Cervical lesions - colposcopy

All patients with abnormal bleeding (IMB / PCB / PMB) or excessive discharge should have a speculum examination to rule out a cervical / vaginal / vulval malignancy.

A smear is not required unless indicated by SCCRS guidance e.g. smear due or previously defaulted.

Most cervical lesions are benign and may be referred routinely to general gynaecology.

Normal Cervix

Atrophic Cervix

Atrophic cervix / vagina

Cervix +/- vagina may appear vascular / red after menopause due to atrophy

→ May benefit from topical estrogen if symptomatic

Cervical cancer

Cervical Cancer

Fungating +/- ulcerated lesions, irregular, friable

→ Refer to colposcopy as USOC

Cervical polyps

Usually benign / smooth outpouching of the lining of the cervix

→ Refer routinely to general gynaecology for removal

Cervical Ectropion

Cervical ectropion / ectopy Physiological

→ Only requires treatment if causing bothersome symptoms (PCB or excessive discharge) and patient wishes intervention

Nabothian follicles Physiological (blocked glands)

→ No intervention required

Prior LETZ treatment (at colposcopy)

Scarring / may appear like an ectropion / will persist after menopause

→ Manage like an ectropion

All the images above are with permission from the NHS Cancer Screening Programmes.

Who to refer, who not to refer, how to refer

Colposcopy (USOC)

Abnormal smears – these patients will be referred via SCCRS
Suspicion of cervical malignancy on speculum examination

Sci Gateway -> BGH -> Gynaecology – Colposcopy (choose URGENT REFERRAL in protocol text and priority USOC)

General Gynaecology (USOC)

Suspicion of vulval or vaginal malignancy

General Gynaecology (routine)

Cervical Polyps – if patient is pre-menopausal the polyp is asymptomatic and the polyp is less than 1cm in diameter, there is no need to refer, and patient can be reassured
Cervical ectropion – ONLY if causing bothersome symptoms and patient wishes intervention