoint immunological researches for detection of the sexually transmitted infections, allergies and other states capable to influence emergence of a pseudo-erosion of a neck of a uterus.
Treatment of a pseudo-erosion of a neck of a uterus
In the absence of complaints and the expressed symptoms of treatment it is not required, rather regular observation from the obstetrician-gynecologist for prevention of complications. In case of accession of an infection carry out etiotropny therapy according to indications. The woman should limit use of hormonal and some barrier contraceptives (caps). If the ektopiya is shown by allocations, belly-aches, characterized by the abnormal growth of a multilayered epithelium, make coagulation of a pseudo-erosion by means of various methods:
- Diatermokoagulyation. Cauterization of the site with a cylindrical epithelium is carried out by thermal influence of electric current. It is characterized by mediocre effectiveness (75-90%) and a number of complications – bleedings, a stenozirovaniye of the tservikalny channel with development of infertility. It is forbidden for treatment of an ektopiya at not giving birth women.
- Laser destruction. Apply carbonic or helium - neon lasers, efficiency very high – 98-100%.
- Cryodestruction. Freezing by liquid nitrogen of the abnormal site with the subsequent healing and an epitelization. The method is widespread widely due to the simplicity, efficiency makes 87-95%.
- Chemical coagulation. It is based on the injuring impact of various connections and pharmacological means. It can be applied in combination with other methods of treatment of a pseudo-erosion of a neck of a uterus to increase in their efficiency.
Considering the widest prevalence of an ektopiya and its characteristic as option of development of a female reproductive system, the forecast of a state favorable. Relative threat pseudo-erosion complications – inflammations can make, pathological growths of integumentary fabrics. But at regular observation and timely correction of changes the risk of serious consequences is very small. For prevention of an ektopiya it is necessary to follow the rules of personal hygiene, to avoid the casual and unprotected sexual contacts, to treat in full inflammatory pathologies of genitals and endocrine violations. The women who are observed at the gynecologist in such occasion have to be careful in contraception selection – hormonal and some barrier methods can lead to complications.