Cervical "erosion": what it really is
"You have an erosion, it needs cauterising" is a sentence almost every patient from the post-Soviet world has heard, and it is also the one most often wrong. In Poland you will most likely be told there is nothing to treat, and that is not indifference: what is habitually called erosion is usually not a disease at all.
The important part first
The red patch around the external os that a doctor sees through the speculum is almost always ectropion, not erosion. Ectropion means the delicate glandular epithelium that normally lines the cervical canal extends a little onto the outside. It is thinner and redder than squamous epithelium, so it looks like a "sore" that is not actually there.
Ectropion is a normal variant in younger women, on hormonal contraception and in pregnancy. It does not hurt, does not prevent conception, does not turn into cancer and needs no treatment in itself.
True erosion — an area where the epithelium really is missing — is uncommon: after trauma, with marked inflammation, or from low oestrogen after menopause. Polish reports stopped conflating the two long ago: they say ektopia or strefa przekształceń, and treat nadżerka as an obsolete word.
What the doctor can actually see
Looking at the cervix takes a minute. The doctor inserts a speculum (wziernik in Polish) and looks at the cervix in ordinary light. Not much is visible: colour, the shape of the os, the border between the two types of epithelium, discharge, signs of trauma or inflammation.
What cannot be seen — and this is the thing to take away:
- altered cells. Only a microscope sees those, which means cytology;
- the papillomavirus. Only a test finds it;
- precancer. To the naked eye it is indistinguishable from ectropion — which is exactly why screening is offered to everyone rather than only to those with "something visible".
Hence a simple conclusion: a healthy-looking cervix does not excuse you from cytology, and an unhealthy-looking one is not a diagnosis. What decides is the result, not the appearance.
Schiller’s test and acetic acid
Sometimes solutions are applied to the cervix to reveal more. These are already elements of colposcopy, but the names turn up in ordinary reports too:
| What is done | What happens | How to read it |
|---|---|---|
| Schiller’s test — Lugol’s iodine | healthy squamous epithelium stores glycogen and stains dark brown; where there is no glycogen a pale patch remains | the pale area is called iodine-negative. On its own it proves nothing |
| 3–5% acetic acid | areas with altered cells whiten briefly, because they contain more protein | this is the "acetowhite epithelium" of the report |
| Viewing under magnification | a colposcope magnifies 10–40× and shows the vascular pattern | see the article on colposcopy |
When the cervix genuinely needs attention
There are signs that stop the red patch being harmless. There are not many and they are specific:
- bleeding after intercourse — so-called contact bleeding;
- bleeding or spotting between periods;
- an abnormal cytology result — ASC-US, LSIL, HSIL and the rest; what they mean is set out separately;
- a positive high-risk HPV test, especially types 16 and 18 — more on the test;
- any discharge or pain after menopause;
- an area that looks atypical under magnification — coarse mosaic, atypical vessels.
In those situations colposcopy is done and, if needed, a biopsy taken. What is then treated is not "erosion" but whatever the histology found.
Why it is not cauterised as a precaution
Cauterisation is not a harmless cosmetic procedure. It has a cost, and there is no reason to pay it without an indication:
- scarring and narrowing of the cervical canal. That impedes menstrual flow and can impede sperm;
- harder screening later. After the procedure the border between the epithelia retreats into the canal, making cytology less informative and colposcopy "inadequate";
- it matters for future deliveries. The volume of tissue removed counts, so it is not spent for nothing;
- it prevents nothing. Ectropion does not become cancer, so there is nothing to remove it against.
Treatment of cervical change is done when the change is confirmed histologically — usually HSIL, meaning CIN 2 or CIN 3. Then konizacja or loop excision is performed, and that is a justified intervention which prevents cancer.
What to do if you have been told "erosion"
- Do not panic and do not rush to have it burned off. The word itself is not a diagnosis.
- Have cytology if you have not had it in the last three years. It is the only way to learn anything about the cells.
- Have an HPV test if you are over 30 or if cytology came back as ASC-US.
- Tell the doctor about contact bleeding if you have it. That is the symptom which changes management.
- Bring earlier reports. If an "erosion" was seen five years ago and cytology has been normal throughout, that is very good news and worth showing.
Examination, cytology and colposcopy are done at the practice in Warsaw at ul. Głębocka 9. I hold the PTGiP certificate of competence in colposcopy and state certification as a colposcopist, so if the result calls for a closer look, it is the same room and the same doctor. Consultations are held in Polish, Russian and Ukrainian.
Short answers
Is cervical erosion dangerous?
What is usually called erosion is ectropion: glandular epithelium from the cervical canal extending slightly onto the outside. It is a normal variant in younger women, on hormonal contraception and in pregnancy. It does not become cancer and needs no treatment in itself. What is dangerous is not the red patch but abnormal cytology, a positive HPV test and contact bleeding.
Does erosion need to be cauterised?
Not without an indication. Cauterising causes scarring and narrowing of the cervical canal, degrades the quality of future cytology and colposcopy, and prevents nothing, because ectropion does not become cancer. What is treated is not the appearance of the cervix but histologically confirmed change — usually HSIL, that is CIN 2 or CIN 3.
What does Schiller’s test mean?
The cervix is painted with Lugol’s iodine. Healthy squamous epithelium stores glycogen and stains dark brown, while an area without glycogen stays pale and is called iodine-negative. Crucially, ectropion does not stain either, so a pale area is not a diagnosis in itself, only a reason to look more closely.
Can you get pregnant with cervical erosion?
Yes. Ectropion does not interfere with conception or with the course of pregnancy. It is in fact more common during pregnancy because of hormonal change, and resolves on its own after delivery. Cauterising before trying to conceive, without an indication, is more likely to harm than to help.
What is cervical erosion called in Polish?
Nadżerka — though the word is considered outdated, and current reports say ektopia or strefa przekształceń. A speculum is wziernik, Schiller’s test is próba Schillera, and examining the cervix is badanie szyjki macicy.
Sources
The primary sources this text rests on. Links open in a new tab.
- Rekomendacje Polskiego Towarzystwa Ginekologów i PołożnikówPTGiP — the standard of care in Poland; my skills certificate is issued under the same rules
- Human papillomavirus and cancerWorld Health Organization — high-risk HPV types, vaccination, the link with cancer
- Program profilaktyki raka szyjki macicy — informacje o programieMaria Skłodowska-Curie National Research Institute of Oncology — programme coordinator: stages and indications for colposcopy
This text describes the general picture and does not replace a consultation. Timings and indications differ from woman to woman and are decided at the appointment, from your history and test results.
