Endocervicitis

ENDOCERVICITIS. The modern doctrine of E. in contrast to the doctrine of endometritis in general remained the same as set forth by older authors. The mucous membrane of the cervix undergoes inflammation much more frequently than the mucous membrane of the body, as it is more accessible to mechanical influences and to the introduction of microbes. Predisposing causes of inflammation are tears and ruptures of the cervix during childbirth and the resulting eversion of the mucous membrane (ectropion), as well as local and general factors causing prolonged hypersecretion of the cervical mucosa. Local factors include prolapses and displacements of the uterus and all factors contributing to increased engorgement of the pelvic organs (coitus interruptus, masturbation, excessive sports activity). General causes include constitutional diseases (chlorosis, chronic anemia, ovarian hypofunction) and inadequate constitution (infantilism, asthenia with often accompanying enteroptosis). In the etiology of E., as in endometritis, infection (mainly gonorrheal and postpartum) and mechanical irritation of the canal mucosa play the main role. Infection can be of exogenous, endogenous-vaginal, and metastatic origin. The penetration of endogenous-vaginal infection is facilitated by the direct contact of the cervical canal with vaginal flora. Metastatic E. is mainly observed in girls with measles and scarlet fever. The main causative agents of E. are gonococci, followed by strepto-, staphylococci, and other pathogenic microbes, and often there is a mixed infection. Mechanical irritation of the cervical mucosa leading to its inflammation is caused mainly by intrauterine and improperly used cervical caps, namely by prolonged wearing of suction rubber and metal caps (of the Kafka type). The same irritation is caused by polyps, myomas, and cancer penetrating from the uterine cavity into the cervix. In acute E., there is hyperemia, edematous infiltration of tissues, small-cell exudate in the stroma, and the introduction of microbes, with gonococci remaining in the superficial layers of the mucosa, while strepto-, staphylococci penetrate much deeper. In chronic E., the inflammatory process occurs mainly in the upper layers of the mucosa, with maceration of the squamous epithelium forming small ulcers-erosions, in other cases, mainly in non-gonorrheal infection, there is scarring in the lower layers of the mucosa. In acute and especially chronic E., the secretion of glands is significantly increased due to inflammatory hyperemia. In the acute stage of E., the secretion is purely purulent or mucopurulent in character, in the chronic stage it becomes more abundant and mucous. Additionally, in chronic E., there is significant proliferation of glands and proliferation of the covering and glandular epithelium. When the excretory pathways are compressed or blocked by the infiltrated stroma, small retention cysts-ovula Nabothi-form in the deep and superficial layers of the mucosa. Chronic E. can lead to partial hypertrophy of the cervix. Scars formed from deep ruptures of the cervix during childbirth, fixing the cervix to the bony pelvis, are very painful and can therefore cause dyspareunia during sexual intercourse. On internal examination, chronic E. is characterized by the softness and velvety feel of the tissues, abundant secretion, and small dense formations formed by ovula Nabothi, and limited thickening of the vaginal portion. (Sometimes biopsy in the area of erosion is required to exclude malignant neoplasm.) For more precise identification of the causative microbe of E. and endometritis, Burlakov and Kandyba proposed the method of regional vaccination into the vagina and cervix, which gives a specific reaction after a certain period of time (according to Teverdovsky, for gonococci after 15-20 minutes, for strepto-, staphylococci after 1/2-3 hours, for bacillus coli after 6-15 hours). When making a prognosis, one must take into account the stubborn and prolonged nature of E., due to the absence of periodic regeneration of the cervical mucosa during menses and favorable conditions for reinfection. According to Slavyansky, chronic E. can cause infertility due to dense obstruction of the cervical canal by abundant secretion. Puerperal E. is one with puerperal endometritis, therefore everything said above regarding etiology, bacteriology, and treatment of the latter is fully applicable to puerperal E. Treatment of E. in the initial stage is strictly conservative, any active measures, including disinfecting douches, are contraindicated due to the danger of exacerbation and spread of the process into the uterine cavity. In chronic E., treatment is mainly directed against leucorrhea and to eliminate the causes contributing to the inflammatory state of the cervical mucosa. For the treatment of leucorrhea, most old and modern authors recommend disinfecting and astringent douches, some use dry treatment with boluses and biological therapy with yeast, Bulgarian rod (biolactin), and lactic acid solution (Ilkevich). Geller recommends the use of animal charcoal (via spray after dilating the cervix to No. 6 according to Hegar, 1/2 teaspoon is introduced) and notes a marked weakening of leucorrhea even after one session. In some cases, good results are obtained from antiviral agent by Bezredka in the form of smearing the canal and tampons, as well as injections into the thickness of the cervix according to Burlakov, Poincloux, and Basset. Regarding cauterization of the mucous membrane of the entire cervical canal, authors' opinions differ: some, e.g. Slavyansky, Snegirev, Bumm, Dederlein, Adler, use this method, others, e.g. Küstner and R. Schröder, are against any intrauterine manipulations due to the danger of carrying infection into the uterine cavity; Many gynecologists successfully use electrocautery (Miller), vaginal diathermy and radiant energy (quartz lamp, X-ray). With strong hypersecretion, it is necessary to destroy the cervical glands by scarification, deep cauterization with pacelen or galvanocautery, but one must remember the danger of causing atresia of the canal. In cases of ruptures and eversion of the cervix, trachelorrhaphy according to Emmet or excision of the mucous membrane according to Schröder is applied. The operation of Sturmdorf is recently becoming widespread among gynecologists, replacing the previously used operation of amputation of the cervix. Some authors (e.g. V. F. Lebedev, Radoulovitch) indicate that the Sturmdorf operation gives excellent results. At present, many authors recommend careful suturing of cervical ruptures immediately after childbirth as a prevention of E. In cases where hypersecretion of the cervix is caused by chlorosis, anemia, and ovarian hypofunction, appropriate general treatment is indicated. Lit.-see lit. to art. Postpartum period and Endometritis.