HPV, cervical erosion, dysplasia and cancer: how are the diseases related?

Cervical erosion is one of the most common gynecological diseases, which almost every 5th woman encounters during her life, and sometimes more than once. However, erosion cannot be called a harmless condition. Although it is almost asymptomatic and can persist for years, over time, pathological changes in the mucous membrane of the cervix progress and ultimately can develop into cancer, which annually claims tens of thousands of women's lives. Therefore, it is important at least once a year, and preferably every six months, to make an appointment with a gynecologist, and if cervical erosion is detected, immediately undergo examination and begin treatment.

Doctor's comment: Almost every woman in her life has heard about such a disease as cervical erosion; many were diagnosed with this and treated, but, unfortunately, not all patients managed to solve this problem. The question arises: “Why?..”

Cervical erosion what is it?

This term hides a defect or local absence of the epithelial cover of the vaginal part of the cervix with exposure of the subepithelial stroma. They pose a serious threat to women's health, since if they are of infectious origin and develop with colpitis and cervicitis, this creates a high risk of subsequent damage to the uterus and appendages, as well as the development of female infertility. In addition, the presence of erosive changes leads to the formation of atypical cells, which can become malignant, i.e., develop cancer.

Expert Opinion of a Doctor

Cervical erosion is characterized by a long, persistent course and practically does not respond to conservative drug therapy. The lack of positive dynamics in the treatment of cervical erosion can lead to cervical dysplasia, i.e. disruption of the maturation and differentiation of cells of the multilayered squamous epithelium covering the cervix. Cervical dysplasia is already a precancerous disease of the cervix, which is why it is necessary to begin treatment for cervical erosion as early as possible.

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Exposure to various etiological factors leads to focal injury and desquamation of epithelial cells of the vaginal part of the cervix.

When examining the cervix in the speculum, a contact bleeding area of ​​a dark red color is visualized. Erosion is detected during colposcopy: at the site of a defect in the epithelial cover of the vaginal part of the cervix, an ulcer with clear edges is visualized, often a contaminated surface covered with fibrous exudate, which bleeds upon contact irritation.

During colposcopy, especially when using digital equipment, the gynecologist notices typical erosion:

• dilated blood vessels;
• swelling of the mucous membrane;
• traces of fibrin;
• mucopurulent discharge with bloody patches.

If the disease is detected at an early stage of development and competent conservative therapy is carried out, the defect is gradually closed by the squamous epithelium that is normal for the vaginal part of the cervix. Epithelization of cervical erosion can occur in a short time after the influence of the damaging factor ceases (1-2 weeks). In some situations, minor cysts, called nabothian cysts, remain on its surface, which also require conservative or surgical treatment to avoid the development of a chronic inflammatory process in the cervix.

Ectropion and ectopia

Cervical ectropion is an inversion of the mucous membrane of the cervical canal into the vagina, which can occur as a result of rupture of the cervix after childbirth or abortion. Eversion is usually localized around the external os of the cervix from the posterior lip, but can be more pronounced.

Cervical ectopia (also called “endocervicosis”) is a condition in which columnar epithelial cells covering the inside of the cervix enter the area of ​​stratified squamous epithelium covering the outer part of the cervix. When examining the cervix in the speculum, an area of ​​hyperemia around the external os of the cervical canal is visualized, ranging in width from several mm to 2 cm without clear boundaries.

In rare cases, ectopia may be congenital. They are formed during the prenatal period due to the displacement of the zone covered by columnar epithelium outside the cervical canal. They are often small in size, bright red in color, have a smooth surface and are not accompanied by an inflammatory process. Congenital erosions can go away on their own, but if they persist until puberty, they tend to become infected in the future.

The cylindrical epithelium covers the resulting defect, but also gradually grows into the tissues, forming peculiar branching glandular ducts. It produces its own secretion, which accumulates in the formed channels. If they are highly branched, the outflow of secretions from them becomes difficult, which leads to the formation of cysts of different sizes and numbers. They can be very small and invisible to the naked eye or reach a large size and become clearly visible even during a standard gynecological examination. Sometimes cysts form in the area of ​​erosion so large that they resemble cervical polyps.

