Discussion on the cervix--ante-partum and post-partum.

I propose to open this discussion with a reappraisal of what is the limit of normal in the cervix. As part of an assay of the value of aspiration cytology tests as compared to the method of scraping the cervix for cell-specimens my colleagues, M J D Noble, F Selby Tait, A L Easton, E M Little and I have completed 5,000 speculum examinations mainly at an early stage in pregnancy. At speculum examination in early pregnancy there is no 'textbook' appearance. The most common finding is a thick opaque mucous plug at the external os. Removal of this very often shows an 'erosion' of variable size, sometimes flat and obviously innocent fromn the clinical point of view but on occasions the appearance at the lower cervix, combined with a marked tendency to bleed on the most gentle mopping, raises clinical suspicion of carcinoma. The time-honoured term to describe these 'raw' red areas on the cervix is an erosion. The term is a poor one since it conjures up a process of 'erosion' or ulceration, which is far removed from the histological picture. For example, a simple punch biopsy through the squamo-columnar edge of an erosion will commonly show no more than a descent of columnar epithelium, while postnatal involution leads to a marked diminution or the complete disappearance of these columnar epithelial areas. All this was described fifty years ago by Robert Meyer (1910), who referred to the epithelium at the portio as 'tidal epithelium'. I think the time has now come to use a new descriptive term. How would my colleagues in obstetrics and pathology consider the term 'PENCE' (Physiologically ectopic normal columnar epithelium) for pregnancy erosions? These lesions, it should be noted, are mainly asymptomatic and must be distinguished from the infected gynicological 'erosion' which produces columns of mucopus; for this pathological clinical entity one uses justifiably the gynccological term 'infected erosion or cervicitis' a cause of mucopurulent discharge, i.e. symptomatic and requiring treatment.