Cervical ectopy

Cervical ectopy is a common gynecological condition, also known as cervical erosion or ectropion. It occurs when cells that are normally present inside the cervical canal (glandular cells or columnar epithelium) begin to extend to the outer surface of the cervix, which is normally covered by squamous cells. These two types of cells are clearly distinguishable upon examination, and the presence of glandular cells on the external surface creates a characteristic contour that can be seen during a colposcopic or vaginal examination. This pathology can be detected in women of different ages, but it is more common in young and sexually active women.

Prevalence of ectopy and association with contraception

Cervical ectropion is one of the most common gynecological conditions, with a prevalence ranging from 17 to 50%. It is interesting to note that the incidence of this condition increases with the number of childbirths, but it decreases in women over 35 years old. In adolescents and young sexually active women, this pathology can occur in 80% of cases. It is important to note that ectopy is also associated with the use of hormonal contraception. Women taking oral contraceptives have a higher risk of developing an ectropion, while barrier methods of contraception, such as condoms, significantly reduce the likelihood of this condition.

Ectropion and its manifestations

Cervical ectropion often does not cause pronounced symptoms, and many women may not realize they have this condition for years. However, when symptoms do appear, they may include:

• Increased vaginal discharge. Glandular cells produce more mucus than squamous cells, leading to increased discharge. This discharge may be clear, white, or slightly yellowish.
• Blood-stained discharge or slight bleeding. This condition is particularly noticeable after sexual intercourse, a pelvic examination, or even after intense physical activity. This is due to the fact that glandular cells are more fragile and prone to damage.
• Postcoital bleeding. Light bleeding after sexual intercourse is a common symptom in women suffering from ectropion.
• Discomfort or pain during intercourse. Glandular cells exposed on the outside of the cervix may cause sensitivity or slight discomfort during or after sexual activity.
• Vaginal irritation. Increased discharge and minor bleeding can cause a feeling of irritation or even itching in the vaginal area.

More rarely, pelvic pain and menstrual irregularities may occur, which are related to other factors and may require further evaluation to assess the need for IVF.

Treatment of cervical ectopy

In most cases, treatment for cervical ectopy is not necessary if it does not cause significant symptoms. However, in cases of discomfort and complications, it is recommended to consider one of the following options:

1. Observation. If the condition is asymptomatic, regular gynecological follow-up is recommended to ensure that there is no progression of the condition or complications.
2. Changing contraception. If using hormonal contraceptives, it is recommended to switch to non-hormonal methods to reduce the effects of hormones on the cervical mucosa.
3. Topical treatment. Estrogen-based creams can promote healing of the cervix, especially in menopausal women.
4. Antibiotics. If an infection is present or suspected, antibiotic treatment is recommended.
5. Cauterization (coagulation). There are several methods of cauterization: electrocautery, cryotherapy (freezing with liquid nitrogen), chemical cauterization (e.g., with silver nitrate).
6. Laser therapy. A very effective and precise method to destroy abnormal epithelium with minimal pain and rapid healing.
7. Surgical intervention. In rare and severe cases, a conization of the cervix is performed.

Reproductive methods and cervical health

In Vitro fertilization and various types of assisted reproductive techniques are a true lifeline for many couples wishing to become parents. It is important to note that each reproductive technique - whether classic IVF, IVF with donation, or double donation - must be implemented with consideration of the woman's health status. Cervical ectopy, although benign, can create obstacles to pregnancy. Therefore, before IVF, it is important for doctors to carefully assess the condition of the cervix and address any abnormalities to minimize risks and maximize the chances of successful implantation and pregnancy development.

Ectopy should not be overlooked, especially in women considering IVF. Consulting a gynecologist, thorough diagnosis, and timely treatment of ectopy will help avoid complications and increase the chances of success of any assisted reproductive technology (ART) program.