Cervical Polyps

Key Features

• 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

• Cervical polyps rarely contain dysplasia (0.5%) or malignant (0.5%) foci

Clinical Findings

• Irregular or postcoital bleeding

• Abnormal bleeding should not be ascribed to a cervical polyp without sampling the endocervix and endometrium

Diagnosis

• The polyps are visible in the cervical os on speculum examination

• Must be differentiated from polypoid neoplastic disease of the endometrium, small submucous pedunculated myomas, large nabothian cysts, and endometrial polyps

Treatment

• Asymptomatic polyps in women under age 45 may be left untreated

• 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

• 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

• Because of the possibility of endometrial disease, cervical polypectomy should be accompanied by endometrial sampling, and all tissue removed should be submitted for microscopic examination