Cervical erosion is a raw-looking granular appearance on the cervix. It occurs when the inner lining of the cervical canal (columnar epithelium) comes out onto the part of the cervix that can be visualised with a speculum. It appears as a red, velvet-like area.
Cervical erosion is related to the hormone called oestrogen and is common in young girls, during pregnancy and in women on the contraceptive pill. It should not be regarded as a sign of disease because it is frequently found in perfectly healthy women.
Normally, the inside of the cervical canal is lined with columnar epithelium and the outside with squamous epithelium. These connect at the squamous-columnar junction. In cervical erosion, the columnar epithelium may extend further down ad protrude on the surface of the cervical OS and onto the vaginal portion of cervix. It may also undergo squamous metaplasia and transform to stratified squamous epithelium.
Causes of Cervical Erosion
Oestrogen level: Cervical erosion is believed to be a response to high levels of circulating oestrogen in the body. Oestrogen levels may be high at different times in a woman's life.
- Cervical Erosion is a very common finding during pregnancy - believed to be due to the high levels of oestrogen levels in the body at that time. It can cause mild bleeding during pregnancy, usually during sexual intercourse when the penis touches the cervix. The erosion disappears spontaneously 3-6 months after childbirth.
- All birth control pills contain the hormones, oestrogen and progesterone in different strengths. Cervical erosion is more common in women taking pills with a high level of oestrogen.
- Cervical erosion is found in at least 1/3rd of all female babies. Many researchers believe that this is a response to the maternal oestrogen that the babies are subjected to while still in the uterus. The erosion disappears in early childhood as the influence decreases.
- Hormone replacement Therapy in menopause mainly consists of replacement of oestrogen in the body through pills, patches, creams etc. This oestrogen can cause cervical erosion.
- Cervical erosion is rarely seen in women after the menopause as the level of oestrogen in the blood is very low.
The belief that infection is the cause of cervical erosion is slowly losing ground. Evidence is increasing that infection does not cause cervical erosion but it is rather the other way around - the changed cells of cervical erosion are more susceptible to various bacteria and yeast and tends to get infected very easily. So cervical erosion and cervical infections are often seen together, leading to the belief that infection causes cervical erosion.
It is believed by many that chronic infection of the vagina, vaginal douching and chemical contraceptions like anti-sperm gels can change the normal level of acidity of the vagina and cause cervical erosion. But these theories are yet to be proved.
Signs and Symptoms of Cervical Erosion
Most women with cervical erosion
do not have any symptoms. But women with a large area of erosion can suffer from:
Tests for Cervical Erosion
- Increased Vaginal Discharge
- Other symptoms of cervical erosion like backache, chronic ill health and even infertility have been said to be due to cervical erosion
Cervical erosion has to be differentiated from other cervical ulcers caused by carcinoma
, syphilis and other sexually transmitted diseases. A cervical biopsy should ideally be carried out.
Treatment of Cervical Erosion
If the cervical erosion has no symptoms but has been discovered on routine examination, treatment is not necessary. In many cases, the erosion tends to disappear spontaneously.
If symptoms are present however, active treatment becomes necessary. The aim of the treatment of cervical erosion
is to destroy the columnar cells so that normal squamous cells can grow in their place:
- Electrocautery: The cells are burned off by using heat generated by electric current.
- Diathermy: High temperature is applied to the area of cervical erosion via shortwave or microwave electric current or by ultrasound to generate deep heat so that the cells are damaged.
- Cryocautery: Extreme cold generated by the application of nitrous oxide gas is used to destroy the cells.
The area of cervical erosion takes 6-8 weeks to heal. So the patient is asked to avoid sex and not to use tampons or douches during this period to avoid any injury.