Cervical erosion: what it is and when it is dangerous

You left the office with the word "erosion" in your head and have already managed to get scared. Calm down: most often this is not a disease but a feature of the structure of the cervix that simply looks unusual. Below — what lies behind the diagnosis, where discharge comes from, and when a conversation with a doctor should not be postponed.

What cervical erosion is

The cervix is the lower part of the uterus that projects into the vagina. Inside its canal the lining is columnar, while on the vaginal surface it is normally stratified squamous epithelium. With erosion, the columnar epithelium ends up on the vaginal side of the cervix: a red patch is visible around the external opening of the canal. The term is outdated: in international practice they say "ectopy", "pseudoerosion" or "endocervicosis", but doctors habitually use the old word, and it is frightening in itself.

Ectopy occurs in about half of women of reproductive age and does not occur in women after 40. The modern position of evidence-based medicine: this is a variant of the norm, not a disease.

Ectopy and true erosion: what the difference is

The word "erosion" describes damage, a small wound — which is why it sounds threatening. On examination something else is seen: on the vaginal part of the cervix lies even columnar epithelium, which usually lines the canal. This is ectopy. Gradually it is replaced by stratified squamous epithelium thanks to germinal cells; the area of change is called the transformation zone, and it is precisely there that more than 90% of cervical cancer cases arise. That is why the doctor is interested not in the red patch but in the state of this zone.

Sometimes the growing epithelium covers the ducts of the nabothian glands, and vesicles with mucous secretion appear in the thickness of the cervix — nabothian cysts. There is no infection in them, they do not create inflammation and do not affect the function of the cervix; this is also a variant of the physiological norm.

Causes of cervical erosion

Columnar epithelium is sensitive to hormones, so the border between the two types of lining shifts sometimes outward and sometimes back inward. This picture is characteristic of the neonatal period, puberty, young age, pregnancy and the use of hormonal contraceptives. Ectopy may appear with infections and with mechanical or chemical irritation of the cervix.

Separately — about what requires attention. Abnormal changes in cervical cells are most often caused by human papillomavirus, which is transmitted sexually. Risk is increased by sex before age 18, childbirth at a very young age, multiple partners, HIV, immunosuppressive medications, and smoking. Ectopy itself is not dysplasia, but an examination is needed to distinguish these things.

Symptoms and discharge in cervical erosion

In the vast majority of cases ectopy is not felt at all. Discharge in cervical erosion appears not because of the red patch but with concomitant inflammation — cervicitis. In rare cases there may be bloody discharge after sexual intercourse, contact bleeding, and pain during sexual intercourse.

How it is diagnosed: examination, colposcopy, smears

Diagnosis begins with a speculum examination. For an accurate picture, colposcopy, a smear for flora and tests for sexually transmitted infections are used. Separately — screening, a test to check the health of the cervix and prevent cervical cancer: it is performed in women aged 25–64 every 5 years.

The first test is usually a Pap test together with an HPV test. Human papillomavirus DNA testing is used for women aged 30 and older, as well as with a slightly abnormal Pap test. In the report, changes are described as LSIL, HSIL, ASC or AGC; if there are abnormalities, further evaluation is prescribed, and if necessary — colposcopy with biopsy. A biopsy involves tiny pieces of tissue; most often only brief pain resembling a spasm is felt. The result is classified as CIN I, CIN II or CIN III; management depends on the grade and is discussed with the doctor.

When to see a doctor

Ectopy without symptoms does not require treatment. It makes sense to see a doctor if:

• bloody discharge appears after sexual intercourse;
• there is vaginal discharge that may indicate cervicitis;
• sexual intercourse has become painful;
• you are 21 or older and have never had a gynecological examination or a Pap test.

Ectopy in itself is not a reason to call an ambulance. The numbers 103 and 112 are for a life-threatening condition: this is how emergencies such as serious injuries, stroke or heart attack are assessed.

This material is for reference: it does not replace a doctor's consultation, which is what you specifically need.

This content is for reference and does not replace a doctor's consultation. Medical disclaimer