Cervical Erosion (Cervical Ectopy)

Overview of Cervical Erosion (Cervical Ectopy)

• Chronic cervicitis often manifests clinically as erosion or as a Nabothian follicle.
• Moreover, The cervical erosion results from the extension of the columnar endocervical epithelium beyond the external cervical os to replace the squamous epithelium covering the portion vaginalis of the cervix.
• Whenever the mouth of an endocervical gland opening gets blocked, it gets distended with inspissated secretion, resulting in a cystic bulge known as the Nabothian follicle. [2]

Causes of Cervical Erosion (Cervical Ectopy)

Congenita i.e.:

• At birth, in about one-third of cases, the columnar epithelium of the endocervix extends beyond the external os.
• This condition persists only for a few days until the level of oestrogen derived from the mother falls.
• Thus, the congenital ectopy heals spontaneously.

Acquired:

          Hormonal:

• The squamocolumnar junction is not static and its movement, either inwards or outwards is dependent on estrogen.
• When the estrogen level is high, it moves out so that the columnar epithelium extends onto the vaginal portion of the cervix replacing the squamous epithelium.
• This state observed during pregnancy and amongst ‘pill users’.
• The squamocolumnar junction returns back to its normal position after 3 months following delivery and little earlier following withdrawal of ‘pill’.

           Infection:

• The role of infection as the primary cause of ectopy has discarded.
• However, chronic cervicitis may associate or else the infection may supervene on an ectopy because of the delicate columnar epithelium which more vulnerable to trauma and infection. [2]

Risk factor of Cervical Erosion (Cervical Ectopy)

• Use of the combined oral contraceptive pill
• Pregnancy
• Adolescence
• Menstruating age (it is uncommon in post-menopausal women) [3]

Pathophysiology of Cervical Erosion (Cervical Ectopy)

• In the active phase of ectopy, the squamocolumnar junction moves out from the os.
• The columnar epithelium of the endocervix maintains its continuity while covering the ectocervix replacing the squamous epithelium.
• The replaced epithelium is usually arranged in a single layer (flat type) or may be so hyperplastic as to fold inwards to accommodate in the increased area—a follicular ectopy.
• At times, it becomes heaped up to fold inwards and outwards-a papillary ectopy.
• Underneath the epithelium, there are evidences of round cell infiltration and glandular proliferation.
• The features of infection are probably secondary rather than primary.
• The columnar epithelium is less resistant to infection than the squamous epithelium.
• During the process of healing, the squamocolumnar junction gradually moves up towards the external os.
• The squamous epithelium grows beneath the columnar epithelium until it reaches at or near to its original position at the external os.
• Alternatively, the replacement is probably by squamous metaplasia of the columnar cells.
• The possibility of squamous metaplasia of the reserve cells is also likely.
• During the process, the squamous epithelium may obstruct the mouth of the underlying glands (normally not present in ectocervix), pent up secretion, retention cyst, Nabothian follicle.

• Alternatively, the epithelium may burrow inside the gland Lumina.
• This process of replacement by the squamous epithelium is called epidermalization. [1]

Sign & Symptoms of Cervical Erosion (Cervical Ectopy)

Symptoms:

• The lesion may be asymptomatic.

However, the following symptoms may be present.

• Vaginal discharge—the discharge may be excessively mucoid.
• It may be mucopurulent, offensive and irritant in presence of infection may be even blood-stained due to premenstrual congestion.
• Contact bleeding especially during pregnancy and ‘pill use’ either following coitus or defecation may be associated.
• Associated cervicitis may produce backache, pelvic pain and at times, infertility.

