Uterus neck erosion
Uterus neck erosion – defect, damage of a flat epithelium of a neck of a uterus on its vaginal part around an external pharynx. Arises owing to an endotservitsit and other inflammatory diseases of the sexual sphere, hormonal violations in a female body more often. The current can be asymptomatic or be shown by pathological allocations mucopurulent, sometimes bloody character, nagging pains in the field of a sacrum. Is risk factor of emergence of new growths of a neck of a uterus (polyps, cancer). Act as the main ways of diagnosis of an erosion of a neck of a uterus survey of a neck in mirrors and a kolposkopiya. In treatment methods of a diatermokoagulyation, a lazerovaporization and cryodestruction, and also a radio wave method can be applied
Uterus neck erosion
The term "uterus neck erosion" designates defect, violation of integrity of an epithelium of a vaginal segment of a neck of a uterus. The erosion of a neck of a uterus belongs to the most frequent gynecologic pathology and occurs at 15% of women. The neck is the lower part of the uterus acting in a vagina in which there passes the narrow tservikalny (cervical) channel. The top department of the tservikalny channel terminates in an internal pharynx, the lower department – an external pharynx. The external pharynx opens on a vaginal part of a neck of a uterus and has the form of a cross crack at the giving birth women and rounded shape – at not giving birth. Damage of a multilayered flat epithelium around an external pharynx of a vaginal part of a neck of a uterus is shown in the form of a uterus neck erosion.
Acting in a vagina, the neck of a uterus is affected by infections, to traumatizing during sexual intercourse and medical manipulations. Long existence of an erosion of a neck of a uterus can lead to changes in cages of an epithelium and emergence of good-quality new growths (uterus neck polyps) and malignant tumors (uterus neck cancer).
The reasons of development of an erosion of a neck of a uterus can be various. Changes in mucous of a neck of a uterus can develop after the delivery, termination of pregnancy, owing to inflammatory diseases of a neck of a uterus, hormonal violations. As the frequent reason of emergence of an erosion of a neck of a uterus serve sexually transmitted infections – clamidiosis, a bacterial vaginosis, ureaplasmosis, trichomoniasis, etc. which activators, getting into the damaged mucous, cause in it an inflammation. The erosion of a neck of a uterus can arise at teenage age and at not giving birth women.
Types of erosion of a neck of a uterus
Erosion of a neck of a uterus happen the following types:
True erosion of a neck of a uterus
True it is accepted to call the uterus neck erosion which is formed as a result of damage and a slushchivaniye of a flat epithelium around an external pharynx of a vaginal part of a neck of a uterus. Formation of a wound surface with inflammation signs is characteristic of a true erosion of a neck of a uterus. As the most frequent reason of development of a true erosion of a neck of a uterus serves the irritation mucous pathological allocations of the cervical channel at an endotservitsita. The true erosion of usually bright red color, irregular rounded shape which is easily bleeding at contact. At kolposkopichesky survey and microscopy of an erozirovanny surface expanded vessels, puffiness, infiltration, traces of fibrin, blood, mucopurulent allocations are visible. In 1-2 weeks the true erosion passes into a healing stage – a pseudo-erosion.
In the course of healing there is a replacement of defect of a flat epithelium cylindrical, extending to an erosive surface from the channel of a neck of a uterus. Cages of a cylindrical epithelium have brighter color in comparison with cages of a multilayered flat epithelium, and the erosive surface remains bright red color.
The stage of replacement of flat epitelialny cages cylindrical is the first stage of healing of a true erosion of a neck of a uterus. Usually in this stage the erosion of a neck of a uterus is diagnosed by the gynecologist.
Growth of a cylindrical epithelium happens not only on an erosion surface, but also in depth to formation of the branching ferruterous courses. In erosive glands the secret at which difficulty of outflow cysts – from the smallest – to seen at visual survey and a kolposkopiya are formed is allocated and accumulates. Sometimes the large cysts located about an external pharynx resemble uterus neck polyps superficially. Multiple cysts lead to a thickening – a uterus neck hypertrophy.
