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Polyp with a wide base is present Inability to differentiate endocervical from endometrial polyp
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Spiewankiewicz B et al Hysteroscopy in cases of endocervical polyps Eur J Gynaecol Oncol 2003;24(1):67 9 [PMID: 12691321]
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CYST & ABSCESS OF BARTHOLIN S DUCT
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Trauma or infection may involve Bartholin s duct, causing obstruction of the gland Drainage of secretions is prevented, leading to pain, swelling, and abscess formation The infection usually resolves and pain disappears, but stenosis of the duct outlet with distention often persists Reinfection causes recurrent tenderness and further enlargement of the duct The principal symptoms are periodic painful swelling on either side of the introitus and dyspareunia A fluctuant swelling 1 4 cm in diameter in the inferior portion of either labium minus is a sign of occlusion of Bartholin s duct Tenderness is evidence of active infection Pus or secretions from the gland should be cultured for Chlamydia and other pathogens and treated accordingly (see 33); frequent warm soaks may be helpful If an abscess develops, aspiration or incision and drainage are the simplest forms of therapy, but the problem may recur Marsupialization (in the absence of an abscess), incision and drainage with the insertion of an indwelling Word catheter, or laser treatment will establish a new duct opening Antibiotics are unnecessary unless cellulitis is present An asymptomatic cyst does not require therapy
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Surgical therapy (marsupialization) is indicated
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Omole F et al Management of Bartholin s duct cyst and gland abscess Am Fam Physician 2003 Jul 1;68(1):135 40 [PMID: 12887119]
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Cervical polyps commonly occur after menarche and are occasionally noted in postmenopausal women The cause is not known, but inflammation may play an etiologic role The principal symptoms are discharge and abnormal vaginal bleeding However, abnormal bleeding should not be ascribed to a cervical polyp without sampling the endocervix and endometrium The polyps are visible in the cervical os on speculum examination Cervical polyps must be differentiated from polypoid neoplastic disease of the endometrium, small submucous pedunculated myomas, and endometrial polyps Cervical polyps rarely contain malignant foci
EFFECTS OF EXPOSURE TO DIETHYLSTILBESTROL IN UTERO
Between 1947 and 1971, diethylstilbestrol (DES) was widely used in the United States for diabetic women during pregnancy and to treat threatened abortion It is estimated that at least 2 3 million fetuses were exposed A relationship between fetal DES exposure and clear cell carcinoma of the vagina was later discovered, and a number of other related anomalies have since been noted In one-third of all exposed women, there are changes in the vagina (adenosis, septa), cervix (deformities and hypoplasia of the vaginal portion of the cervix), or uterus (T-shaped cavity) All women known to be exposed prenatally are advised to have an initial colposcopic examination to outline vaginal and cervical areas of abnormal epithelium, followed by cytologic examination of the vagina (all four quadrants of the upper half of the vagina) and cervix at yearly intervals Lugol s iodine stain of the vagina and cervix will also outline areas of metaplastic squamous epithelium
Treatment
Cervical polyps can generally be removed in the office by avulsion with a uterine packing forceps or ring forceps If the cervix is soft, patulous, or definitely dilated and the polyp is large, surgical D&C is required (especially if the pedicle is not readily visible) Hysteroscopy may aid removal and lead to identification of concomitant endometrial disease Because of the possibility of endometrial disease, cervical polypectomy should routinely be accompanied by endometrial sampling
CMDT 2008
Many women are not aware of having been exposed to DES Therefore, in the age groups at risk (36 60 years), examiners should pay attention to structural changes of the vagina and cervix that may signal the possibility of DES exposure and indicate the need for follow-up The incidence of clear cell carcinoma is approximately 1 in 1000 exposed women, and the incidence of cervical and vaginal intraepithelial neoplasia (dysplasia and carcinoma in situ) is twice as high as in unexposed women DES daughters have more difficulty conceiving and have an increased incidence of early abortion, ectopic pregnancy, and premature births In addition, mothers treated with DES in pregnancy appear to have a small increase in the incidence of breast cancer, beginning 20 years after exposure
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