CERVICAL ECTOPY (EROSION)
Definition: 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.
ETIOLOGY: - Congenital and Acquired.
Congenital: 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 estrogen derived from the mother falls. Thus, the congenital ectopy heals spontaneously.
ACQUIRED:- After birth.
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 is 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 been discarded. However, chronic cervicitis may be associated or else the infection may supervene on an ectopy because of the delicate columnar epithelium which is more vulnerable to trauma and infection.
CLINICAL FEATURES: -
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.
Ectropion: The lips of the cervix are curled back to expose the endocervix. This may be apparent when the lips of the cervix are stretched by the bivalve speculum.
Early carcinoma: It is indurated, friable and usually ulcerated which bleeds to touch.
Primary lesion (chancre): The ulcer has a punchedout appearance.
Tubercular ulcer: There is indurated ulcer with caseation at the base. Biopsy confirms the diagnosis.
HOMOEOPATHIC MANAGEMENT OF CERVICAL EROSION: -
- Kreosotum:- Well indicated for cases of Cervicitis with offensive vaginal discharge. The vaginal discharge is yellow or white colored. It has extremely putrid, offensive odour. It is acrid and causes itching, smarting in genitals.
- Alumina:- Valuable for managing vaginal discharge with extreme burning in genitals. The vaginal discharge is profuse and transparent. It is corrosive with burning. Discharge is worse during the daytime.
- Nat mur:- Helpful in managing thick white vaginal discharge. The discharge is profuse. It causes itching especially at night. Smarting pain may also attend itching. Excessive debility accompanies vaginal discharge.
- Hydrastis:- Valuable to manage thick yellow vaginal discharge. The discharge may be tenacious, viscid, and ropy attended with offensive smell. Offensive pus like discharges from the vagina is also indicative.
- Sepia: - There is terrible pain during coition. Alongwith this there is severe itching of vulva and vagina. Vaginal discharge of thick yellow or green color is present. The discharge is of acrid and excoriating nature. The discharges tend to get worse after urination. A prominent bearing down in the Pelvis is marked