Endometriosis of the cervix

Endometriosis of the cervix. The prevalence of endometriosis of this localization is associated with cervical damage during gynecological manipulations, diathermoconization of the cervix. Trauma during childbirth, abortion, and various manipulations can contribute to the implantation of the endometrium in the damaged tissue of the cervix. Possible occurrence of endometriosis of the cervix of the elements of Mullera tubercle of the primary vaginal plate. In addition, lymphogenous and hematogenous spread of endometriosis on the cervix from other foci is not excluded.

Depending on the depth of the lesion, there are distinguished ectocervical and endocervical endometriosis of the vaginal part of the cervix, less often endometrioid heterotopies affect the cervical canal.

Diagnostics. In endometriosis of the cervix, there may be complaints about the appearance of a spotting of blood on the eve of menstruation or during sexual intercourse. Pain is observed in atresia of the cervical canal or endometriosis of the uterus isthmus. Sometimes cervical endometriosis is not clinically manifested and is diagnosed as foci of red or dark purple color only when examining the cervix. Endometrioid heterotopies increase significantly on the eve or during menstruation. During this period, individual lesions may be opened and emptied. At the end of menstruation, endometrioid heterotopies decrease in size and turn pale. During colposcopy, differential diagnosis of cysts of nabot glands, ectopia, erythroplasia, polyps of the mucous membrane of the cervical canal, ectropion and endometriosis of the cervix is ​​performed. The data of cytological examination of prints from the mucous membrane of the cervix of the uterus are not very informative for the diagnosis of endometriosis, but they make it possible to judge the state of the stratified squamous epithelium of the cervix and to reveal cellular atypia.

Endometriosis of the vagina and perineum. The vagina and perineum are more often affected by endometriosis secondary to germination from the retrocervical lesion, and more rarely as a result of the implantation of endometrial particles into the damaged area during labor.

Leading with endometriosis of this location is a complaint of pain in the vagina – from moderate to very strong and painful. Pains appear cyclically, on the eve and during menstruation, aggravated by sexual contact. Severe pain is observed with involvement in the process of the perineum and the external sphincter of the rectum. Defecation during periods of exacerbation is accompanied by severe pain.

Diagnosis is based on complaints related to the menstrual cycle, and data of the gynecological examination, which includes examination of the cervix and vagina with the help of mirrors, two-handed vaginal abdominal and rectovaginal examination. Thick painful scars, nodes or thickenings are palpated in the thickness of the vaginal wall or in the rectovaginal-vaginal recess. On examination, the vaginal mucosa is determined by examining brown or dark blue foci. On the eve and during menstruation, endometrioid heterotopies increase in size and may bleed.
To determine the extent of the process, additional research methods are used: rectoromanoscopy, ultrasound of the pelvic organs, laparoscopy, tissue biopsy, and histological examination of biopsy.

Retrocervical endometriosis. In retrocervical endometriosis, the pathological process is localized in the projection of the posterior surface of the cervix and its isthmus at the level of the sacro-uterine ligaments. Outbreaks are capable of infiltrative growth, usually in the direction of the rectum, posterior vaginal fornix, and rectum-vaginal depression.

Clinical picture. Complaints in retrocervical endometriosis due to the proximity of the rectum and pelvic nerve plexus. Patients complain of aching pain in the depths of the pelvis, lower abdomen and lumbosacral region. On the eve and during menstruation, the pain intensifies, becomes pulsating or twitching, and may be given to the rectum and vagina. Less commonly, pain radiates to the side wall of the pelvis, to the leg. Patients may complain of constipation, sometimes – the secretion of mucus and blood from the rectum during menstruation. Severe endometriosis in 83% of cases causes periodic disability and, in a significant number of cases, mimics diseases of other organs.

Diagnostics. Consider the complaints of patients and gynecological examination data. In retrocervical endometriosis, a dense formation in the rectovaginal tissue behind the cervix is ​​palpated. Rather informative ultrasound data; the heterogeneity of the formation behind the cervix, smoothness of the isthmus and the fuzzy contour of the rectum are determined by echo-density. To clarify the prevalence of the process, sigmoidoscopy, colonoscopy, excretory urography, cystoscopy, MRI are necessary.

local_offerevent_note March 16, 2019

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