If the pathology is not detected in a timely manner and treatment is not started, the number of cysts will progressively increase, which will provoke thickening of the cervix (hypertrophy). Depending on what cystic formations are formed, different types of cervical ectopia are distinguished:

• follicular or glandular - characterized by the presence of clearly marked cysts and glandular ducts;
• papillary - characterized by the presence of papillary growths on the surface of cystic formations with characteristic signs of inflammation;
• mixed - have features of both types of pseudo-erosions.

Doctor's comment: Cervical ectropion is a favorable environment for the proliferation of pathogenic microorganisms that cause inflammatory diseases. Ectopia of any kind itself becomes the cause of inflammation, and with a long course it leads to pathological changes in epithelial cells, in particular atypia and dysplasia. Since the presence of dysplasia is considered to be a precancerous condition of the cervix, such erosions require treatment as quickly as possible, and surgically.

For pregnant women, the presence of erosion can increase the likelihood of miscarriage or premature birth. But treatment is not carried out during this period, since it will further increase the likelihood of miscarriage.

Doctor's comment: Sometimes erosions of nonspecific etiology can self-epithelialize after a short time (from 3-5 days to 1-2 weeks), but, unfortunately, this outcome is extremely rare.

Consequences of cauterization

If cauterization was carried out justifiably, in the presence of strict indications, the procedure itself was carried out by a qualified specialist, the consequences will be minimal. Undesirable effects may occur after treatment:

1. Pain in the chest and lower abdomen - this condition occurs for 2-3 days and is considered normal. If the pain does not go away within 1 week, you should consult a specialist.
2. Relapse, when erosion occurs again after cauterization. Repeated cell damage occurs for the same reasons that ectopia initially appeared - HPV carriage, regular cervical injury, hormonal imbalance. But most often, erosion recurs during pregnancy due to hormonal changes in the body. In this case, the disease may go away on its own after delivery.
3. Scar on the cervix. This phenomenon practically does not occur after treating erosion with radio waves or a laser; with other types of cauterization it occurs as an undesirable effect. Scars and deformations subsequently lead to problems with conception and miscarriage.
4. Discharge. A dangerous side effect is bleeding - it sometimes occurs immediately after the procedure and lasts for several days, rarely even requiring hospitalization of the patient. The main cause of bleeding is damage to healthy tissue. Scanty discharge with blood disappears 10 days after the procedure. Such leucorrhoea has a liquid consistency and is odorless and does not cause discomfort.

Depending on the results of cauterization and the choice of procedure method, a woman rarely experiences individual side effects, for example, intolerance to the components for chemical cauterization, increased pain, and menstrual disorders.

Causes of cervical erosion

The disease has no age restrictions and occurs with almost equal frequency in teenage girls, nulliparous and parous women. But there are still factors that contribute to the development of cervical erosion:

• endocervicitis is the main cause of cervical erosion, which is an inflammatory process in the tissues of the cervix, which is provoked by their damage by bacteria, viruses and other pathogenic microorganisms;
• human papillomavirus, especially oncogenic types (16, 18, 31,33, 35, 39, 51, 52, 56, 58, 59, 66,68);
• infectious diseases of the genital organs (ureaplasmosis, chlamydia, trichomoniasis, gardnerellosis) - provoke the development of an inflammatory process that can affect the cervix;
• hormonal disorders - early or late onset of menstruation, taking incorrectly selected hormonal contraceptives, pregnancy, endocrine diseases;
• ectropion (often the result of a violation of the integrity, ruptures of cervical tissue during complex natural childbirth, as well as during artificial termination of pregnancy) - is a disease accompanied by inversion of the cervix;
• the effects of traumatic factors (rough sexual intercourse, the use of objects not intended for sexual play, etc.) provoke mechanical damage to the mucous membrane, which creates favorable conditions for the penetration of pathogenic microorganisms and the development of the inflammatory process.

