Throughout this page, we will discuss cervical polyps as well as cervical ectropion and nabothian cysts.
Cervical polyps, as with most other polyps, are benign growths that occur on the cervix. They are most commonly on the endocervix, and are referred to as endocervical polyps. They are present in about 4% of women and very rarely (0.2-1.5%) do they develop into cancer.
🔢 Pathophysiology and classification
As they most commonly occur in the endocervix, they are predominantly occur due to columnar epithelial hyperplasia. The reasoning for this is unclear, but it may be due to either:
- Chronic inflammation
- Congestion of cervical vasculature - disrupts blood flow and
- Response to oestrogen
We can categorise them based on their location and cell types:
- Endocervical polyps - typically occurring in premenopausal women. They are made up of simple columnar cells.
- Ectocervical polyps - typically occurring in postmenopausal women. They are made up of stratified squamous cells.
⚠️ Risk factors
- Multigravida
- History of STI
- History of cervical polyps
- Oestrogen exposure and premenopausal
😷 Presentation
They are most commonly asymptomatic and are found on cervical screening as a result of the screening programme.
They sometimes may cause symptoms, such as:
- Abnormal vaginal bleeding - menorrhagia, intermenstrual bleeding, post-coital bleeding, post-menopausal bleeding.
- Vaginal discharge
- Infertility
🔍 Investigations
As mentioned, they are often seen incidentally during cervical screening. The only way to definitively diagnose them is histologically after removal of the polyp.
We may opt to do a cervical smear to rule out CIN and an endocervical swab + high vaginal swab may be done to rule out infection.
🧰 Management
- Polypectomy - this may be done even in primary care. It can be done with polypectomy forceps. Haemorrhage or bleeding can be cauterised with silver nitrate.
- Monitoring - polyps may recur and therefore it may require monitoring in the long term.
Cervical ectropion refers to eversion of the endocervix onto the ectocervix. It was previously referred to as cervical erosion and sometimes is known as cervical ectopy. However, the term “cervical erosion” implied that some form of erosion occurs, which is not the case. In fact, what actually occurs is high levels of oestrogen exposure result in alterations to the transformation zone in which the simple columnar epithelium of the endocervix becomes present on the ectocervix. This type of epithelium has fine blood vessels which can become torn which leads to bleeding. Also as the simple columnar cells are glandular, and secrete mucus we see vaginal discharge.
It is a benign condition, occurring predominantly in women of reproductive age.
⚠️ Risk factors
As it occurs due to high levels of oestrogen exposure, we see it most commonly in:
- Adolescents
- Pregnancy
- Hormonal contraception
In post-menopausal women the degree of ectropion shrinks.
😷 Presentation
- Vaginal discharge - this is the most common symptom.
- Dyspareunia
- Postcoital bleeding and intermenstrual bleeding
👀 On examination we will clearly see the demarcation between the pale pink squamous epithelium (that is typically present on the ectocervix) versus the velvety red columnar epithelium (normally present in the endocervix).
🔍 Investigations
It is a clinical diagnosis, as seen on speculum examinanation.
It might be useful to do other tests such as:
- Pregnancy test - to rule out pregnancy.
- Swabs - to rule out infection.
- Cervical smear - to rule out CIN.
🧰 Management
It typically requires no treatment and resolves as the patient gets older, or once they have completed pregnancy or if they discontinue their hormonal contraceptive treatment.
If there is bleeding that is considered “problematic” we can perform ablative treatments such as:
- Silver nitrate - superficially cauterises the ectropion and does not usually require local anaesthesia.
- Cold coagulation - despite the name, it uses a hot metal probe (100ºC) for 30-60 seconds to cauterise the area. It requires local anaesthesia.
- Diathermy - uses temperatures higher than 100ºC via an electric current to cauterise the ectropion. Also requires local anaesthesia.
Nabothian cysts, also known as nabothian follicles, mucinous retention cysts or epithelial cysts are another benign cervical condition. They are simply cysts containing neutrophils and proteinacious material. They are located at the transformation zone of the cervix. They hold no clinical significance and require no treatment. They are asymptomatic and may be seen on examination, but are of no concern.
