Good point and I would totally agree - and disagree in the same time. The bimanual exam can deliver so much more information - once examining women that delivered and would not like to talk about problems like painful cohabitation or incontinence. By examining the pelvis regarding muscular tonus and defects that would otherwise not be seen, we could easily address the women carefully to that subject. I have experienced lots of patients, that were happy someone but them started that topic. I agree that women that are young, nullipareae and without any symptoms, should not get an bimanual exam. But again, to my experience women do not only ask for the exclusion of a disease - they also want to have the proof of being healthy - what resembles the same, but isnt ! There are findings, that are not malignant, not even affecting women health - but wouldnt we want to now about what is going on inside ? So why not switch to ultrasound, as we do upon request ? Of course - studies show, that vaginal ultrasound is not detecting ovarian cancer if performed without symptoms - but here are lots of other diagnosis women want to be aware - not only the malignant ! We together with our patients should decide, what is the best way for each individual regarding her prevention. Still there is no study, that without any doubt proofs, that performing a pap-smear only every second or third year would not put women at risk. HPV-vaccination-programs (onl 35-40 % of the eligible patients in germany participate) and HPV-detection-only-programs have still not shown to be superior to yearly pap-smears and colposcopy. Currents studies are showing trends towards combination of those programs - but as I may compare - once a plane has not shown to be flying, no passenger should be transported ! Regarding HPV-only screening every 5 years according to age, studies still have to proof effectiveness: company-based studies have the bitter taste of shifting money from one part of the health-system towards another. HPV-positive women do not necessarily develop cervical neoplasia - and surely will be highly affected by that diagnosis. PAP-smears have shown to be highly effective reducing the prevalence of cervical cancer and still there is no proof, that HPV-based screening would reduce this any further. Other sties show, that if the acceptance of the existing preventive could be enhanced, cervical neoplasias and others could be reduced. So if you address your gynoin the future, ask him about what is best for you as an individual and what he thinks is best for you - as you should have chosen her/him as your trustful preventive health-specialist !
Posted on: Tue, 01 Jul 2014 15:42:27 +0000
Trending Topics
Recently Viewed Topics
© 2015