Cervical Polyps

What cervical polyps are

The cervix is the lower part of the uterus that opens into the vagina. Polyps grow from its surface lining and hang on a stalk. They are typically:

• smooth, red, purple or gray
• soft and fragile, so they bleed easily when touched
• a few millimeters to 2 cm in size
• single, although several can occur

There are two types:

Polyps from the uterine lining can also hang down through the cervix; these are endometrial polyps and need different assessment.

Causes and risk factors

The exact cause is not known. Contributing factors are thought to include:

• estrogen stimulation
• chronic inflammation of the cervix (cervicitis)
• blocked blood vessels in the cervix
• having had children
• being in the 40s or 50s

They are not caused by sexually transmitted infections, although infections can coexist.

Symptoms

Many women have no symptoms. When present:

• light bleeding or spotting after sex
• bleeding between periods (intermenstrual bleeding)
• heavier periods
• bleeding after menopause
• increased white or yellow discharge, sometimes foul-smelling if the polyp is infected

These symptoms have many other causes, including cervical cancer, so they should always be checked rather than assumed to be a polyp.

Diagnosis

Polyps are usually seen during a speculum examination. The doctor may also:

• take a Pap test and HPV test if screening is due
• test for infection
• arrange a pelvic ultrasound if an endometrial polyp or other uterine cause of bleeding is suspected
• perform colposcopy (a magnified look at the cervix) if the cervix looks abnormal
• assess the lining of the uterus with ultrasound or a biopsy after menopause, because postmenopausal bleeding can come from the endometrium even when a cervical polyp is present

Treatment

Removal (polypectomy)

Most polyps are removed in the office:

1. A speculum is inserted, as for a Pap test.
2. The polyp is grasped with forceps and twisted off at the base, or tied with a thread and cut.
3. The base may be cauterized with a chemical such as silver nitrate to stop bleeding.

It usually takes a few minutes and causes mild cramping, if anything. Larger polyps, those with a broad base, or polyps arising high in the canal may need removal under anesthesia, sometimes with hysteroscopy.

The removed tissue is sent to a lab. The vast majority are benign; cancerous or precancerous changes are found in well under 1 percent.

After removal

• Expect light spotting or brown discharge for a day or two.
• Avoid sex, tampons and douching for a few days or as advised.
• Report heavy bleeding, fever or foul discharge.

Small, symptom-free polyps

Some doctors monitor small polyps in women without symptoms, especially when removal would be inconvenient, but most are removed for testing.

Cervical polyps in pregnancy

Polyps can enlarge with pregnancy hormones and bleed, causing spotting that can be worrying. Any bleeding in pregnancy should be checked. Small polyps are often left alone until after delivery unless they bleed heavily or look suspicious, in which case they can usually be removed safely.

Outlook

Removal cures the polyp. New polyps can form later in some women, so report any new bleeding. Keep up with regular cervical screening, because polyps do not protect against, or signal, cervical cancer, which is caused by persistent HPV infection.

Frequently asked questions

Are cervical polyps cancerous?

Almost never. More than 99 percent of cervical polyps are benign. Because a small number contain abnormal cells, and because the same symptoms can come from cancer, polyps are usually removed and examined under a microscope.

What causes cervical polyps?

The cause is not fully known. They are linked to estrogen, chronic inflammation of the cervix and blocked blood vessels, and are most common in women in their 40s and 50s who have had children. They are not a sexually transmitted infection.

Does cervical polyp removal hurt?

Most women feel little or mild cramping, similar to a Pap test. Removal takes a few minutes in the office and does not usually need anesthesia. Light spotting for a day or two afterward is normal.

Can cervical polyps cause bleeding after sex?

Yes. Polyps are fragile and bleed easily when touched, so spotting after sex is one of the most common symptoms. Bleeding after sex can also come from infection, cervical ectropion or, rarely, cervical cancer, so it should always be checked.

Can cervical polyps come back?

They usually do not regrow from the same spot after complete removal, but new polyps can develop elsewhere on the cervix. Report any new bleeding or discharge to your doctor, and continue regular cervical screening.