A Case

Study About
Cervical
Polyps
 Introduction

Cervical Polyps is a common benign polyp or tumour on the surface of the cervical canal. It it smooth,
red, finger-shaped benign tumor that grows outside the cervix. Cervical polyps have a shorter, broader
base and occur more often in women who are menopausal. Even though a cervical polyp is completely
benign in nature, there is a 1% chance that the cervical polyp might show neoplastic change in the future,
leading to cervical cancer. Since cervical polyps symptoms are completely absent in most cases, it is
usually difficult to diagnose the formation of cervical polyps. More than 99% of polyps are benign. The
incidence of malignant polyps of the cervix is rare. Less than 1 in every 200 polyps is malignant.

Causes:
>Raised levels of Estrogen

>Clogged Cervical Blood Vessels

Signs and Symptoms:

Cervical polyps often show no symptoms. Where there are symptoms, they include

> intermenstrual bleeding

>abnormally heavy menstrual bleeding

>vaginal bleeding in post-menopausal women,

>bleeding after sex

>thick white vaginal or yellowish discharge

Diagnostic Tests:
>Pap Smear Test

>Pelvic Examination

>Cervical Biopsy

Prevention:
Visit your doctor for an annual Pap test and for regular pelvic exams. A direct examination is the best way to identify
cervical polyps.

Nursing Management:
>Explain the condition and rationale for removal of the polyps and giving follow up
care instructions

>Assist also in the procedure of Removal of the Polyps

 Anatomy and Physiology
Physiology (External Female Organ)

Mons Pubis
a.k.a. Mons Veneris that protects the pubic bone and vulva from the impact of sexual
intercourse. After puberty, it is covered by pubic hair (responsible for not easily harboring
the microorganisms in the vagina.
Prepuce of Clitoris
protective cover of glans of clitoris.
Glans of Clitoris
a short erectile organ above the vagina that is responsible for sexual excitation or
pleasure.
Vestibule
the gland at the point where vagina and vulva join that secretes lubricatingsubstance. It
consists of 3 parts:
1.Urethral Opening
a.k.a. Meatus that drains urine from the bladder.
2. Clitoris
functions sexual pleasures.
3. Vestibule of Vagina
a.k.a. Vaginal Introitus that is for the vaginal entrance.
Openings of Paraurethral
connected to the urethra and lubrication.
Labium
a fleshy and liplike structure folds that protect the openings from bacterial invasion. It has:
1 Labia Majora
o elongated hair covered skin folds that are responsible for lubrication.
2 Labia Minora
o smaller folds enclosed by the labia majora and their function is to protect the
vagina and urethra openings. And they also produce lubricant.
Vagina
receives penis and semen during mating, and passageway of childbirth and menstrual
flow.
Hymenal Caruncle
a.k.a. Hymen, a membrane which partially covers the vaginal passage.
Opening of Greater Vestibular Gland
a.k.a. Bartholins Glands, the two glands at the
side of the vagina and between the vulva that secretes a lubricating substance.
Vestibular Fossa
a.k.a. Navicular Fossa, a small cavity of between the vaginal orifice and fourchette.
Frenulum of Labium
the fold connecting the two labia minora posteriorly.
Posterior Labia Commissure
rear joining of the labia majora above the perineum.
Perineal Raphe
ridge along the median line that runs forward from the anus.
Anus
a.k.a. Anal Orifice, in which feces passes through

Physiology (Internal Female Organ)

Ovaries
paired shape of almonds. It produces ova (singular, ovum), or eggs.
The two ovaries present in each female are held in place by the following ligaments:
1 Broad Ligament
o is a section of the peritoneum that drapes over the ovaries, uterus, ovarian
ligament, and suspensory ligament. It includes both themesovarium and
mesometrium. The mesovarium is a fold of peritoneum that holds the ovary in place.
2 Suspensory Ligament
o anchors the upper region of the ovary to the pelvic wall. Attached to this ligament
are blood vessels and nerves, which enter the ovary at the hilus.
Ovarian Ligament
anchors the lower end of the ovary to the uterus.
The following two tissues that cover the outside of the ovary:
1 Germinal Epithelium
o is an outer layer of simple epithelium.
2 Tunica Albuginea
o is a fibrous layer inside the germinal epithelium.
The inside of the ovary, or stroma, is divided into two indistinct regions:
1 Outer Cortex and the Inner Medulla
o embedded in the cortex are saclike bodies called ovarian follicles. Each ovarian
follicle consists of an immature oocyte (egg) surrounded by one or more layers of
cells that nourish the oocyteas it matures.
2 Follicular Cells
o the surrounding cells if they make up a single layer, orgranulosa cells, if more than
one layer is present.
3 Uterine tubes (oviducts)
o transport the secondary oocytes away from the ovary and toward the uterus (the
ovaries consist of primary oocytes, which develop into secondary oocytes). The
following regions characterize each of the two uterine tubes(one for each ovary):
4 Infundibulum
o is a funnel-shaped region of the uterine tube that bears fingerlike projections called
fimbriae. Pulsating cilia on the fimbriae draw the secondary oocyte into the uterine
tube
5 Ampulla
o is the widest and longest region of the uterine tube. Fertilization of the oocyte by a
sperm usually occurs here.
6 Isthmus
 o is a narrow region of the uterine tube whose terminus enters theuterus.
Wall of the Uterine Tube
consists of the following three layers:
1 Serosa
o a serous membrane, lines the outside of the uterine tube.
2 Middle Muscularis
o consists of two layers of smooth muscle that generateperistaltic contractions that
help propel the oocyte forward.
3 Inner Mucosa
o consists of ciliated columnar epithelial cells that help propelthe oocyte forward, and
secretory cells that lubricate the tube and nourish theoocyte.
Uterus
a hollow and pear-shaped organ that is to house, nourish and expel the fetus during
delivery; and for menstrual flow. It composes 3:
1 Body or Corpus
o the main body part of the uterus.
2 Fundus
o superior rounded region above the entrance of the uterine tubes.
3 Isthmus
o slightly constricted portion that joins the corpus to the cervix.
Uterus is held in place by the following ligaments:
Broad ligaments
o fold of peritoneum supporting the uterus, extending fromthe uterus to the wall of the
pelvis on either side
Utero-sacral ligaments
o a part of the thickening of the visceral pelvic fasciabeside the cervix and vagina;
called also Petit's Ligament.
Round ligaments
o a fibromuscular band attached to the uterus near theuterine tube, passing through
the inguinal ring to the labium majus
Cardinal (lateral cervical) ligaments
- part of a thickening of the visceralpelvic fascia beside the cervix and vagina, passing laterally to
merge with theupper fascia of the pelvic diaphragm.
Wall of the Uterus consists of the following three layers:
1 Perimetrium
o is a serous membrane that lines the outside of the uterus.
2 Myometrium
o consists of several layers of smooth muscle and imparts the bulk of the uterine wall.
Contractions of these muscles during childbirth help force thefetus out of the uterus.
3 Endometrium
o is the highly vascularized mucosa that lines the inside of theuterus. If an oocyte has
been fertilized by a sperm, the zygote (the fertilized egg)implants on this tissue.
Vagina (birth canal)
serves both as the passageway for a newborn infant and as adepository for semen during
sexual intercourse. It consists of the following layers:
Outer Adventitia
holds the vagina in position.
Middle Muscularis
 consists of two layers of smooth muscle that permitexpansion of the vagina during childbirth
and when the penis is inserted.
Inner Mucosa
has no glands. But bacterial action on glycogen stored in thesecells produces an acid
solution that lubricates the vagina and protects it againstmicrobial infection. The acidic
environment is also inhospitable to sperm. Themucosa bears transverse ridges called
rugae

