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: -