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Cervical polyps commonly occur after menarche and are occasionally noted in postmenopausal women. The cause is not known, but inflammation may play an etiologic role. The principal symptoms are discharge and abnormal vaginal bleeding. However, abnormal bleeding should not be ascribed to a cervical polyp without sampling the endocervix and endometrium. The polyps are visible in the cervical os on speculum examination.

Cervical polyps must be differentiated from polypoid neoplastic disease of the endometrium, small submucous pedunculated myomas, large nabothian cysts, and endometrial polyps. Cervical polyps rarely contain dysplasia (0.5%) or malignant (0.5%) foci. Asymptomatic polyps in women under age 45 may be left untreated.

TREATMENT

Cervical polyps can generally be removed in the office by avulsion with uterine packing forceps or ring forceps. If the cervix is soft, patulous, or definitely dilated and the polyp is large, surgical D&C may be required (especially if the pedicle is not readily visible). Hysteroscopy may aid removal and lead to identification of concomitant endometrial disease. If there is suspicion of endometrial disease, cervical polypectomy should be accompanied by endometrial sampling.

WHEN TO REFER

  • Polyp with a wide base is present.

  • Inability to differentiate endocervical from endometrial polyp.

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Levy  RA  et al. Cervical polyps: is histologic evaluation necessary? Pathol Res Pract. 2016 Sep;212(9):800–3.
[PubMed: 27465834]  

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