Signs:

Internal examination reveals:

• Per speculum—there is a bright red area surrounding and extending beyond the external os in the ectocervix.
• The outer edge is clearly demarcated.
• The lesion may be smooth or having small papillary folds.
• It is neither tender nor bleeds to touch.
• On rubbing with a gauze piece, there may be multiple oozing spots (sharp bleeding in isolated spots in carcinoma).
• The feel is soft and granular giving rise to a grating sensation. [1]

Investigation of Cervical Erosion (Cervical Ectopy)

• Cervical ectropion is a clinical diagnosis. The main role of any investigation is to exclude other potential diagnoses:
• Pregnancy test
• Triple swabs – if there is any suggestion of infection (such as purulent discharge), endocervical and high vaginal swabs should be taken.
• Cervical smear – to rule out cervical intraepithelial neoplasia.
• If a frank lesion is observed, a biopsy should be taken (note that biopsies are not performed as routine). [3]

Differential Diagnosis of Cervical Erosion (Cervical Ectopy)

• Syphilitic ulcer
• Tuberculosis of the cervix
• Carcinoma in situ and
• Cancer of the cervix must be ruled out and the case confirmed as erosion of the cervix. [2]

Treatment of Cervical Erosion (Cervical Ectopy)

1. Diathermy cauterization: Gives satisfactory results.

• The tissues of the cervix are coagulated, the columnar epithelium is destroyed.
• The raw area on the vaginal portion of the cervix gets subsequently covered by squamous epithelium.
• In the cervical canal, diathermy coagulation destroys all infection lying in the depths of the racemose glands and in due course healthy epithelium grows down from the upper part of the cervical canal to cover the raw area.
• Endocervical cauterization requires cervical dilatation and general anesthesia, otherwise, cervical stenosis can occur.

       2. Cryosurgery: is now being used in place of cauterization in many centers.

• The refrigerants used in cryosurgery are carbon dioxide (278°C), Freon (281°C), nitrous oxide (288°C) and nitrogen (2186°C). All are equally effective.
• Cryotherapy is safer than cautery as it avoids accidental burns in the vagina and is painless.
• Besides, it does not require anesthesia and is an OPD procedure.
• Its main disadvantage is that the patient develops copious discharge per vaginam and causes potassium loss through extensive destruction of the tissue.
• The patient should be advised to drink plenty of either fruit juice or take potassium salt.
• The area epithelializes also  heals in about 6 weeks.
• Repeat cryosurgery is required if any residual area is left untreated.
• Intercourse is prohibited for 6–8 weeks.

       3. Laser therapy:

• Has replaced cautery and cryosurgery in the management of chronic cervicitis also erosion in some centers.
• Advantages of laser are either precision of excision or burning of tissue, absence of infection and haemorrhages and fast healing in 4 weeks.
• However, laser equipment is very expensive.

      4. Conization operation:

• If chronic cervicitis covers an extensive area or is not cured by any of the above methods.
• It may be necessary to perform conization operation, under general anesthesia, using cold knife, diathermy or laser and a cone-shaped piece of cervical tissue. [2]

Homeopathic Treatment of Cervical Erosion (Cervical Ectopy)

Homeopathy treats the person as a whole. It means that homeopathic treatment focuses on the patient as a person, as well as his pathological condition. The homeopathic medicines selected after a full individualizing examination and case-analysis.

which includes

• The medical history of the patient,
• Physical and mental constitution,
• Family history,
• Presenting symptoms,
• Underlying pathology,
• Possible causative factors etc.

A miasmatic tendency (predisposition/susceptibility) also often taken into account for the treatment of chronic conditions.

What Homoeopathic doctors do?

A homeopathy doctor tries to treat more than just the presenting symptoms. The focus is usually on what caused the disease condition? Why ‘this patient’ is sick ‘this way’?.

The disease diagnosis is important but in homeopathy, the cause of disease not just probed to the level of bacteria and viruses. Other factors like mental, emotional and physical stress that could predispose a person to illness also looked for. No a days, even modern medicine also considers a large number of diseases as psychosomatic. The correct homeopathy remedy tries to correct this disease predisposition.

The focus is not on curing the disease but to cure the person who is sick, to restore the health. If a disease pathology not very advanced, homeopathy remedies do give a hope for cure but even in incurable cases, the quality of life can greatly improved with homeopathic medicines.

