Cervical Polyp
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Direct answer
A cervical polyp is a benign hyperplastic protrusion of endocervical mucosa (the common "mucus" or endocervical polyp), presenting as a red, soft, pedunculated mass at the cervical os, usually 1-2 cm, causing intermenstrual bleeding, postcoital spotting, discharge or being found incidentally on speculum examination. Removal is by grasping the base with a sponge-holding forceps and twisting the polyp off (twist-and-avulse), with chemical or electrocautery to the base; the specimen always goes for histology because benign appearance does not exclude a malignant polyp or an endocervical extension of endometrial pathology. The critical clinical rule is that bleeding attributed to a visible polyp still requires evaluation of the endometrium in women over 40 or with risk factors, since a prolapsed endometrial polyp or carcinoma can masquerade as a "cervical" polyp.
What you must remember
- Types: endocervical (mucous) polyps — most common, from endocervical glands, single, red, soft, glassy; endometrial polyps prolapsing through the os — broader stalk, often larger, associated with abnormal bleeding and need endometrial sampling; fibroid polyp (pedunculated submucosal myoma) — firm, may project and even prolapse at the os; and rare adenoma and malignant polyps.
- Presentation: intermenstrual bleeding, postcoital bleeding, heavy or irregular bleeding, mucoid or blood-stained discharge, or an asymptomatic finding; occasionally a long pedicle lets the polyp protrude at the introitus.
- Removal technique: outpatient avulsion by twisting polyp base with ring forceps, base cauterised with silver nitrate or electrocautery; pain is minimal, bleeding trivial; larger bases or prolapsed endometrial polyps go for hysteroscopic resection.
- Histology mandatory: endocervical polyps show cystically dilated glands with inflammation and squamous metaplasia; malignancy within a polyp is rare (well under 1 per cent) but the sending rule is absolute.
- The mimic rule: a "polyp" in a woman over 40-45, or with obesity, diabetes, nulliparity or unexplained bleeding, is biopsied or sampled with endometrial aspiration before dismissal — endometrial carcinoma can prolapse through the cervix.
- Pregnancy context: cervical polyps are common causes of bleeding in pregnancy; conservative observation usually suffices, avulsion reserved for troublesome bleeding in the second trimester.
- Cervical cancer screening link: any lesion at the os deserves visual inspection with acetic acid and/or Pap smear status review before discharge — a fungating carcinoma can be mistaken for a large polyp.
From speculum finding to discharge plan
A 34-year-old reports spotting between periods for four months; speculum examination shows a 1.5 cm glistening red mass arising from the endocervical canal, mobile, non-tender, bleeding on touch. Her Pap smear is normal and current. In the outpatient clinic the polyp is grasped at its base with ring forceps and twisted steadily clockwise until it avulses, the base touched with silver nitrate or ball cautery, and the tissue dropped into formalin. Histology returns a benign endocervical polyp with chronic inflammation. Bleeding resolves; a six-week check confirms healing (recurrence runs at a few per cent, and recurrent polyps deserve hysteroscopy).
The same finding at 52 in a diabetic, obese woman with irregular bleeding changes the tempo: this "polyp" is biopsied, and an endometrial aspiration or hysteroscopy accompanies the polypectomy — a prolapsed endometrial polyp or carcinoma descending through the os presents exactly like a cervical polyp, and treating only the visible tip cures nothing. In pregnancy, a 2 cm polyp bleeding after intercourse at 16 weeks is observed conservatively; avulsion in the second trimester only if bleeding is heavy.
Where students slip
Two slips dominate. First, dismissing the polyp once avulsed — "send for histology" is an unbreakable reflex, and options often include the trap "no follow-up needed for a benign-looking polyp". Second, the age-40-plus woman: attributing all bleeding to a visible polyp without endometrial evaluation misses the prolapsed endometrial lesion. Technique recall — twisting avulsion rather than sharp excision — is a viva favourite, as is the pregnancy answer of conservative management. Finally, do not conflate pill-related endocervical glandular hyperplasia with a true polyp: the polyp is a structural lesion you can grasp, not a cytological change.
Frequently asked questions
How is an endocervical polyp removed?
By grasping the base with ring or sponge forceps and twisting until it avulses, followed by cautery or silver nitrate to the base; the tissue is always sent for histology.
Which symptom pattern suggests a cervical polyp?
Intermenstrual or postcoital spotting with mucoid or blood-stained discharge in a reproductive-age woman, confirmed by a red pedunculated mass at the os on speculum examination.
Why is histology mandatory even for benign-looking polyps?
Malignant change, though rare, and prolapsed endometrial polyps or carcinomas cannot be excluded by appearance; histology is the only confirmation.
When should a "cervical polyp" prompt endometrial sampling?
In women over 40-45, or with obesity, diabetes, nulliparity, or abnormal bleeding patterns, because endometrial hyperplasia and carcinoma can prolapse through the internal os and mimic a cervical polyp.
How are cervical polyps managed in pregnancy?
Conservatively — observation and avoidance of trauma; avulsion is reserved for significant bleeding, ideally in the second trimester, since most pregnancy-related polyps are benign and settle postpartum.