Sexually Transmitted Diseases/cervical extropion

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Question
Dr. Mark hello , I have a doubt, the Cervical ectropion is normal? generates some damage? which is the reason for this condition , thank you.

Answer
Hello Lorena,
Cervical ectropion (or ectopy) is absolutely a normal condition of the developing cervix by many but not all women.   Some of the tissue at the opening of the cervix appears to protrude (somewhat like a pouting lip) through the opening.   Estrogen drives the changing of the columnar cervical tissue (red, elongated, mucous secreting cells) into stratified squamous cells (smoother, superficial, flatter, and pink appearing) and which is known as metaplasia. The dividing zone between these two discrete cell types is aptly called the "transformation" zone.  Metaplasia is normal.  You may have heard the term "dysplasia" which is an abnormal transformation of the columnar to squamous cells that has usually incorporated the DNA of human papilloma virus, and may therefore progress to warts or in more serious situations, to cervical pre-cancers and cancers.   Metaplasia that abnormally transforms from such things as HPV becomes dysplastic. Since this occurs during the first one or two decades following puberty, THAT is the most critical time for cervical cancers to develop. So technically, the large the zone of ectopy, the greater potential for abnormal transformation if HPV is present.  That's why the HPV vaccination is so important as an effective method of preventing cervical cancer.  When women become older and as they approach menopause, metaplasia no longer is active, and without metaplasia, there can be no dysplasia!

Hopefully this doesn't sound too dense! The bottom line is that cervical ectopy and ectropion is NOT abnormal, and is just a developmental phenomenon that some women have and others do not.   

One other piece of trivia that I find fascinating. There are several other "borderline" zones of tissue growth in the body-- the dividing area between mucous secreting columnar cells, and the more rigorous stratified squamous epithelium:  the cervix (called "transformation" zone), and between the esophagus and stomach, and between the rectum and anus (both called "transition" zone).  Also the tonsils & throat, the sinuses, and probably other places. Where-ever there is such a zone, there is a potential for abnormal cell transformation, especially if there is a virus such as HPV to instigate such a change.  And indeed, HPV is highly associated with cancers of the throat and anus as well!

Good luck!
--mark  

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Mark P. Behar

Expertise

Almost any question or concern about gay men's health issues, sexually transmitted infections, abnormal Pap smears, anal cytology (anal "Pap smears"), etc. There is no such thing as “d/d free” or “clean” (free of infection), so why do so many of us deceive ourselves into thinking that some people are indeed totally free from a potentially infectious disease, like HIV, herpes, hepatitis, syphilis, chlamydia, warts, gonorrhea, etc., just because they say so? Clinical laboratory tests are not perfect, and having a “negative” or “nonreactive” test does not mean that a person is free from infection. Perhaps at the moment the test was taken, the person was uninfected; or, perhaps, the test wasn’t sensitive enough to detect presence of the infection. There is really no way that anyone can determine that they are truly “disease free,” and there are over a hundred of infectious conditions that can be spread without your knowing anything. Rather than trying to “pre-screen” or “serosort” a potential sex-mate with deceptive questions that are impossible to know by today’s technologies, a wiser option may be to consider everyone infected with something, and either use appropriate protective measures (“safer sex”), or accept the responsibility and consequences of possibly “catching” something from someone who’s hotter than expected (pun intended!). There is much research that supports the contention that an HIV positive person reliably taking HIV medications, and having an undetectable viral load, presents a lower risk for transmission of HIV than people who may think or say they are HIV negative, but are not. Food for thought!

Experience

Family Practice PA since 1981; Volunteer Clinician for Brady East STD (BESTD) Clinic, Milwaukee, since 1977; answered STD questions submitted to their web site. Professionally lectured at national and regional Physician Assistant and Nurse Practitioner conferences, and at national gay & lesbian health conferences on topics including HIV/AIDS, herpes, hepatitis, STDs, human papilloma virus (the cause of venereal warts), abnormal Pap smears, gay and lesbian health issues, among others.

Organizations
Co-Founder, Lesbian, Bisexual, & Gay Physician Assistant Caucus of the American Academy of Physician Assistants, Inc.; American Academy of Physician Assistants; Wisconsin Academy of Physician Assistants; National Co-Chair (2012-16), National Association of Black and White Men Together: A Gay, Multiracial Organization for All People (NABWMT)

Publications
Journal of the American Academy of Physician Assistants (JAPA) Q Visions, Quarterly Newsletter of the NABWMT

Education/Credentials
Bachelor's of Arts, 1972 (University of Wisconsin, Milwaukee, WI) Graduate Credits Experimental Psychology, 1972-75 (Tulane University, New Orleans, LA) Physician Assistant, Bachelor's of Science, 1981 (George Washington University, Washington, DC); Masters in Physician Assistant Studies, 2000 (University of Nebraska Medical Center, Omaha, NE)

Awards and Honors
Colposcopy Recognition Award (CRA), the American Association of Colposcopy and Cervical Pathology; Distinguished Fellow, Clinical Preceptor, American Academy of Physician Assistants; Fellow, Wisconsin Academy of Physician Assistants

Past/Present Clients
Brady East STD Clinic, Milwaukee, WI Milwaukee Health Services, Inc. (Martin Luther King Heritage Health Center), Dept. of Family Medicine and Early Intervention Program for HIV Infected Persons

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