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Cervical polyps – Information for GPs

Definition

A cervical polyp is a common, usually benign growth on the cervix and is often found at routine speculum examination. A polyp may occasionally cause IMB, PCB, changes in vaginal discharge or prevent a smear test being taken.

Excluding red flag symptoms

Cervical cancer e.g. fungating mass

General points

Cervical polyps arise from glandular epithelial hyperplasia. They are commonly benign but they can be malignant in 0.2–1.5% of the cases. The risk is even less with asymptomatic polyps.

  • They are more common in parous women and women in their 40s and 50s.
  • The removal of polyps is a painless procedure suitable for primary care management.

Cervical polyp image

Management

Symptomatic polyps should be removed due to the small risk of malignancy. Polyps can be removed in primary care (technique described below) and should be sent off for histological examination.

Asymptomatic polyps: if asymptomatic the risk of malignant change is so small you can offer woman a choice of removal or monitoring.

Technique for removal of cervical polyp

  • Gain verbal consent
  • Routine speculum examination
  • Grasp polyp at base using sponge-holding forceps, twist clockwise with gentle traction (several 360 degree twists may be required) until it falls off.
  • Apply Silver nitrate to base
  • Send the polyp off for histology

Advise the patient that she may experience light bleeding and mild period cramps for up to 24hrs after removal. She may also get some grey/brown coloured discharge for a couple of days.

Removal of a Cervical Polypvideo link.

Technique for removal of cervical polyp

  • Consent – removal of polyps is not a painful procedure and is similar to a smear test
  • Routine speculum examination
  • Grasp polyp at base with polyp or sponge-holding forceps, twist clockwise with gentle traction (several 360 degree twists may be required)
  • Apply Silver Nitrate to base
  • Send polyp for histology
  • Advise the patient that she may experience light bleeding and mild period cramps for up to 24hrs after removal

Removal of a cervical polyp - (video link)

Outcome

  • Histology: if it is a normal benign cervical polyp no further action required.
  • Histology: if it is found to be an endometrial polyp a USS needs to be requested to check for other endometrial polyps. If there are more present the patient will require referral on to Gynaecology.

Indications for referral

  • The base of the polyp is not visible (could be a prolapsed endometrial polyp)
  • the polyp is >1cm wide
  • You are unable to remove in primary care
  • confirmed endometrial polyp

Investigations prior to referral

  • Cervical smear (if due)
  • USS if suspected prolapsing endometrial polyp

Information to include in referral letter

  • Any current hormonal treatment
  • Smear history (including last smear result)
  • Relevant past medical/surgical history
  • Current regular medication and allergies

Patient information

References

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