Physiology of the Cervix

Cervix is the 3rd lower portion of the uterus, neck line part, narrowed where it joins
the top end of the vagina. Cylindrical in shape and protrudes through the upper
anterior vaginal wall.

It has cervical mucus that is made of 90% of water, depending on the water content
which varies during the menstrual cycle that functions as a barrier. It is usually
contains electrolytes, mainly Calcium, Sodium, and Potassiun, organic compounds
such as Amino acids and soluble proteins. It is also composed of Zinc, Copper, iron,
Manganese and selenium elements.

After menstrual period, the external OS is blocked by mucus that is thick and acidic
and it undergoes a series of changes in position and texture of cervix uteri and wall.
Menstrual Cycle
The activities of the ovary and the uterus are coordinated by negative- and positive-
feedback responses involving gonadotropin releasing hormone (GnRH) from the
hypothalamus, follicle stimulating hormone (FSH) and luteinizing hormone (LH) from
the anterior pituitary, and the hormones estrogen and progesterone from the follicle
and corpus luteum. A description of the events follows):

Hypothalamus and anterior pituitary initiate the reproductive cycle:

The hypothalamus monitors the levels of estrogen and progesterone in the blood. In
a negative-feedback fashion, low levels of these hormones stimulate the
hypothalamus to secrete GnRH, which in turn stimulates the anterior pituitary to
secrete FSH and LH.2.

Follicle develops:
FSH stimulates the development of the follicle from primary through mature
stages.3.

Follicle secretes estrogen:

LH stimulates the cells of the theca interna and the granulosa cells of the follicle to
secrete estrogen. Inhibin is also secreted by the granulosa cells.4.

Ovulation occurs:
Positive feedback from rising levels of estrogen stimulate the anterior pituitary
(through GnRH from the hypothalamus) to produce a sudden mid cycle surge of LH.
This high level of LH stimulates meiosis in the primary oocyte to progress toward
prophase II and triggers ovulation.5.
Corpus luteum secretes estrogen and progesterone:
After ovulation, the follicle, now transformed into the corpus luteum, continues to
develop under the influence of LH and secretes both estrogen and progesterone.6.

Endometrium thickens:
Estrogen and progesterone stimulate the development of the endometrium, the
inside lining of the uterus. It thickens with nutrient-rich tissue and blood vessels in
preparation for the implantation of a fertilized egg.7.

Hypothalamus and anterior pituitary terminate the reproductive cycle:

Negative feedback from the high levels of estrogen and progesterone cause the
anterior pituitary(through the hypothalamus) to abate the production of FSH and LH.
Inhibin alsosuppresses production of FSH and LH.8.

Endometrium either disintegrates or is maintained, depending on whether

implantation of the fertilized egg occurs, as follows:

Implantation does not occur: In the absence of FSH and LH, the corpus luteum
deteriorates. As a result, estrogen and progesterone production stops. Without
estrogen and progesterone, growth of the endometrium is no longer supported, and
it disintegrates, sloughing off during menstruation.

Implantation occurs: The implanted embryo secretes human chorionic gonadotropin

(hCG) to sustain the corpus luteum. The corpus luteum continues to produce
estrogen and progesterone, maintaining the endometrium. (Pregnancy tests check
for the presence of hCG in the urine).

Menopause

is the cessation of menstruation. This usually occurs in women between the ages of
45 and 50. Some women may reach menopause before the age of 45 and some
after the age of 50. In common use, menopause generally means cessation of
regular menstruation. Ovulation may occur sporadically or may cease abruptly.
Periods may end suddenly, may become scanty or irregular, or may be
intermittently heavy before ceasingal together. Markedly diminished ovarian
activity, that is, significantly decreased estrogen production and cessation of
ovulation, causes menopause.