Cervical Polyps

Question 1

What are cervical polyps?

Answer 1

Benign growths protruding into the inner surface of the cervix

Question 2

What causes them?

Answer 2

Focal hyperplasia of the columnar epithelium of the endocervix
Suggested causes:
Chronic inflammation
Abnormal response to oestrogen - cervical polyps are associated with endometrial hyperplasia
Localised congestion of cervical vasculature

Question 3

What age is the peak incidence?

Answer 3

Between 50-60 years

Question 4

Are they more of less common in multigravidae?

Answer 4

More

Question 5

They are estimated to be present in what percentage of women?

Answer 5

2-5%

Question 6

Describe the clinical features?

Answer 6

Often asymptomatic 
Abnormal vaginal bleeding:
Menorrhagia 
IMB
PCB
PMB 

Increased vaginal discharge
Rare cases: block the cervical canal and cause infertility

Question 7

What is typically seen on speculum exam?

Answer 7

Polyps usually visible as polypoid growths projecting through the external os

Question 8

What differentials are there?

Answer 8

Large number of causes for abnormal vaginal bleeding:
Cervical ectropion
Cervical cancer or CIN 
STIs
Fibroids
Endometritis 
Endometrial carcinoma 
Pregnancy related bleeding

Question 9

What investigations can be done?

Answer 9

Definitive diagnosis = histological examination after its removal
Triple swab - if suggestion of infection
Cervical smear - rule out CIN
If bleeding persists after polyp removal: USS to assess endometrial cavity

Question 10

In what percentage of women with cervical polyps are there also endometrial polyps?

Answer 10

27% - particularly the case in post menopausal women

Question 11

Describe the management

Answer 11

Removal when identified due to small (less than 0.5%) risk of malignant transformation
If small: polypectomy forceps - grasp and twist several times, the polyp is avulsed as the pedicel twisted, should not be pulled off as will result in more bleeding. If blooding occurs use silver nitrite to cauterise
Larger polyps: diathermy loop excision in colposcopy clinic or under GA if broad based polyp

If any are excised, send for histological examination

Question 12

What complications of polypectomy are there?

Answer 12

Infection
Haemorrhage
Uterine perforation - very rare. Only polyps that are easily visible should be removed in outpatient setting