Cervical erosion: cauterization is not necessary! 2 errors of erosion treatment in Russia
Ectopia of the cervix, or erosion, is one of the most well-known gynecological conditions, which not only all women know, but also men have heard about. For our country, the discussion on the topic of “burning erosion before or after childbirth?” Is also relevant. Paradoxically, for the rest of the land, the question of the treatment of cervical erosion is long gone. Obstetrician-gynecologist Dmitry Lubnin tells about the most common errors in erosion treatment.
In western medicine there is only two indications for cauterization cervical erosion: a situation in which the surface erosion vessels cause contact bleeding (more simply, bleeding after intercourse) and the presence of excess daily mucous secretionswhich affect the quality of life of a woman (in such cases, patients complain that they go all the time "wet", there is not enough even a daily lining). All, in all other cases, cervical erosion in the West is not treated.
What is cervical erosion
Erosion, or more correctly speak cervical ectopia, in fact, is physiological phenomenon, the stage of maturation of the cervix. The cylindrical epithelium lining its canal contains many glands that must secrete mucus into the lumen of the canal, creating a “filter plug” on the way to the uterine cavity.
This plug protects the sterile cavity from the penetration of pathogenic microorganisms into it, and also participates in the transport of spermatozoa during the period of ovulation. In the process of maturation in young girls, this epithelium extends beyond the channel to the outside and is located on the surface of the cervix as a cuff on the neck of a turtleneck.
Gradually, stratified squamous epithelium (your epithelium is lined with your vagina, lips, inner surface of the mouth) grows into a cylindrical one, displacing the border between them directly to the canal entrance, and ideally the cylindrical epithelium should line only the cervical canal.
The ideal situation does not always occur, and the process of growth of one epithelium on another can take a long time, go unevenly, and the boundary between these two epithelium often resembles a surf line. This process can be slowed down by the inflammatory process, as well as the use of contraceptives, but sooner or later it will end, and it is not necessary to help.
As noted above, superficial vessels or an excessive amount of mucus-secreting glands rarely appear in the cylindrical epithelium located outside the cervix, and only this circumstance requires cauterization regardless of whether you gave birth or not. Modern methods of cauterization of erosion are very sparing, and therefore do not affect the elasticity of the cervix and its ability to stretch in childbirth.
In our country, quite often, cervical erosion is cauterized only by the fact of its existence, intimidating with horrible consequences, or rather, “cervical cancer”. But, if you look, not everything is so scary.
Prevention of cervical cancer: what tests to take
The most important study to diagnose the condition of the cervix - cytological smear. Based on its results, it is possible to determine whether there is erosion on the cervix or not - in the presence of erosion, the value of this analysis will increase slightly. Cytological examination is carried out annually to all women in Europe and America, for which a special distribution of letters of invitation is made to come to the clinic. This approach allows us not to miss the beginning of changes in the cervical cells that are heading towards a malignant disease.
The fact is that cervical cancer is preceded by three reversible stages at which it is possible to slow down the process in time and prevent the development of the cancer itself. Since we do not have such a system, patients need to rely on themselves and do not forget to take a cytological smear annually.
I want to note that for screening for cervical cancer is not performed research for the presence of human papillomavirus oncogenic types, as it is considered impractical. Infection with this virus does not mean that the cells of the cervix will undergo bad changes - the probability of this is extremely small. In the vast majority of women, the virus is suppressed by the immune system until the age of 30, leaving no trace in the body. In our country, on the contrary, the first place put the study on HPV, and not a cytological smear and offer treatment for this virus.
Such an approach is fundamentally wrong, frighteningly illiterate and in many ways harmful, because in addition to prescribing unnecessary expensive treatment, the patient receives a significant emotional shock associated with the fear of oncology and a sense of her "infectiousness and danger for the partner."
Since the treatment does not have any effect on the human papillomavirus, it is often again detected on control tests that causes the woman to become even more depressed. In my practice, I often encounter such tortured patients with hopelessness in their eyes, and it is quite difficult for me to dissuade them, that all this treatment was unnecessary, the virus is not dangerous for her or for her partner, and since her cytological smear is normal, nothing extra to do.
The only important additional study is colposcopy - examination of the cervix under a microscope using two colors. This method allows you to supplement the data of a cytological smear and is mandatory when deviations are detected. Colposcopy is a completely painless method.
If you want the cytological examination to be the most informative and accurate, do the analysis not using the usual cytology method (the material is applied with a brush on a glass slide), and the liquid cells from the cervix are picked up with a special brush, the head of which is disconnected together with the material and immersed in a special container .
This method has several advantages:
- All collected cells are available for examination by a cytologist, as they are washed, grouped and applied on the glass in one layer;
- from the container in which there was material, it is possible, if necessary, to make clarifying analyzes (without re-sampling the analysis), allowing to assess the severity of the identified changes and make a forecast.
Such an analysis is more expensive, but its information content and accuracy are worth it.