Accurate determination of the causes of cervical erosion is very important, since if there is no influence on them, the disease will constantly recur. Also, what provoked the appearance of changes in the structure of the squamous epithelium of the cervix determines the degree of danger of the disease.

One of the common causes of cervical erosion is the human papillomavirus (HPV). Today, several dozen types of HPV have been discovered, each of which can provoke erosion with a different probability. HPV types 16 and 18 are considered the most dangerous. It is when they are detected that the risks of cervical erosion turning into cancer are considered the highest.

Our clinic has a special approach to the treatment of cervical erosion: we take into account the individual characteristics of each patient and use our own proven treatment methods. There are 10 main factors that we evaluate:

• woman's age;
• number of births and abortions in history;
• the beginning, duration and nature of sexual activity;
• hereditary predisposition;
• the nature of blood flow in the pelvis;
• lifestyle, bad habits;
• concomitant extragenital pathology;
• allergic reactions, including to used lubricants, spermicides, personal hygiene products and other substances;
• woman's hormonal status;
• the presence of foci of chronic infection.

Expert Opinion of a Doctor

If you do not take into account at least one of these factors when choosing patient management tactics, then the chances of successful treatment of cervical erosion are reduced... “Sedentary lifestyle”, how often we come across this phrase, but we don’t even imagine how strong an impact it has on blood flow in the pelvis, and this, in turn, affects women's health in general. That is why we pay special attention to this factor.

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Pre-invasive cancer

The condition is also called precancer, which describes its main feature – the absence of deep germination in the tissue. It does not metastasize and develops slowly; it can be caught in the initial stages and removed. Otherwise, the tumor will begin to penetrate the epithelium; a penetration depth of 4-5 mm corresponds to stage 1b.

It takes about 5 years for CIN 1 to transform into carcinoma in situ. Time is on your side. Regularly see a gynecologist, so as not to miss the disease, undergo a cytological examination. Modern diagnostics are accurate (99% confidence), which reduces mortality from malignant tumors by up to 10 times.

Symptoms

Cervical erosion in most cases occurs almost unnoticed and is detected only during a preventive gynecological examination. Only in isolated cases may women notice the occurrence of:

• more abundant vaginal discharge;
• slight pain in the lower abdomen;
• discomfort and bleeding during or after sexual intercourse;
• menstrual irregularities;
• vaginal discharge with an unpleasant odor and unusual color, for example, yellowish, greenish, foamy, etc. (with the addition of sexually transmitted infections).

In especially advanced cases, the disease may be accompanied by a constant discharge of thick, viscous discharge, which may contain traces of pus and blood.

Prices

Price (RUB) In installments* (RUB) Consultation with a surgeon on the operation (SPECIAL)0—Online doctor’s opinion on the operation (SPECIAL)0—Treatment of erosion, leukoplakia of the cervix using radio wave surgery, Cat. I. complexity from 5050—Treatment of erosion, leukoplakia of the cervix using radio wave surgery, category II. complexity from 8500—Treatment of erosion, leukoplakia of the cervix using radio wave surgery, category III. complexityfrom 12500—

* You can read more about the conditions here - Treatment on credit or in installments

The cost is preliminary. The exact cost of the operation can only be determined by a surgeon during a free consultation.

Diagnosis of cervical erosion

Since almost always, with rare exceptions, cervical erosion does not cause significant discomfort to women, most often it is discovered completely by accident during a routine preventive examination. Initially, the doctor may notice signs of changes in the epithelium of the cervix after inserting a gynecological speculum into the vagina.

For a more thorough examination and clarification of the diagnosis, as well as the stage of development of erosion, colposcopy is used. Using a special device with the possibility of multiple magnification (colposcope), it is possible to examine the focus of pathological changes in all details.

