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ORIGINAL ARTICLE |
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| Year : 2002 | Volume
: 56
| Issue : 12 | Page : 598-601 |
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Role of socio-economic factors and cytology in cervical erosion in reproductive age group women.
RN Kulkarni, PM Durge
Dept. of PSM, MGM Medical College, Kamothe, Navi Mumbai,
| Date of Acceptance | 31-May-2002 |
Correspondence Address:
R N Kulkarni
Dept. of PSM, MGM Medical College, Kamothe, Navi Mumbai
PMID: 14514242
A cross-sectional study involving 357 females in the reproductive age group (15-44) was conducted in an urban community of Nagpur with the objective of studying the role of socio-economic factors & cytology in cervical erosion. Cervical erosion was detected in 82 (22.96%) females. Out of these mild dysplasia was seen in 9.75% females & moderate dysplasia in 2.43% females. High percentages of inflammatory smears i.e. (75.68%) were obtained in women with cervical erosion. Cervical erosion was more common in illiterate & women with low literacy status as compared to women with higher education. Majority of cases of cervical erosion (75.6%) were detected in women with high parity. A statistically significant association was found between lower socio-economic status, early age at marriage & ocurrence of cervical erosion (p<0.001 & p<0.01 respectively). The study concludes that socio-economic factors such as illiteracy and low literacy status, lower socio-economic status, early age at marriage and high parity are contributory for the occurrence of cervical erosion and regular cytological screening by Pap smear will help in early detection of carcinoma cervix and thereby reduce the morbidity and mortality caused by the same.
Keywords: Adult, Cervix Dysplasia, epidemiology,pathology,Cervix Erosion, epidemiology,pathology,Cervix Uteri, cytology,Cross-Sectional Studies, Female, Human, India, epidemiology,Parity, Socioeconomic Factors, Vaginal Smears,
How to cite this article:
Kulkarni R N, Durge P M. Role of socio-economic factors and cytology in cervical erosion in reproductive age group women. Indian J Med Sci 2002;56:598-601 |
In India, women of the child bearing age (15-44) constitute 19% of the total population.[1] Gynecological Health is an important component of any women's health status. Social factors play a vital role for the occurrence of certain gynecological diseases. Hence, a study of these factors, influence of these factors in the causation of disease would be crucial for the prevention of various gynecological problems.
Cervical erosion is a common finding on routine pelvic examination during the fertile years. It is a true epithelial defect that can be produced by trauma, inflammation or, by carcinoma. The naked eye evaluation of such cases is deceptive and it is easy to dispose of the intraepithelial cancer precursors as simple cases of erosion or inflammation. Since lesions of the cervix such as chronic, erosions, unhealthy cervix and lacerations are predisposing conditions for malignancy of the cervix, it is of paramount importance to detect these lesions early enough and treat them adequately if cancer of the cervix is to be warded off.[2]
The present study was undertaken with the objective of studying the role of socioeconomic factors in cervical erosion such as literacy status, socio-economic status, age at marriage and parity and also the cytological findings in cases of cervical erosion in reproductive age group women in the community adopted by Urban health centre (UHC), Indira Gandhi Medical College (IGMC), Nagpur.
| ¤ MATERIAL and METHODS: | |  |
A Community based cross sectional study was carried out in UHC area, Nagpur, having total population of 2951. A survey was carried out and the total no. of women in reproductive age group was found to be 506. Out of these, 149 were unmarried while 357 were married which formed the study population.
A house-to-house visit was done and basic information of each woman was obtained with the help of pre-tested proforma. Each woman was then asked to attend the UHC for further medical examination. At the UHC, detailed history, clinical examination and gynecological examination i.e. per speculum and per vaginal examination was done in all the women. Cervical smear for cancer cytology was taken by Papanicolaou method. The smears were fixed immediately in 95% ethyl alcohol and transported to department of Pathology, IGMC, Nagpur for reporting. Out of 357 smears, reports of 337 smears could be obtained as in the remaining, either the smears were inadequate or drying artifact was present.
| ¤ Results | | |
On per speculum examination, cervical erosion was found in 82 (22.96%) females. This shows that it is more common in women of fertile age.
Symptoms such as leucorrhoea and backache were more common in women with cervical erosion i.e. 69.51% and 65.2% respectively as compared to dyspareunia (2.13%) and post coital bleeding (1.12%) and disturbances of micturition (2.54%).
