18-04: Cervical Polyps

ESSENTIALS OF DIAGNOSIS

CLINICAL FINDINGS

Cervical polyps commonly occur during the reproductive years, particularly after age 40, 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 foci of dysplasia (0.5%) or of malignancy (0.5%). 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. Polyps with a wide base may require electrocautery at the base to prevent bleeding and decrease recurrence risk.

WHEN TO REFER

• Polyp with a wide base.

• Inability to differentiate endocervical from endometrial polyp.