Doctor's comment: The most accurate data on the nature and boundaries of cervical lesions is provided by digital colposcopy, the advantage of which is that the woman herself can see the cervix with foci of pathological changes on the screen.

If there is a suspicion of the formation of atypical cells or the presence of dysplasia, the doctor may decide to perform an extended colposcopy. The method involves treating the vaginal part of the cervix with a solution of acetic or salicylic acid and a 5% aqueous solution of iodine, after which the cervix is ​​examined again through a colposcope. Thanks to the use of iodine solution, areas of dysplasia are painted yellow, atypia - white, and healthy tissues are evenly stained brown.

In cases where extended colposcopy confirms the presence of dysplasia, the patient is prescribed:

• scraping from the cervix for a PAP test;
• targeted biopsy with histological analysis of the sample;
• HPV analysis of all strains with quantitative HPV typing.

But detection of erosion is not the final stage of diagnosis. To develop the most effective treatment, it is necessary to determine exactly what caused the disease. Therefore, women are prescribed a comprehensive examination, which may include:

• flora smear
• PCR analysis for the presence of sexually transmitted diseases (STDs or STIs);
• blood test for hormone levels;
• Ultrasound of the pelvic organs;
• blood test for HIV and syphilis.

Doctors

Radio wave surgery is a fairly new method of treating gynecological diseases in our country. Therefore, we advise you to contact only a clinic where proven professionals work. Before seeking help from a surgeon specializing in this treatment method, you should be examined by a gynecologist, who will decide whether surgery is necessary or whether the disease can be cured in other ways.

Treatment with radio waves in our center is carried out by high-class specialists who have undergone special training and thoroughly know the technique. Rich experience, extensive practice and the ability to act harmoniously and quickly in serious situations are what distinguish our doctors. They regularly undergo advanced training courses and have all the necessary skills in handling the most modern equipment.

Treatment of cervical erosion

How a gynecologist decides to treat cervical erosion depends on many factors. If STDs are identified during the examination, the patient is prescribed various medications to eliminate them. Only after receiving negative results from repeated tests do they move on to treating erosion directly, although often both diseases are treated simultaneously. In this case, the woman’s age, the area of ​​the lesion, planning a pregnancy in the future, etc. are taken into account.

Expert Opinion of a Doctor

In my practice, I focus on treating the underlying disease that caused the development of cervical erosion. I am not a supporter of prescribing surgical treatment for a patient with cervical erosion at the initial examination. Just surgically eliminating the pathological area on the cervix is ​​not enough; you need to approach the treatment of cervical erosion in a comprehensive manner. I conduct a full examination of each patient, evaluate the results of clinical and laboratory tests, always take into account 10 key factors, and only after that I develop treatment tactics. Most often, in the treatment of cervical erosion, two-stage or three-stage therapy takes place, including drug treatment aimed at restoring the vaginal microflora, hormonal status, and normalizing blood flow.

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In some cases, erosion gradually goes away on its own after eliminating the causes of its development, i.e. hormonal imbalance, STDs, etc., against the background of local therapy that stimulates the natural processes of tissue regeneration. As the area formed on the vaginal part of the cervix heals, the columnar epithelium is replaced by the flat epithelium typical of the vagina, and the amount of discharge also decreases.

Doctor's comment: Healing of erosion is considered final if there is rejection of the glandular ducts and columnar epithelium against the background of its complete replacement with flat epithelium.

But this is not always possible, especially if it is not possible to reliably determine the cause of erosion. In such situations, especially when areas of atypia and dysplasia are detected, the patient is prescribed minimally invasive surgical treatment.

Thus, treatment for cervical erosion may include medication and surgery. In some cases, for example, when diagnosing congenital erosion or detecting a disease during pregnancy, gynecologists take a wait-and-see approach, i.e., they conduct dynamic monitoring of the condition of the cervix.

Drug treatment

Drug therapy is prescribed for:

• STD;
• hormonal disorders;
• mild forms of erosion.