Homeopathic Medicines for Cervical Erosion (Cervical Ectopy)

The homeopathic remedies (medicines) given below indicate the therapeutic affinity but this is not a complete and definite guide to the homeopathy treatment of this condition. The symptoms listed against each homeopathic remedy may not be directly related to this disease because in homeopathy general symptoms and constitutional indications also taken into account for selecting a remedy, potency and repetition of dose by Homeopathic doctor.

So, here we describe homeopathic medicine only for reference and education purpose. Do not take medicines without consulting registered homeopathic doctor (BHMS or M.D. Homeopath).

Medicines:

Kali Bichromicum:

• Nymphomania; during puerperal state.
• Moreover, Sterility from excessive sexual indulgence.
• Ovarian neuralgia from ungratified sexual desire.
• Cystic tumours of ovaries.
• Flooding in young women, with sexual desire.
• Menorrhagia, from strong sexual desire.
• Besides, Subinvolution.
• Sexual feeling lost, aversion to coition.
• Lastly, Aggravation Sexual excess, Puberty, Unsatisfied sexual desire.[4]

Hydrastis Canadensis:

• Erosion of cervix.
• Thick; acrid, yellow; ropy leucorrhoea.
• Pruritus vulvae, with profuse leucorrhoea, with sexual excitement.
• Cancer of breast, nipples, retracted, sore, cracked, in nursing women.
• Menorrhagia and metrorrhagia, with fibroids.
• Removes the tendency to habitual adherent placenta.
• Vagina sore, during coition, bleeding after.
• Pain in breast (especially, right) on sneezing.
• Hot, watery, discharge from uterus. [4]

Alumina:

• Menses, too early, short, scanty, pale followed by great exhaustion.
• Leucorrhoea; acrid profuse, runs to feet, worse during daytime; before menses better by washing with cold water.
• Intolerable bearing down pain.
• Tickling and itching in genitals; with strong desire for embrace.
• Nipples itch, burn, looks angry (especially, during pregnancy).
• It takes a woman all her time to recuperate from one menstrual period to the next. [4]

Argentum Nitricum:

• Coition painful, followed by bleeding.
• Prolapsus, with ulceration of os or cervix uteri.
• Metrorrhagia, with nervous erethism at the change of life; also of young widows and childless women.
• Ovaries painful, with pains radiating to sacrum and thighs.
• Menses; irregular, too soon, too late or last one day only.
• Pain in stomach and spasmodic contraction in chest before menses.
• Menses scanty, with Dyspnoea.
• Infants die early after delivery.
• Leucorrhoea; profuse, with erosion of cervix. [5]

Kreosotum:

• Menses; profuse, lumpy; intermittent; worse lying; better sitting, or walking.
• Leucorrhoea, gushing, like bloody water, offensive, corrosive, causing itching, staining the linen yellow; with accompanying complaints; white, having odours of green corn.
• Violent pain during coition; burning in parts, followed by discharge of dark blood; next day.
• Violent itching of vulva and vagina worse during urination. Lochia, lumpy, offensive, intermits.
• Cancer, erosion of cervix.
• Dwindling of mammae with small hard painful lumps in them.
• Menses worse lifting, over exertion.
• Stitches in vagina, make her start. [5]

Diet & Regimen of Cervical Erosion (Cervical Ectopy)

• Wear cotton underwear.
• Wash the genital area with warm water also mild soap.
• Avoid vaginal [5]

Frequently Asked Questions

What is Cervical Erosion?

Cervical ectopy is a condition where the squamous epithelium of the ectocervix is replaced by columnar epithelium, which is continuous with the endocervix. It is not an ulcer.

Homeopathic Medicines used by Homeopathic Doctors in treatment of Cervical Erosion?

• Kali Bichromicum
• Hydrastis Canadensis
• Alumina
• Argentum Nitricum
• Kreosotum

What are the main symptoms of Cervical Erosion?

• Vaginal discharge
• Mucopurulent, offensive also irritant
• Contact bleeding
• Backache
• Pelvic pain also at times, infertility.

What are the 3 causes Cervical Erosion?

• First, Congenital
• Secondly, Hormonal
• Lastly, Infection