March 10th, 2011 by Harriet Hall, M.D. in Opinion, Research
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A new article in the Journal of Women’s Health by Westhoff, Jones, and Guiahi asks “Do New Guidelines and Technology Make the Routine Pelvic Examination Obsolete?”
The pelvic exam consists of two main components: The insertion of a speculum to visualize the cervix and the bimanual exam where the practitioner inserts two fingers into the vagina and puts the other hand on the abdomen to palpate the uterus and ovaries. The rationales for a pelvic exam in asymptomatic women boil down to these:
- Screening for chlamydia and gonorrhea
- Evaluation before prescribing hormonal contraceptives
- Screening for cervical cancer
- Early detection of ovarian cancer
None of these are supported by the evidence. Eliminating bimanual exams and limiting speculum exams in asymptomatic patients would reduce costs without reducing health benefits, allowing for better use of resources for services of proven benefit. Pelvic exams are necessary only for symptomatic patients and for follow-up of known abnormalities. Read more »
*This blog post was originally published at Science-Based Medicine*
September 10th, 2010 by Peggy Polaneczky, M.D. in Better Health Network, Health Policy, Health Tips, News, Opinion, Research
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The Telegraph reports that the number of screening pap smears performed in the UK has declined after an 8 percent blip upwards in 2009 when publicity surrounding the death of Jade Goody from cervical cancer may have led more women to have this important screening test:
NHS laboratories processed 415,497 tests in 2009-2010, about 35,000 fewer than the previous year when 450,522. Miss Goody’s death in March last year prompted a 20 percent increase in the number of Scottish women taking tests. More than 122,000 were processed between April and June last year, the statistics revealed.
The irony of course, is that British reality TV star Jade Goody did have pap smears, but chose to ignore her doctor’s recommendations for treatment when her pap smears came back abnormal.
Nonetheless, the decline in pap smears has led NHS of Scotland to initiate a campaign to reach the up to 25 percent of young women who do not respond to invitations to have pap smears. Read more »
*This blog post was originally published at tbtam*