The cytological pattern in women with cervical erosion is shown in [Table - 1]. Out of 337 smears, 132 (39.16%) females had normal smears, 190 (56.39%) had inflammatory smears while 15 (4.45%) had dysplastic changes {Mild dysplasia 12 (3.56%) and Moderate dysplasia 2 (0.89%)). Out of the 82 cases of cervical erosion, 9.75% were of mild dysplasia and 2.43% were of moderate dysplasia. High percentages of inflammatory smears i.e. (75.68%) were obtained in women with cervical erosion.
[Table - 2] shows that cervical erosion was more common in females who were illiterate (3.09%), those who had primary education (50%) or secondary education (40.24%), as against females who had higher secondary and above education (3.65%).
Cervical erosion was found to be more common in women belonging to class IV and V as compared to females belonging to class II and III and this association was found to be statistically significant (x2=33.57, d.f=1,p<0.001). [Table - 3]
A statistically significant association was found between early age at marriageand occurrence of cervical erosion (x2=9.29, d.f=1, p<0.01) [Table - 4].
It was observed that majority of cases of cervical erosion (75.6%) were found in women having more than three children [Table - 5]
| ¤ Discussion | | |
High percentage of inflammatory smears in females with cervical erosion could be due to the presence of vaginitis and cervicitis in these women. The changes in the pH of the vagina may lead to cervical erosion in these women.
Bang et a1[3] in their study reported cervical erosion to be 45.70% which is higher than that found in the present study (22.96%).
Jaju. and Ranade[4] reported 13.33% dysplastic smears in cases of cervical erosion, which is slightly higher than that found in the present, study (12.18%). Chhabra et aI[5] in their study reported 3% dysplastic smears in women with cervical erosion, which is quite lower than that found in the present study. The incidence of grades I, II and III of dysplasia in cervical erosion was reported to be 36.6%, 10.8% and 2.9% respectively by Singh and Jain[6] which is quite higher than that found in the present study. Thus women with cervical erosion form risk group for dysplasia, which may lead to cervical malignancy. Hence, there is need for regular screening by Pap smear More Details in this group.
A highly significant association between lower socio-economic status and occurrence of cervical erosion (p<0.001) could be as the socio-economic status of the individual can be directly correlated with the general hygienic standard of the patients. Also, women in lower socio-economic status groups tend to marry earlier and have their child at a young age; they are exposed to rapid and repeated pregnancies and high parity. This may lead to changes in cervical epithelium cervical erosion.
Early age at marriage is a risk factor for cervical erosion and this association was found to be statistically significant (p<0.01). This may be as early age at marriage is associated with onset of sexual experience at an early age at marriage is associated with onset of sexual experience at an early age, which leads to trauma to the sensitive cervical epithelium. Also early onset of sexual experience may exert a cumulative effect and hence lead to occurence of cervical erosion.
Singh and Jain[6] in their study found 54.6% females with cervical erosion had their age at marriage below 20 years.
Majority of cases of cervical erosion (75.6%) in women with high parity could be attributed to cervical trauma, which may occur due to multiple pregnancies at short intervals.
| ¤ Conclusion | | |
The socio-economic factors, which play a vital role for the occurrence of cervical erosion, are lower socio-economic-status, illiteracy and low literacy status, early age at marriage, and high parity. Women with cervical erosion should undergo regular cytological screening as they form risk group for dysplasia, which may lead to cervical malignancy.
| ¤ References | | |
| 1. | Park K. Park's Text Book of Preventive and Social Medicine 16th Ed. 2000, Jabalpur: MIS Banarsidas Bhanot Publishers. p. 352.  |
| 2. | Gulati N, Chandra K. Clinicocytological study of benign cervical lesions. J Obs Gynec India 1973;23:347-9. |
| 3. | Bang RA, Bang AT, Baitule M, Choudhary Y, Sarmukaddam S, Tale 0, High prevalence of gynecological diseases in rural Indian women. Lancet 1989;1:85-7. |
| 4. | Ranade JK. A critical review of cases of cervical erosion. J Obs Gynec India 1991;41:228-30. |
| 5. | Chhabra S, Aher K, Narang P, Gagane N. Chlamydia Trachomatis infection and Cervical intraepithelial neoplasia. J Obs Gynex India 1993;43:93-4. |
| 6. | Singh VK, Jain R. Clinico-pathological study of erosion of cervix. J Obs Gynec India 1984;34:539-43. |
Tables
[Table - 1], [Table - 2], [Table - 3], [Table - 4], [Table - 5]
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