The presence of white patches on the mucosal surface of the cervix is called hyperkeratosis. This is the beginning sign of dysplasia or carcinoma in situ of the cervix.
1. What are cervical white patches?
Cervical white patches, medically termed "leukoplakia," are firm, adherent white lesions on mucous membranes associated with an increased risk of cervical cancer.
Upon examination through a speculum with appropriate lighting, these lesions appear as changes in the mucosa. They involve the superficial epithelium and underlying layers, exhibiting hypertrophy and thickening due to keratinization. As a result, the epithelial surface takes on a distinct white coloration.
2. What causes cervical white patches?
The exact etiology behind the development of cervical white patches remains unclear. Hypotheses suggest potential causes stemming from both endogenous (internal) and exogenous (external) factors.
Endogenous factors include:
- Hormonal imbalances at any level within the hypothalamic-pituitary-ovarian axis, such as anovulation, excess or deficiency of sex hormones, and endometrial hyperplasia.
- Chronic inflammatory conditions affecting the uterus and adnexa.
- Metabolic disorders.
- Immunosuppression.
Exogenous factors include:
- Cervical trauma: Occurring during childbirth, abortion, rough sexual activities, early sexual initiation, or frequent changes in sexual partners.
- Genitourinary infections: Such as condyloma acuminata, genital herpes, and chlamydia infections.
- Cervical pathologies: Including ulcerations and cervicitis.
3. What are the signs of cervical white patches?
In most cases, cervical white patches progress silently without any noticeable symptoms and are typically discovered incidentally during routine gynecological check-ups.
In advanced stages, as these patches proliferate, symptoms may include dyspareunia (pain during intercourse) and increased vaginal discharge with an unpleasant odor. The discharge may vary in color. However, these symptoms are often mistaken for other gynecological conditions.
When the patches extend beyond the cervix and reach the vaginal walls, patients may experience persistent itching and burning sensations, even in the absence of external stimuli. In some cases, there may be spotting or minor bleeding from the vagina following intercourse.
4. Are cervical whites patches dangerous?
Cervical white patches are typically classified into three forms:
- Flat form: The lesion's surface is level with the surrounding normal epithelium. This area maintains a stratified squamous structure and is often an incidental finding during routine gynecological exams.
- Protruding form: The lesion's surface is raised and uneven, resembling warts. The white patches protrude above the cervical mucosal level, sometimes overlapping and altering the cervical surface's uniformity.
- Ulcerative form: This form features erosions or fissures within the white patches.
Flat cervical white patches are generally benign and must be differentiated from infections or fungal conditions. In contrast, protruding and ulcerative white patches are potential warning signs of malignancy, indicating precancerous processes.
5. What should be done if cervical white patches are present?
- Cytology screening: A smear is collected from the patch surface for analysis, although this test may not always yield definitive results.
- Colposcopy: This method helps delineate the lesion’s boundaries and size.
- Biopsy: This remains the gold standard, particularly when performed under colposcopic guidance. Biopsy results inform treatment decisions.
- If the white patches are benign, a gynecologist will oversee treatment. However, the detection of atypical cells in the biopsy necessitates referral to an oncologist for staging and, if feasible, curative intervention.
All these procedures can be conducted on an outpatient basis, ideally scheduled on the fifth day of the menstrual cycle. Treatment duration may range from 2 weeks to 2 months.
Cervical white patches may indicate the potential for malignant transformation in the future. Women who are sexually active should prioritize regular gynecological check-ups, cytology screenings, and colposcopy examinations to detect and address these lesions early, thereby improving prognosis and long-term outcomes.
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