The uterus is a part of the uterus that connects it with the vagina.
1. Outdoor 2. The inner seats. 3. Surface of the cervix - exocervix (vaginal part) - part of the cervix, available for direct examination during colposcopy or conventional gynecological examination using a vaginal mirror. 4. Cervical canal - endocervix (superficial part of the cervix, the inner part of the cervix) - connects the surface of the cervix with the body of the uterus (in fact, the uterus). A part of the cervix is practically not available.
The surface of the cervix (exotservix) is normally covered by a multilayered flat epithelium. This multi-layered epithelium on the surface of the cervix consists of 4 layers of cells. In the most superficially layered cell layer contains glycogen and keratin, thanks to which the multilayered flat epithelium has a protective function in the system of external barrier of female genital organs. In the menopause there is a thinning of the epithelium and a decrease in the concentration of protective factors.
The cervical canal is represented by a single-layer cylindrical epithelium. The absence of cylindrical epithelium of glycogen and keratin causes a decrease in protective reactions. But the cylindrical epithelium has other mechanisms of protection - the production of mucus containing a large amount of lysozyme, interferons, which, in turn, are capable of destroying microbial and viral cells.
The site of the joint of two types of cervical epithelium in normal in women of reproductive age is in the field of external iodine (Fig.). However, until 22-23 years, the cylindrical epithelium from the cervical canal can enter 1/3 of the surface of the cervix. This condition is called ectopic cervix or false erosion of the cervix. With normal results of strokes and cytology (no inflammation, no dysplasia), such erosion of the cervix does not require treatment, but only a dynamic observation.
Erosion of the cervix
Erosion of the cervix is described - congenital erosion. Similarly, there are acquired erosion of the cervix. The mechanism of the occurrence of acquired erosion is that the movement of the mucous membrane of the cervical canal (single-layer, poorly performing mechanical protective properties of the epithelium) occurs on the surface (vaginal part) of the cervix.
Causes of erosion of the cervix:
- Disormonal erosion of the cervix - a violation of the smooth functioning of sex hormones;
- Post-traumatic erosion of the cervix - erosion of the cervix after delivery, abortion;
- Inflammatory erosion of the cervix - in the presence of sexually transmitted infections - chlamydia, ureaplasmosis, mycoplasmosis, trichomoniasis, gonorrhea - specific inflammation. With non-specific inflammation (caused by conditionally pathogenic microflora - E. coli, staphylococci, streptococci, etc.).
Diagnosis of erosion of the cervix
For a complete diagnosis of cervical erosion, the following are used:
- Cytology (PAP-test, oncocytology, cytomorphological examination of the cervical epithelium);
- The second stage in the detection of inflammation is the collection of analyzes on sexually transmitted infections, baccosis of gonogenital secretions;
- In case of suspicion of dyshormonal erosion, a hormonal mirror is studied.
Treatment of erosion of the cervix
Treatment of erosion and dysplasia of the cervix depends on many factors and the decision as to which method will be optimal is taken on the basis of a detailed analysis of all circumstances individually.
The purpose of treating erosion and dysplasia is to remove abnormal tissues from the surface of the cervix and the cervical canal in order to avoid the risk of cell regeneration and the development of cervical cancer.
What circumstances are taken into account when planning treatment for erosion:
- Degree of dysplasia during PAP test (microscopic examination of cells from the surface of erosion after coloring with a special substance). If CIN I dysplasia is detected or simply epithelial metaplasia, it often does not require any treatment. Usually such erosion is healing on their own. For control, colposcopy is performed once every 3 months for 6 months. If erosion does not heal on its own, it needs to be treated. Severe degrees of dysplasia are subject to compulsory treatment;
- If, in the presence of erosion or dysplasia, CIN I is detected in high-cancers of the neck of high-risk papillomaviruses (type 16, 18, 31, 33) - even light dysplasia should be treated;
- Age of the patient. In cases where a woman has not given birth, but there is a dysplasia of mild to moderate degree, use only gentle methods of treatment (argonoplasmic coagulation);
- With a defeat of the canine of the cervix, a cone-cone-shaped cutting of the transformation zone is used. In the cervix channel, the surface is difficult to control and visual assessment, so when data on the presence of dysplasia cells are obtained, a complete removal of the area in which cancer can develop can be done.
