Treatment of cervical ectropion by cryotherapy

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Cervical ectropion is a condition in which cells inside the cervix grow outward and form a red, swollen patch. This condition is completely benign and the treatment of cervical ectropion has been highly effective with cryotherapy, which helps to reduce uncomfortable symptoms for women as well as limit the possibility of malignancy. in the long term.

1. What is cervical ectropion?

The normal external cervix is ​​a small opening, about 1-2mm in diameter. This position is the opening into the cervical canal, cylindrical in shape, about 2-3 cm long and ending with the intrauterine neck before entering the uterine cavity. The outer cervical surface is pale pink, covered with squamous cells, has a laminar structure, is continuous with the epithelium lining the vaginal wall, and is completely incapable of mucus secretion. In contrast, the cells lining the inside of the cervical canal are glandular epithelium, which has a vertical cylindrical structure and is capable of secreting mucus. Because when these cells gradually move out, under the influence of the hormone estrogen, the glandular area appears and cervical ectropion will occur.
In other words, cervical ectropion is a common inflammatory condition that occurs when cells from within the cervical canal, called glandular cells, are present on the outer surface of the cervix. bow. In the course of pathophysiology over time, levels of cervical ectropion will pass through four levels in turn. These grades are determined by the patient's symptoms, features observed with speculum or colposcopy, and by pap smear examination.
Specifically, the area of ​​ectopic pregnancy will slowly increase in size until it occupies the entire area of ​​the cervix, the patient will have uncomfortable symptoms such as pain or bleeding during sex, strong-smelling discharge, abnormal color... Until grade 4 cervical ectropion, this stage is the presence of dysplastic cells on cervical smear, histological treatment and observation. under the electron microscope. This is also known as the precancerous stage of the cervix.

2. What are the treatments for cervical ectropion?

Treatment of cervical ectropion is initially measures to limit the source of estrogen in the body, especially when using exogenous hormones from the outside.
The next step before considering specific treatment options depends on the patient's age and local or systemic comorbidities. Accordingly, the treatment is mainly conservative in premenopausal women because the disease will tend to self-resolve when the ovaries are no longer functional. However, this only applies to grade 4 anterior cervical ectropion. In cases where the patient has other problems in the uterus and adnexa in general, surgical intervention will soon only be effective. determined.
Minimally invasive procedures to limit the progression of the affected area are:
Apply silver nitrate to destroy inflammatory cells. This does not cause any pain; however, some people may experience transient discomfort. Cryotherapy: By using specialized tools that cause local cooling, to cut or burn cells in the affected area. Compared with using silver nitrate, cryotherapy is more effective in shrinking the infected area; however, it can sometimes cause pain, especially in pain-sensitive women. Therefore, a local anesthetic in the private area before performing this method is necessary.

3. What is cryotherapy in the treatment of cervical ectropion?

The basic principle of cryotherapy in application to treat injuries on the body is to "freeze" abnormal cells and they will self-regenerate afterwards. In general, in medicine, this is a minimally invasive means of intervention, minimizing the possibility of damage to nearby tissues as well as helping the patient recover quickly.
Cryotherapy in the treatment of cervical ectropion is indicated in patients with any degree of the disease. However, if done as soon as possible, the lesion will soon be localized, preventing the possibility of malignancy.
Similar to topical silver nitrate, the current cryotherapy for cervical ectropion is usually performed in clinics with colposcopy capabilities and conditions. After the procedure, the patient can go home and resume normal activities. However, even with minimal intervention, cryotherapy can still make the cervical area more susceptible to discharge and bleeding, causing persistent dull pain. Therefore, women should be careful not to cause trauma on this area, including using tampons, cleaning the intimate area deep into the vagina or having penetrative sex. These things to avoid will help the cervical area heal quickly, stop bleeding and create conditions for cells to increase their resistance better.

4. What is the procedure for performing cryotherapy in the treatment of cervical ectropion?

Because the treatment of cervical ectropion is not a diagnosis requiring urgent intervention, before performing cryotherapy, the patient is always informed of the appointment with a high level of physical and mental preparation. most dual. However, the ideal time to take it is right after the end of the cycle, usually on day 5 to day 10. If the menstrual cycle is irregular and signs of menstruation appear on the day of the appointment or a few days before. , the patient can notify and reschedule the appointment after the end of the cycle.
Before going to the clinic for cryotherapy, the patient can completely eat and drink as usual, including drinking water or taking medicine to treat accompanying diseases. At the same time, patients need to remember to bring prescriptions and medical records for these conditions, including birth control pills. Besides, a loved one is also necessary, because cryotherapy needs to be done under local anesthesia or mild sedation, so the patient needs someone to take home after the procedure.
Before entering the procedure room, the patient will be instructed to remove all clothing, including underwear and only wear a specialized gown. Then, the patient will be instructed to lie on the intervention table with the legs raised on the support and the knees extended. The entire external genital area will be cleaned. Next, the doctor will use an instrument called a speculum to open the vagina, expose the cervix, and clean it by irrigation with physiological saline. The endoscope will be adjusted with enough intensity and direction to help the doctor see the entire area and facilitate manipulation.
If the patient is very nervous and excitable, a mild sedative will be prescribed. Conversely, an injection of local anesthetic may be sufficient.
Next, when the inflamed area has been clearly observed and identified, the doctor will use a small forceps with a long handle to insert it into the clamp to fix the cervix. With the other hand, the doctor will put another device called "cold burner", which is applied to the damaged area to be destroyed. The temperature of the probe is very cold, can go down to -60oC, causing local burns, so it may cause temporary discomfort to the woman.
When the entire lesion has been reassessed, the doctor will remove all instruments and the instructed woman to the operating table, change her clothes and can leave.

5. What to watch after performing cryotherapy in the treatment of cervical ectropion?

Although minimally invasive, cryotherapy can cause silent pain for about two to four weeks afterward. To relieve pain, a woman can take common pain relievers such as paracetamol; However, the level of pain is absolutely not enough to limit the usual activities of the day.
Some women may experience light vaginal bleeding for up to six weeks afterward. Don't worry too much about this, though; at the same time should limit trauma to the vagina to help limit bleeding. Conversely, if the amount of bleeding is heavy, accompanied by an unusual color or strong-smelling discharge..., this may be an infection and the patient needs to be examined again soon for proper local treatment, only appropriate antibiotic determination.
Although cryotherapy for cervical ectropion has no effect on fertility at all, all patients are advised to abstain from intercourse for 4 weeks, in order to allow the cervix to heal. Heal in the best condition.
In summary, cryotherapy has proven its role and is quite popular in the treatment of cervical ectropion. It is a safe, effective, fast-acting and affordable therapy.
In order to help customers detect and treat other gynecological diseases early, Vinmec International Hospital has a basic gynecological examination and screening package, helping customers detect early inflammatory diseases Easy, inexpensive treatment. Screening detects gynecological cancer (cervical cancer) early even when there are no symptoms.
Basic gynecological examination and screening package for female customers, has no age limit and may have the following symptoms:
Abnormal vaginal bleeding Having menstrual problems: irregular menstrual cycle, irregular menstrual cycle Irregular vaginal discharge (smell, different color) Vaginal pain and itching Female clients have several risk factors such as poor personal hygiene, Unsafe sex, abortion,... Female customers have other symptoms such as: Abnormal vaginal discharge, itching, pain in the private area, abnormal vaginal bleeding. To register for examination and treatment at Vinmec International General Hospital, you can contact Vinmec Health System nationwide, or register online HERE
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