- follicular (ferruterous) – the having expressed ferruterous courses and cysts;
- papillary - the sosochkovy growths having on a surface with inflammation signs;
- ferruterous and papillary or mixed – the combining signs of the first two types.
The pseudo-erosion without treatment can remain for several months and years up to elimination of the reasons of its development and existence. The pseudo-erosion itself is a source of inflammatory process in a uterus neck because of presence of an infection at erosive glands.
When subsiding an inflammation independently or treatments process of the return replacement of a cylindrical epithelium flat, i.e. restoration of a normal integumentary epithelium of a neck of a uterus - the second stage of healing of an erosion results. On the place of the healed erosion quite often there are small cysts (a cyst nabotova) which are formed as a result of obstruction of channels of erosive glands.
The long course of pseudo-erosion and the accompanying inflammatory process can lead to pathological changes of cages of an epithelium – an atipiya and a dysplasia. The uterus neck erosion with existence of an epitelialny dysplasia is considered as a precancer disease.
Pseudo-erosion can have the small sizes (from 3do 5 mm) or to take a considerable part of a vaginal segment of a neck of a uterus. Primary localization – around an external pharynx or on the rear edge (lip) of a neck of a uterus. Pseudo-erosion represent the modified site of mucous irregular shape, with bright red coloring, the velvety or uneven surface covered with mucous or putreform allocations. At the edges of the healing pseudo-erosion sites of a flat epithelium of light pink color and a nabotova of a cyst are visible.
Pseudo-erosion, in particular papillary, easily bleed at sexual contacts and tool researches. Also raised bleeding is noted at a dysplasia of a pseudo-erosion and during pregnancy. Healing of a pseudo-erosion is considered full if there is a rejection of erosive glands and a cylindrical epithelium and restoration of a flat epithelium on all surface of defect.
Congenital erosion of a neck of a uterus
Formation of congenital erosion of a neck of a uterus results from the shift of borders of the cylindrical epithelium covering the tservikalny channel out of its limits. Shift (ektopiya) of an epithelium occurs in the pre-natal period of development of a fruit therefore such erosion are considered as congenital.
The congenital erosion of a neck of a uterus usually occupies the small site in the area of an external pharynx, has bright red coloring, a plain surface. At an objective research (in mirrors or a kolposkopiya) pathological secretion from the cervical channel and symptoms of an inflammation are absent.
Congenital erosion of a neck of a uterus come to light at children's and teenage age, often recover independently. At preservation of a congenital erosion till the polovozrely period, its infection, an inflammation and the subsequent changes is possible. Occasionally against the background of congenital erosion of a neck of a uterus flat condylomas develop, the ozlokachestvleniya of congenital erosion is not noted.
Reasons and mechanism of development of an erosion of a neck of a uterus
In a question of the reasons and the mechanism of development of an erosion of a neck of a uterus the leading role belongs to the inflammatory theory of an origin of a disease. Endotservitsit and tservitsit, followed by pathological secretion from the cervical channel and a uterus, lead to irritation of an epitelialny cover in an external pharynx and to the subsequent rejection of an epithelium. The true erosion which microflora of a vagina and neck of a uterus occupies is formed.
The Disgormonalny theory puts forward change of level of sexual hormones steroids as the reason of development of an erosion of a neck of a uterus. Clinical observations show emergence of erosion of a neck of a uterus during pregnancy and regress in the postnatal period with stabilization of a hormonal background.
Erosion are also formed at the ektropiyena (eversion) of a mucous membrane of the channel of a neck of a uterus at patrimonial injuries. The uterus neck erosion (pseudo-erosion - follicular, papillary, mixed) which are differing in a long, persistent, recidivous current, not giving in to conservative therapy, having the microscopic symptoms of a dysplasia inclined to contact bleedings are regarded as pretumoral a zabolevnaiya.
Diagnosis of erosion and pseudo-erosion of a neck of a uterus
Diagnosis of an erosion of a neck of a uterus is often complicated in view of lack of characteristic complaints of the patient or an asymptomatic course of disease. Changes in a subjective state usually are caused by the disease serving as the reason of development of an erosion. Therefore the main methods of diagnostics are visual survey of a neck of a uterus in mirrors and the kolposkopiya allowing to consider in details the pathological center under repeated increase.
