Cervical erison

Cervical erison or ectropion

1. CERVICAL EROSION

2. ECTROPION. CERVICITIS. POLYPS. WARTS. NABOTHIAN CYSTS. MYOMAS. MICROGLANDULAR HYPER……… CERVICAL STENOSIS. BENING LESIONS OF CERVIX

3. Cervical ectropion is a condition where cells from inside the cervix form a red, inflamed patch on the outside the cervix . Also known as cervical erosion, cervical ectropion is not usually a health concern. However, because of the way it looks, it can be hard to distinguish from the early stages of  cervical cancer . For this reason, it is essential to understand the difference between the two conditions . This presentation explores the causes, symptoms, and treatments for cervical ectropion. INTRODUCTION

4. Cervical ectropion (also known as cervical erosion and ectopy) is a common condition caused when cells from inside the cervical canal, known as glandular cells (soft cells), are present on the outside surface of the cervix (neck of the womb). Cervical ectropion can be caused by hormonal changes, pregnancy and being on the pill. It is not linked to the development of cervical cancer or any other condition that causes cancer. DEFINITION

5. Some women are born with cervical ectropion. It may also be caused by: Hormonal changes : Cervical ectropion may be caused by fluctuations in hormone levels and is most common in women who are of reproductive age. Women who have gone through  menopause  rarely get cervical ectropion. Taking the contraceptive pill : Taking  birth control  pills affects a person's hormone levels and may cause cervical ectropion. Pregnancy : Being pregnant may also cause cervical ectropion due to the changes in hormone levels. The symptoms of cervical ectropion are caused by the delicate glandular cells that appear on the outside of the cervix. They produce mucus and bleed easily, which may lead to spotting and pain during or after sexual activity. Causes

6. It is thought that cervical ectropion is induced by high levels of  oestrogen . Therefore, factors that increase the risk of ectropion are related to those that increase levels of oestrogen: Use of the combined oral contraceptive pill Pregnancy Adolescence Menstruating age (it is uncommon in post-menopausal women) Risk Factors

7. Etiology and Pathophysiology The  cervix  is the lower portion of the uterus. It is composed of two regions; the ectocervix and the endocervical canal. Endocervical canal  (endocervix) – the more proximal, and ‘inner’ part of the cervix. It is lined by a mucus-secreting simple columnar epithelium. Ectocervix  – the part of cervix that projects into the vagina. It is normally lined by stratified squamous non-keratinized epithelium. In cervical ectropion, the stratified squamous cells of the ectocervix undergo  metaplastic change  to become simple columnar epithelium (the same as the endocervix). This change is thought to be induced by high levels of oestrogen. The columnar epithelium contains  mucus-secreting glands , and thus some individuals with cervical ectropion experience increased vaginal discharge. It may also give rise to post-coital bleeding, as the fine blood vessels present within the epithelium are easily broken during intercourse.

8. The primary symptom of cervical ectropion is a red, inflamed patch at the neck of the cervix — the transformation zone. The transformation zone looks red and inflamed because the glandular cells are red, delicate, and easily irritated. Other symptoms a woman may experience include: pain during sex bleeding during or after sex light discharge of mucus spotting between periods SYMPTOMS

9. Some women will only have mild symptoms, while others experience more severe discomfort. It is important to note that cervical ectropion is not the only cause of symptoms such as these. If a woman has any of the above symptoms, it is a good idea to speak with a doctor to rule out more serious causes.

10. Pap test : Also known as a Pap smear, this involves a healthcare professional scraping a small sample of cells from the cervix to test for  human papillomavirus  (HPV) and cancerous or precancerous cell changes. Colposcopy : This is when a healthcare professional examines the cervix more closely with bright lighting and a magnifying instrument. Biopsy : This is when a small tissue sample is taken and tested for cancerous cells. A woman may experience cramping during the procedure. DIAGNOSIS

11. Cervical ectropion is a  clinical diagnosis . The main role of any investigation is to exclude other potential diagnoses: Pregnancy test Triple swabs  – if there is any suggestion of infection (such as purulent discharge), endocervical and high vaginal swabs should be taken. Cervical smear  – to rule out cervical intraepithelial neoplasia . If a frank lesion is observed, a biopsy should be taken (note that biopsies are not performed as routine). INVESTIGATIONS

12. Cervical ectropion is not a harmful condition and does not usually require treatment . There are three different versions of cauterization therapy: Diathermy : This uses heat to cauterize the affected area. Cryotherapy : This uses very cold carbon dioxide to freeze the affected area. A 2016 Study found this to be an effective treatment for women with cervical ectropion who were experiencing a lot of discharge. Silver nitrate : This is another way to cauterize the glandular cells. TREATMENT

13. After the treatment, the doctor may recommend that a woman avoids some sexual activity and using tampons for up to 4 weeks. After this time, her cervix should have healed. If a woman experiences any of the following after the treatment, she should go back to the doctor: discharge that smells bad heavy bleeding (more than a average period) ongoing bleeding

14. MANAGEMENT Cervical ectropion is regarded as a  normal variant , and does not require treatment unless symptomatic. First-line treatment is to stop any oestrogen containing medications – most commonly the combined oral contraceptive pill . This is effective in the majority of cases. If symptoms persist, the columnar epithelium can be  ablated , typically using cryotherapy or electrocautery . This will result in significant vaginal discharge until healing is completed. Medication to acidify the vaginal pH has been suggested, such as boric acid pessaries.

15. To assess the patient condition and explain to the patient . Cervical ectopic is very common during pregnancy . Pregnant women are more likely to experience signs and symptoms due to hormonal changes and high levels oestrogen in their body . Although those changes are common, any unusual discharger bleeding in pregnancy should be investigated by patient GP. midwife or early pregnancy unit ensure there is no other cause of the bleeding. To advice the patient to medications – most commonly the combined oral contraceptive pills. It is important that patient will be invited for routine cervical screening ,patient should attend . This helps to assess the patient cervix regularly and check for any abnormal cells or changes that may need further treatment . Medication to acidify the vaginal PH has been suggested such as boric acid pessaries. To educated avoid the sex till the treatment will get completed. NURSING MANAGEMENT

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