Anatomical significance and role in the development of inflammation
The cervical canal plays an essential role in protecting the reproductive system. The anatomical boundary separating pelvic inflammatory diseases (PID) into lower and upper genital tract pathologies is the internal os of the uterus.
Inflammation of the canal mucosa — endocervicitis — belongs to lower tract diseases (along with vulvitis, colpitis, and bartholinitis). If the infectious process crosses the internal os, severe upper tract pathologies develop: endomyometritis, salpingooophoritis, or pelvioperitonitis.
During intrauterine interventions (e.g., instrumental abortion), the cervical canal undergoes mechanical stress. To access the uterine cavity, the cervix is fixed with bullet forceps on the anterior lip, traction is applied to straighten the cervical canal, and then the cervical canal is dilated.
Etiology and diagnostics of endocervicitis
Endocervicitis rarely occurs in isolation and most commonly accompanies non-specific vaginitis (colpitis) or exocervicitis.
- Pathogens: inflammation is caused by both absolute pathogens (gonococci, chlamydia, trichomonads, Mycoplasma genitalium) and opportunistic flora (staphylococci, E. coli, Candida fungi, non-spore-forming anaerobes). The current trend in pelvic inflammatory diseases is the predominance of mixed microflora.
- Routes of transmission: the primary route is sexual. Domestic transmission is rare and occurs mainly in girls when sharing hygiene items.
- Diagnostics: to identify the pathogen, bacteriological and bacterioscopic examination of discharges from the cervical canal, vagina, and urethra is mandatory. Smear microscopy reveals a large number of leukocytes, desquamated epithelium, and abundant Gram-positive or Gram-negative flora.
Important: the presence of acute or subacute endocervicitis is a strict contraindication to artificial abortion, as it threatens the generalization of the infection.
Acquired cervical ectopia
Ectopia forms as a result of the epithelization of true erosion, when columnar epithelium proliferates on the vaginal portion of the cervix (its source is reserve cells). Predisposing factors include hormonal disorders and urogenital infections (including viral ones).
- Clinical presentation: the disease is typically asymptomatic. Possible complaints of leukorrhea and contact bleeding are usually caused by concomitant inflammation (endocervicitis).
- Physical examination: gynecological speculum examination reveals an irregularly shaped, bright red area against the pale mucosa of the exocervix (often asymmetrical on the anterior or posterior lip).
- Colposcopy: areas with numerous rounded or elongated red papillae are identified, giving the surface a velvety appearance. The bright red color occurs because blood vessels of the underlying stroma shine through the single layer of columnar cells.
Transformation zone and treatment tactics
The colposcopic picture of ectopia is often complemented by the transformation zone. It reflects the process of replacement of columnar epithelium by stratified squamous epithelium. Metaplastic and immature squamous epithelium, as well as open and closed glandular ducts, are visualized in this zone. The latter are formed when crypts in the ectopia zone are blocked by encroaching stratified squamous epithelium.
Patient management tactics are determined based on the results of colposcopy, cytology, human papillomavirus (HPV) testing, and biopsy (if necessary).
- Active surveillance: indicated for uncomplicated ectopia in nulliparous women.
- Complex treatment: used for persistent inflammatory processes and the presence of HPV. The first stage involves anti-inflammatory and antiviral treatment. The second stage involves surgical intervention: cryodestruction, laser coagulation, or radiosurgery.
To remember the boundary of inflammation, imagine an hourglass: the narrow neck is the internal os. Everything below (endocervicitis, colpitis) is the lower tract, and everything above (endomyometritis) is the upper tract.
Class and exam questions
Why does ectopia appear bright red upon examination?
The columnar epithelium consists of just a single layer of cells. Blood vessels of the underlying stroma show through them clearly, which gives them a bright color.
Should ectopia be cauterized in nulliparous women?
If ectopia is uncomplicated, only active surveillance is indicated. Surgical treatment is used only for persistent inflammation and the presence of HPV.
How do closed glandular ducts form in the transformation zone?
They form when the encroaching stratified squamous epithelium blocks crypts lined with columnar epithelium.
What else to study on this topic
- Classification and etiology of pelvic inflammatory diseases (PID).
- Non-specific vaginitis (colpitis): acute and chronic stages, cure criteria.
- Methods of pregnancy termination and prevention of Rhesus sensitization.
- Rules for taking smears from the vagina, urethra, and cervical canal.
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