History and Examination

History:

• Frequency of occurrence
• Related to changes e.g change in contraceptive pill
• Associated with pain?

Examination:

• View cervix
• Cervical smear if over 25 years old and due under the screening programme
• Triple swab (high vaginal, endocervical and chlamydia swabs)
• Any evidence of infection
• View for polyps

Differential Diagnoses

• Menstrual irregularity
• Infection
• Intermenstrual bleeding
• Cervical polyps
• Endometrial polyps
• Cervical Cancer

If the cervix appears/feels abnormal/suspicious upon speculum examination, refer urgently for colposcopy (2 week wait)

Cervical cancers are rare in women of reproductive age.

Risk factors for cervical cancers include:

• Human Papilloma Virus (HPV)
• Previous abnormal smear result
• Multiple sexual partners
• Smoking

Visually normal cervix/vagina

• Normal smear result or under 25
  • Check swab results and treat as appropriate
  • If all examination and investigation findings are normal, then patient can be reassured
  • If however symptoms are particularly troublesome, consider routine referral to Gynaecology
• Abnormal smear result
  • If Dyskaryotic smear - direct referral initiated by pathology
  • Refer to Colposcopy

Ectropion or polyp with normal smear or under 25

• Cervical polyps may be removed in primary care
• Ectropion is a physiological phenomenon and does not require referral unless patient suffers from persistent or annoying symptoms, consider routine referral to Gynaecology

Visually abnormal cervix/vagina

• Refer 2ww Gynaecology

Referral Criteria

• Consider referral to routine Gynaecology:
  • If troublesome symptoms persist after management in primary care
• Refer to Colposcopy under 2ww:
  • If vagina or cervix appears/feels abnormal/suspicious

Referral Instructions

For referral to Gynaecology, refer via e-Referral Service:

e-Referral Service selection:

• Speciality: Gynaecology
• Clinic Type: Not otherwise specified
• Service: DRSS-Eastern-Gynaecology-Devon ICB- 15N

For referral to 2ww Gynaecology, refer via e-Referral Service:

• e-Referral Service selection:
• Speciality: 2ww
• Clinic Type: 2ww Gynaecology
• Service: Two Week Wait Gynaecology-RDE-RH8

Referral Forms

DRSS Referral Form

2ww Gynaecology

This guideline has been signed off on behalf of NHS Devon.

Publication date: November 2018