 CERVICAL EROSION:

• Cervical eversion is a condition in which the cells from the 'inside' of the
cervical canal, known as glandular cells (or columnar epithelium), are
present on the 'outside' of the vaginal portion of the cervix. The cells on
the 'outside' of the cervix are called squamous epithelial cells. Where the
two cells meet is called the transformation zone, also known as the
stratified squamous epithelium.
 Histology of Cervix:
• The endocervical mucosa is about 3 millimetres (0.12 in) thick, lined
with a single layer of columnar mucous cells, and contains numerous
tubular mucous glands which empty viscous alkaline mucus into the
lumen. In contrast, the ectocervix is covered with nonkeratinized
stratified squamous epithelium, which resembles the squamous
epithelium lining the vaginal. The junction between these two types of
epithelia is called the squamocolumnar junction. Underlying both types
of epithelium is a tough layer of collagen. The mucosa of the endocervix
is not shed during menstruation. The cervix has more fibrous tissue,
including collagen and elastin, than the rest of the uterus.
• In prepubertal girls, the functional squamocolumnar junction is present just within
the cervical canal. Upon entering puberty, due to hormonal influence, and during
pregnancy, the columnar epithelium extends outwards over the ectocervix as the
cervix everts. Hence, this also causes the squamocolumnar junction to move
outwards onto the vaginal portion of the cervix, where it is exposed to the acidic
vaginal environment. The exposed columnar epithelium can undergo physiological
metaplasia and change to tougher metaplastic squamous epithelium in days or
weeks.which is very similar to the original squamous epithelium when mature. The
new squamocolumnar junction is therefore internal to the original squamocolumnar
junction, and the zone of unstable epithelium between the two junctions is called the
transformation zone of the cervix. After menopause, the uterine structures involute
and the functional squamocolumnar junction moves into the cervical canal.
 Cervical Histology:
• Nabothian cysts (or Nabothian follicles) form in the
transformation zone where the lining of metaplastic epithelium
has replaced mucous epithelium and caused a strangulation of
the outlet of some of the mucous glands. A build up of mucus in
the glands forms Nabothian cysts, usually less than about 5 mm
(0.20 in) in diameter,[3] which are considered physiological
rather than pathological. Both gland openings and Nabothian
cysts are helpful to identify the transformation zone.
1)Congenital Erosion:
Natural process OR changes.
Estrogen dependant especially in mother.
Develop at birth and persist for few days.
But abnormal develop at age of puberty.
2) Erosion associated with chronic cervicitis OR Infection:
Due to chronic cervicitis with pus and mucus.
Due to alkanity of discharge maceration of squamous epithelium and desquamtion develop.
In healing process transition of columnar epithelium over desquamated area and
macroscopically look smooth glistening translucent red epithelial area.(Flat erosion)
 Appearance of Cervix in Erosion:
After sometime the squamous epithelium from vaginal portion
of cervix replace columnar epithelium of the erosion.
Recurrent cervical erosion due to Untreated chronic cervicitis.
3).Hormonal OR Papillary Erosion:
Common during pregnancy and in pill users,pessaries,tampons.
Develop due to oestrogen surge.
Hyperplasia of endocervical epithelium.
Replaced epithelium becomes heaped up to fold inwards and
outwards thats why called Papillary erosion.
• The squamo-columnar
junction returns back to its
normal position after 3
months following delivery
and little earlier following
withdrawal of pill.
 Clinical Features:
 Symptoms:
• Sometimes asymtomatic.
However following symptoms may be present:
• Vaginal discharge:Either profuse mucoid OR Mucopurulent(infection) OR
Blood stained (congeston).(Cervical Leucorrhoea)
• Postcoital bleeding.
• During pregnancy an erosion becomes very vascular and bleed easily.
• sometimes Low back pain,abdominal OR pelvic pain.
 Signs:
Per speculum Examination:Reddened area around the external os
with its inner margin continous with endocervical lining and with
well difined outer margin.The reddened area of erosion may be
slightly raised above the level of squamous epithelium of the
cervix and is smooth and glistening if it is covered by columnar
epithelium.The erosion is soft and bleed easily if swabbed
vigorously during examination.
 Differential Diagnosis:

 Syphilitic ulcer,
 Tubeculosis of cervix
 Carcinoma in situ
 Cancer of the cervix.
 How to Diagnose?

• All cases should be suspected to cytological examiation from

the cervical smear to exclude dysplasia OR Malignancy.
• In doubtful cases colposcopy OR/and cervival biopsy should be
consider.
• Per speculum Examination:Reddened area around the external
os with its inner margin continous with endocervical lining and
with well difined outer margin.
 Miasmatic Diagnosis:Syco-Syphilitic Taint.Why ?
• due to process of chronic inflamation and Hyperplasia of
local tissue followed by desquamation of epithelium.
• Asymptomatic chronic cervicitis and erosion do not require
treatment.
• Auxillary Mode of Treatment:private part hygiene,take
nutritous food(hypovitaminosis)
• Remove irritating device like contraceptives,tampons,pessaries.
• Diathermy cauterisation.
• Cryosurgery.
• Laser Therapy.
 Repertory Part:
1.Kent Repertory:
Chapter:-Genitalia-Female
Rubrics:Swollen,Subrubrics:Uterus
SubSubrubrics:Cervix
2.Repertory of Herring guidings symptoms:
Chapter:Female sexual organs
 Rubrics:Leucorrhoea,Subrubrics:Cervical(Cross ref.-Uterus)
 Rubrics:Leucorrhoea,Uterus.Subrubrics:1)Cervical.
2)From Glandular portion of cervix
3)Leucorrhoea in pregnancy
3.Boericke's Repertory:
Chapter:Female sexual organs
Rubrics:Leucorrhoea in pregnant women.
Concomitants:Subsubrubric:Cervical erosion,bleeding easily.
Rubric Cervix:Inflammation,Redness
4.Phatak's Repertory:
Rubric:Cervix,Subrubric:Erosion.
5.Clinical Repertory by Dr Clarke
Chapter :Clinical repertory
Rubric:Cervix,affections of.
5.Phatak's Repertory:
Rubric:Cervix,Subrubric:Erosion.
6.Uterine Therapeutics by Minton:
Chapter:Leucrrhoea
Rubric:1)Cervical
2)Chronic
7.Murphy Repertory:
Chapter:Female
Rubric:Discharge,Subrubric:1)Cervical,excoriation with.
2)Pregnancy,during.
Rubrics:Cervicitis,inflammation of cervix.
Subrubrics:bleeding easily
Subrubrics:Excoriation with.
8.Synthesis Repertory:
Chapter:Female Genitale
1)Rubrics:Inflammation,Subrubric:Cervix(Acute)
Subsubrubric:Chronic
2)Rubrics:Erosion of cervix,Subrubric:bleeding easily with leucorrhoea.
3)Rubrics:Leucorrhoea,pregnancy during.