Cervical eversion/leukorrhea revisited--Question for Dr. and others

[Guest guest]

Hi,

This question is specifically for Dr. , but others are welcome to chime in also.

Can you please explain what happens in a cervical eversion that occurs right after childbirth, that is, if the explanation is different than what you described at the very bottom of this email?

I am assuming that such an eversion would not have anything to do with follicular progression as the ovaries are quiescent. Then, please explain how you advise patients in this particular situation. I understand about the need for observations to detect if there is an unchanging pattern of discharge. What I need clarification on is: Do you advise the patient to wait it out and allow the situation to resolve on its own?

Please advise.

Thanks in advance.

Sincerely,

Vicki Braun

Project Manager/Consultant

The Couple to Couple League

vbraun@...

1- Ext. 3100

From: nfpprofessionals [mailto:nfpprofessionals ] On Behalf Of obdoc2000@...Sent: Friday, February 22, 2008 12:01 AMTo: nfpprofessionals Subject: Re: Codes for NFP (Leukorrhea explained)

First, be certain that your client is ovulatory. I would be happy to assist you with the chart if there is doubt.If indeed it appears that she is ovulating, has not yet been sexually active, and finds the amount of mucus objectionable (some teens are very fastidious) discourage the use of pantiliners and have her chart as if she were blind. In other words, is there a progression of sensation toward slippery? If not, she is overproducing estradiol and has an undiagnosed problem with follicular progression. No amount of treatment in the luteal phase will correct follicular progression. The estrogen produced in each cycle is follicle-dependent. If too many follicles are above the stimulus threshold, the cervix and vagina will respond as previously described. With tongue-in-cheek, I remind those who are familiar with "'s First Law;" The uterus is an end-organ and must obey the hormones.Juvenile ectropion is self-limited and need not be a problem with detection if one observes for the changing or unchanging pattern of discharge.

Re: Codes for NFP (Leukorrhea explained)

With all due respect for your experience, hyfrecation, cryotherapy or chemical cautery may have the net effect of decreasing discharge, but at the cost of destroying the very cells which facilitate female cervical fertility. Cervical eversion or ectropion is the response of (mucus-producing) columnar epithelium to a stimulus: excess estradiol (iatrogenic or the natural response to puberty and pregancy), and inflammation, to the relatively hostile enviroment of the vagina. The squamous epithelium, which normally lines the vagina and other mucus membranes, advances over this everted glandular epithelium as a protective mechanism, thus advancing the squamocolumnar junction into the endocervical canal, resulting in "squamous metaplasia." Ablative therapies such as the ones described above simply make it more difficult to evaluate the transformation zone colposcopically, if warranted. We can split hairs indefinitely about the effect of drugs, pathogens, irritants and carcinogens on the consistency and characteristics of cervical mucus. The point I am trying to make is that the cervix and vagina are a perfect barometer of ovarian function when one simply observes whether there is a changing or unchanging pattern of discharge.(Brown) Since a recent Italian study indicates that mean time to immune clearance of even potentially carcinogenic HPV viral types in women under the age of 28 is 18-24 months, destructive procedures are unwarranted for purposes of "treating" leukorrhea.mmKathy Schmugge

Family Life Coordinator

Diocese of ton

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