Cervical Polyp

A cervical polyp is a benign, finger-like growth of the cervical mucosa, most often arising from the endocervical canal and protruding through the external os.

• It is most frequent in multiparous women aged 30 to 60 years.
• Causes include chronic inflammation, high oestrogen and local vascular congestion.
• Cancer within a cervical polyp is rare, but every polyp is sent for histology.

Many are found at routine speculum examination.

• Intermenstrual bleeding, post-coital bleeding, postmenopausal bleeding and mucoid or purulent discharge.
• A smooth, soft, red or purple polyp 0.5 to 3 cm on a stalk at the external os.
• Differential diagnosis: endometrial polyp prolapsing through the os, prolapsed submucosal fibroid, cervical cancer, retained products of conception, cervicitis, cervical ectropion.
• Complications: bleeding, infection, torsion with pain, anaemia (rare) and recurrence.

Diagnosis is by speculum examination, with histology of the removed polyp.

• Speculum examination with a clear view of the stalk and the base.
• Cervical cytology, HPV test or VIA.
• Endocervical swabs for chlamydia and gonorrhoea when discharge is present.
• Histology of the polyp after removal.
• Transvaginal ultrasound or hysteroscopy for postmenopausal bleeding, or when the base is high in the canal or the polyp may arise from the endometrium.

Remove symptomatic polyps and send every polyp for histology.

• Supportive: reassure; use sanitary pads for bleeding; avoid douching.
• Pharmacological: no drug is needed. Paracetamol 1 g oral 6-hourly (maximum 4 g in 24 hours) for pain after removal. Treat infection if present: metronidazole 400 mg oral 12-hourly for 7 days for bacterial vaginosis; doxycycline 100 mg oral 12-hourly for 7 days for chlamydia.
• Procedures: remove symptomatic polyps in the outpatient clinic with polyp forceps by twisting at the stalk, or by ligation or excision for a broad base. Cauterise the base with silver nitrate or diathermy. Send all tissue for histology. Hysteroscopic removal when the stalk is high or the base is not visible.
• Special groups: in pregnancy remove a polyp only if it bleeds heavily or causes persistent discharge; otherwise leave until after delivery. In postmenopausal women, always investigate the endometrium.
• Red flags: friable or irregular polyp, a polyp that bleeds on touch with ulceration, postmenopausal bleeding, abnormal histology.
• Follow-up: review at 6 weeks; repeat screening if overdue; re-examine if bleeding recurs.