For each woman, the quantity and combination of medications are selected strictly individually based on test results. Therefore, drug therapy may include both drugs intended for oral use and local therapy in the form of vaginal or rectal suppositories, ointments, gels, and creams.

It may include:

• antibiotics - indicated for infections of bacterial origin, in particular chlamydia and ureaplasmosis;
• antiviral drugs - prescribed when HPV, herpetic, cytomegalovirus infections are detected;
• immunostimulants – used to strengthen the immune system and increase the body’s resistance to infectious agents;
• antifungal agents - prescribed in isolation for vaginal candidiasis or in addition to antibiotics during aggressive antibiotic therapy;
• hormonal drugs - indicated when abnormalities in hormone levels are detected and can be prescribed both in relatively short courses and as part of lifelong replacement therapy;
• antispasmodics - used to eliminate discomfort in the lower abdomen.

After treating the discovered cause of cervical erosion and repeating tests (sometimes multiple times) with negative results, they move on to treating the erosion itself. To speed up the healing process of a defect in the mucous membrane, patients are prescribed vaginal suppositories (suppositories) and/or ointments that have local healing, anti-inflammatory properties, as well as suppress the growth and reproduction of pathogenic microorganisms. Additionally, gynecologists may recommend inserting gauze swabs moistened with solutions of various medications with a similar effect into the vagina.

Attention! Chinese and other tampons, actively promoted on the Internet, are, at best, ineffective in combating cervical erosion, and in the worst case, lead to the development of complications.

Separately, it is worth considering the method of “cauterizing” erosion using special chemicals. The procedure involves the use of the drug Solkovagin and its analogues, and its essence is to treat erosion with a chemical composition. It provokes the death of the columnar epithelium, in place of which a scab forms. Over time, this “crust” falls away, exposing the cervix, covered with healthy epithelium. But the method is rarely used due to its low efficiency.

Surgery

Unfortunately, it is not uncommon for conservative treatment of cervical erosion to fail to produce positive results, and the disease continues to gradually progress. Its development cannot be called rapid, nevertheless it occurs, therefore, in order to avoid complications and malignancy of cervical cells, women are recommended to “cauterize” the erosion in one way or another.

Today, there are many options for surgical treatment of cervical erosion, which, by and large, can hardly be called serious interventions in the body. Therefore, the procedures are carried out under local anesthesia, take no more than an hour and are distinguished not only by a high level of effectiveness, but also by complete safety when performed by a qualified specialist. Therefore, once a decision is made to radically solve the problem of cervical erosion in the majority of cases, it allows you to forget about this insidious disease forever and reduce the risk of developing cervical cancer to a minimum.

The basis of all modern methods of surgical treatment of the disease is the destruction of columnar epithelial cells by one or another type of influence. As a result, they are rejected, which leads to the gradual closure of the wound defect by squamous epithelial cells. Today, the following are used for surgical treatment of the disease:

• diathermocoagulation;
• laser vaporization;
• cryocoagulation;
• radio wave treatment.

Expert Opinion of a Doctor

Each method has its own advantages and disadvantages. The method of radio wave coagulation can be considered the most progressive, effective and safe. Our clinic has the latest modern equipment for radio wave treatment of cervical erosion. In our clinic, treatment of cervical erosion is carried out individually, taking into account her age, plans for further pregnancy, taking into account concomitant diseases. We use in our practice new approaches to the treatment of cervical erosion. Most often, the patient is offered several options to choose from, based on her individual characteristics, among which she independently chooses the most suitable treatment method for her.

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But “cauterization” of erosion is possible only after performing not only an extended colposcopy, but also a targeted biopsy, confirming the absence of an oncological process. If malignant cells are detected during the study, the woman will be advised to consult an oncologist and subsequently undergo surgical treatment. In this case, the degree of radicality of the operation will largely depend on the stage at which cervical cancer is diagnosed.

