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

"All routine referrals have been changed to telephone consultation where possible and if required can attend the department for examination and further investigation."

• 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:

• Specialty: Gynaecology
• Clinic Type: Not otherwise specified
• Service: DRSS-Western-Gynaecology-Devon ICB-15N

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

e-Referral service selection:

• Specialty: 2WW
• Clinic Type: 2WW Gynaecology
• Service: DRSS-Western-2WW Gynaecology-NHS Devon

Referral Forms

DRSS Referral Form

2ww Gynaecology Proforma

Pathway Group

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

Publication date: November 2018