Cervical polyps are small growths (generally less than 1 cm) that form from either the outside of the cervix (the neck of the womb; Pic. 1) or inside the cervical canal (the passageway between the vagina and the womb). They are usually benign, or not cancerous. They are generally bright red in color, with a spongy texture. They may be attached to the cervix by a stalk (pedunculated) and occasionally prolapse into the vagina where they can be mistaken for endometrial polyps (Pic. 3) or submucosal fibroids that are located in the muscle beneath the endometrium of the uterus and distort the uterine cavity (Pic. 4).
Early clinical features may include abnormal vaginal bleeding, postcoital vaginal bleeding, and abnormal vaginal discharge. Cervical polyps are the most common cause of intermenstrual vaginal bleeding (vaginal bleeding (other than postcoital) at any time during the menstrual cycle other than during normal menstruation).
The cause of cervical polyps is uncertain, but their formation may be linked to increased levels of estrogen (female sex hormone), chronic inflammation (lasting for prolonged periods of several months to years) of the cervix, vagina, or uterus; or clogged blood vessels.
The diagnosis of cervical polyp is made with a cervical biopsy (Pic. 5), findings may include inflamed and dilated endocervical (mucus) glands and myxoid stroma (resembling mucus; Pic. 6). Cervical polyps can be removed using ring forceps. They can also be removed by tying surgical string around the polyp and cutting it off. The remaining base of the polyp can then be removed using a laser or by cauterisation. If the polyp is infected, an antibiotic may be prescribed.
Cervical polyp is usually asymptomatic. However, symptoms of cervical polyp may include the following:
Rarely, cervical cancer may arise from cervical polyps. Cervical cancer involves changes to the cells of the cervix, which is the lower part of the uterus (womb), which protrudes into the vagina. Cancer of the cervix is one of the most preventable cancers. Up to 90% of the most common form of cancer of the cervix could be prevented if women had regular screening. To preserve fertility, conservative surgery (with preservation of uterine body) and ovarian transposition are discussed.
The majority of patients with cervical polyp remain asymptomatic for years. If left untreated, common complications of cervical polyp include malignant transformation (0.2–1.7% of patients), bleeding, and recurrence.
Common risk factors in the development of cervical polyp, include:
Cervical polyp is more commonly observed among perimenopausal (before menopause) and postmenopausal (after menopause) women.
Effective measures for the primary prevention of cervical polyp include periodical ultrasound and cervical screening. Patients with cervical polyp are followed-up every 12 or 6 months once they are diagnosed and successfully treated. Follow-up testing includes pelvic examination, vaginal ultrasound, and colposcopy (cervical endoscopy).
The connection between cervical polyps and infertility is associated to where the polyp is placed. High up in the cervix, polyps can block the opening of the cervix and make it impossible for fertilization to occur. Also, the polyp may interfere with the production of cervical mucus. During ovulation, cervical mucus should be thin and slippery to help the sperm on its journey to fertilizing the egg. If the mucus is thick and sticky instead, it can prevent to fertilization occur.
Prognosis is generally excellent, and the 5-survival rate of patients with cervical polyp is approximately 100%. With proper treatment, the fertility is not affected. If patient don't have polyps removed, it can inhibit implantation and/or cause miscarriage.