After surgical treatment of cervical erosion by any method, a recovery period begins. When using diathermocoagulation it is longer, in other cases it is shorter, but the recommendations for this time are the same. Women require:

• complete sexual rest during the entire rehabilitation period (return to sexual life is possible after examination by a gynecologist);
• gentle physical activity with complete avoidance of lifting heavy objects;
• refuse to visit the pool, sauna, bathhouse, open reservoirs, or take a bath;
• use medications prescribed by your doctor to speed up the tissue healing process;
• carefully monitor personal hygiene, wear underwear made from natural fabrics;
• stop smoking and drinking alcohol.

Planning a pregnancy is possible only after 1-2 months, or better yet six months, after the erosion has been “cauterized.”

Diathermocoagulation

Diathermocoagulation is the oldest method of treating cervical erosion, which is based on the use of thermal energy created by high-frequency alternating electric current. As a result, the treated tissues are significantly heated and coagulated, and then rejected by the body. This may be accompanied by minor bleeding. The resulting wound heals completely after 1.5-3 months.

Diathermocoagulation is the most affordable method of treating erosion, but is used mainly to treat women during menopause, when there is no longer any chance of pregnancy.

But diathermocoagulation is not recommended for use by nulliparous girls, as it leads to the formation of scars at the site of exposure, which will prevent normal dilatation of the cervix during natural childbirth. Also, using the method increases the likelihood of developing endometriosis. Therefore, if the choice falls on this method, the procedure is planned for the 2nd phase of the menstrual cycle.

Diathermocoagulation requires the use of local anesthesia, since it causes significant pain. If errors are made in the procedure, the procedure can lead to problems in bearing the fetus.

Laser vaporization

The method involves the use of laser thermal energy to destroy columnar epithelium and cystic formations in pseudo-erosion of any type. Laser vaporization is indicated on days 5-7 of the menstrual cycle, i.e. immediately after the end of menstruation.

Among the advantages of the procedure are:

• painlessness;
• no risk of scar formation, which allows it to be used for the treatment of cervical erosions in nulliparous women;
• rapid rejection of dead cells and complete regeneration of healthy tissues.

After laser vaporization, restoration of normal cervical epithelium occurs within a month.

Cryocoagulation

The method is based on the use of liquid nitrogen, which instantly freezes cells at the affected sites. This leads to their death and replacement with healthy squamous epithelium. Cryodestruction is different:

• bloodlessness;
• painlessness;
• no risk of scar formation at the site of exposure;
• early epithelization of the wound surface;
• low cost.

After cryocoagulation, complete restoration of the cervix is ​​observed after 1-1.5 months, but on the first day after the procedure, women should be prepared for heavy watery discharge and discomfort in the lower abdomen caused by tissue swelling. The disadvantage of this method is the possibility of relapse of the disease over time.

Radio wave treatment

Radio wave ablation and conization are considered the most modern method of combating cervical erosion, including signs of atypia and dysplasia. It provides almost 100% efficiency and at the same time has a maximum level of safety.

The essence of the procedure is to influence erosion with very high frequency electromagnetic oscillations created by a special device “Fotek”. A person practically does not feel their effects, so radio wave treatment is absolutely painless. In addition, the advantages of the method are:

• lack of direct contact of the instrument with tissues;
• no risk of scarring;
• no need for postoperative wound treatment;
• speed of implementation;
• the possibility of treating erosion with deep penetration into the thickness of the tissues of the cervix (radio wave conization is performed with the removal of a section of tissue in the form of a cone).

During the procedure, an unpleasant odor may be felt, which is considered normal.

The only drawback of the method can be considered the rather high cost.

Thus, almost every woman can experience cervical erosion, but you should not be afraid or, conversely, be negligent about this disease. If a diagnosis is made and the cause is found, it is important to begin treatment immediately. This will be the key to a quick recovery and complete preservation of reproductive function. And in order not to miss the moment of erosion and not to trigger the disease, you should not neglect preventive examinations and visit a gynecologist at least once a year, and preferably every 3-6 months.