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 / vagina
Cervix +/- vagina may appear vascular / red after menopause due to atrophy
→ May benefit from topical estrogen if symptomatic
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 / 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.
Colposcopy (USOC)
- Abnormal smears – these patients will be referred via SCCRS
- Suspicion of cervical malignancy on speculum examination
Sci Gateway>RIE/SJH>Gynaecology – Colposcopy (choose URGENT REFERRAL in protocol text and priority USOC)
General Gynaecology (USOC)
- Suspicion of vulval or vaginal malignancy
Sci Gateway>RIE/SJH>Gynaecology>LI Gynae Basic Sign Referral (priority routine)
General Gynaecology (routine)
- Cervical Polyps
- Cervical ectropion – ONLY if causing bothersome symptoms and patient wishes intervention
Sci Gateway>RIE/SJH>Gynaecology>LI Gynae Basic Sign Referral (priority routine)
Please see also http://www.cancerreferral.scot.nhs.uk/gynaecological-cancers/
Scottish Cervical Screening Programme: https://www.nsd.scot.nhs.uk/services/screening/cervicalscreening/
changes-to-cervical-screening-programme-faq.pdf
cervical-screening-routine-pathway-diagram-march-2022.pdf
Useful Patient information
NHS Inform
Colposcopy https://www.nhsinform.scot/tests-and-treatments/non-surgical-procedures/colposcopy
Cervical Screening/Smear test https://www.nhsinform.scot/healthy-living/screening/cervical/cervical-screening-smear-test
Jo’s Cervical Cancer Trust https://www.jostrust.org.uk/