The method of an expanded kolposkopiya is used at suspicion of ozlokachestvleny erosion of a neck of a uterus. The zone of an erosion is processed by 5% spirit solution of iodine and is considered under kolposkopy. The true erosion (pseudo-erosion) has light pink color, a dysplasia zone – yellow, the atipichesky centers – white color. At detection of sites of an erosion, doubtful in respect of a dysplasia, carry out an aim biopsy of a neck of a uterus with the histologic analysis of the received fabric.
Treatment of erosion and pseudo-erosion of a neck of a uterus
In treatment of erosion of a neck of a uterus the practical gynecology follows the following rules:
- observation of congenital erosion, lack of need of their treatment;
- true erosion and pseudo-erosion are treated along with the background diseases which caused or supporting them;
- in the presence of inflammation signs the carried-out therapy has to be directed on causative agents of an infection (a trikhoionada, a hlamidiya, a gonokokka, etc.);
- erosion in an active stage of an inflammation treat in the sparing ways (vaginal tampons with sea-buckthorn oil, cod-liver oil, a sintomitsinovy emulsion, aerosols with the maintenance of antibiotics - chloramphenicol, etc.).
Modern approaches to treatment of an erosion of a neck of a uterus are based on use of the mechanism of destruction of cages of a cylindrical epithelium, their rejection and the subsequent restoration of a flat epithelium on a pseudo-erosion surface. Methods of a diatermokoagulyation, a lazerovaporization, cryodestruction, a radio wave method are for this purpose applied.
Diatermokoagulyation is method of cauterization of the changed fabric influence of the variable current of high frequency causing considerable heating of fabrics. Coagulation is not applied at not giving birth patients because of danger of formation of the hems interfering disclosure of a neck of a uterus in labor. The method is traumatic, rejection of a necrosis of a koagulirovanny surface can be followed by bleeding. Full healing after a diatermokoagulyation occurs 1,5-3 months later. After a diatermokoagulyation endometriosis therefore it is expedient to plan holding a procedure for the second phase of a menstrual cycle quite often develops.
Lazerovaporization or "cauterization" of an erosion of a neck of a uterus a laser beam is carried out for 5-7 days of a menstrual cycle. Before a lazerovaporization the patient takes a course of careful sanitation of a vagina and neck of a uterus. The procedure is painless, does not leave a hem on a uterus neck, and, therefore, does not complicate the course of the subsequent childbirth. Laser destruction of the changed fabrics causes bystry rejection of a zone of a necrosis, an early epitelization and full regeneration of a wound surface already a month later.
Cryodestruction (cryocoagulation) is based on a vymorazhivaniye, holodovy destruction of fabrics of an erosion of a neck of a uterus by liquid nitrogen or nitrous oxide. In comparison with a diatermokoagulyation, cryocoagulation is painless, bloodless, does not attract consequences of cicatricial narrowing of the channel of a neck of a uterus, is characterized rather bystry epitelizatsiy wound surface after rejection of a necrosis. The first days after cryodestruction are celebrated plentiful liquid allocations, uterus neck hypostasis. The full epitelization of defect occurs in 1-1,5 months.
Radio wave treatment of an erosion of a neck of a uterus the device "Surgitron" consists in impact on the pathological center electromagnetic oscillations of ultrahigh frequency – radio waves which the person physically does not feel. The procedure takes less than a minute, does not demand anesthesia and further postoperative processing. The radio wave method in treatment of an erosion of a neck of a uterus is recommended to earlier not giving birth women since does not lead to formation of the burns and hems complicating childbirth.
Diatermokoagulyation, a lazerovaporization, cryodestruction, treatment is carried out by a radio wave method after an expanded kolposkopiya and an aim biopsy for an exception of an onkoprotsess. At suspicion on malignant regeneration of an erosion of a neck of a uterus radical surgical treatment is shown. Even after treatment of an erosion of a neck of a uterus one of the called methods, the woman has to be on the dispensary account and observation at the gynecologist.