What are the methods of treating erosion and dysplasia?
Disormonal erosion of the cervix Is effectively treated by restoring the normal hormonal function of a woman. Most often, in cases of dyshormonal erosion of the cervix, eruption of the cervix is not performed. Moreover, after burning the dyshormonal erosion of the cervix and even the restored hormonal balance, it may appear again. In post-traumatic erosion of the cervix (erosion after childbirth or abortion), apply all sorts of destructive methods of treatment or cramping. Candles, ointments, tampons for treatment are used as auxiliary procedures, which helps to accelerate the erosion of the cervix as soon as possible before and after cooking, but they are not effective as an independent treatment. This is a clinically proven fact.
Chemical coagulation of cervical erosion. The most accessible but also the least effective procedure. It lies in the application of erosion solution of solvagina, which causes coagulation of the affected tissue. Manipulation is carried out under the control of colposcopy (with increasing field of processing) for more accurate application of drugs. A few days after the treatment with solovagin begins the rejection of dead cells of erosion. Underneath, a new layer of healthy epithelium is formed. The procedure is painless and there are no complications in it. Unfortunately, the processing efficiency of solkovaginom is small and often it is necessary to carry out repeated processing. In addition, the treatment of dysplasia, even of mild degree, can not be carried out with the help of solvolchinin.
Treatment of erosion with liquid nitrogen. Quite an effective method. Based on the rapid freezing of affected tissues. However, there is a danger of too deep penetration of the cold and, as a consequence, the formation of scarring on the cervix. Scarring leads to a violation of the course of pregnancy and childbirth.
Electrocoagulation (Diatomaceous earth) - the effect on the fabric of an electrode, which is heated under the influence of electric current. The mechanism of action is thermal burn, which can be painful and require good anesthesia. In addition, because of the difficult visualization (the treated area is quickly covered with scab), under the treated surface areas may remain untreated cells of the dysplasia, which leads to a possible recurrence.
Laser treatment of erosion - a safe and effective method. However, this method requires high qualification from the doctor, as errors can lead to significant burns and scarring of the cervix.
Radiowave surgery - uses the energy of high frequency radio waves that cause instant necrosis of the treated tissue, have a high penetration depth. Can be used to take a biopsy (a piece of tissue for research).
Treatment of erosion of the cervix by method Argonoplasmic ablation (Coagulation). The progressively new method of treating erosion of the cervix is argonoplasmic ablation (coagulation) of the cervix - the effect on tissue plasmas molded with ionized argon. This is a contactless procedure, without touching the instrument to the tissues. Safe fabric effect due to clearly controlled penetration depth. No charred fabrics, no unpleasant odors during manipulation. Effectively used for surface coagulation, homogeneous hemostasis and tissue deviations. It is practically painless, does not leave scars and is widely used to treat erosion of the cervix and dysplasia in women who gave birth. The procedure is completely safe, since the depth of the entrance of the torch of argon plasma is 0.5 mm to 3 mm.
Methods of prevention
The following recommendations will help reduce the chances of developing erosion and dysplasia:
- Eat calcium-rich foods, including beans, almonds, cabbage and spinach;
- Use vegetables of the family of crucifers: broccoli and cauliflower;
- Eat foods rich in antioxidants: lobster, tomatoes, cherries, zucchini, pumpkin;
- Avoid the use of refined products: white bread, pasta and sugar;
- To provide protein, eat low-fat meat, sea fish (low-fat varieties) and legumes (soybeans, beans);
- Use in the food unrefined oil (in no case used during roasting);
- Avoid the use of rich trans-isomers of fatty acids products: cakes, cakes, biscuits, fried potatoes, donuts, chips;
- Drink at least 8 glasses of water per day;
- Do not eat coffee, alcohol or cigarettes;
- Exercise at least 5 times a week for 30 minutes;
- There is evidence that the use of green tea contributes to the prevention of the development of dysplasia and cervical cancer.