> Gynecological examination, when, how, and whyé

The current guidelines of the American Congress of Obstetrics and Gynaecology (ACOG) for the visits of healthy women include a recommendation on running the regular gynecological examination.

The ACOG recommends considering the individual needs of a woman, requests and preferences when you decide to perform gynecological visits. However, the ACOG believes that a gynecological examination annual is useful to discover urinary incontinence and sexual dysfunction.

examination the American College of Physicians (ACP) has issued new guidelines clinical procedures against the gynecological examination annual in adult women, non-pregnant, asymptomatic. The College describes the recommendation as strong, with evidence of qualityà moderate.

The guidelines were published online on 1 July 2014 in the Annals of Internal Medicine.

The authors have analysed the evidence and found that the damage associated with the controls by using the examination outweigh the benefits. The guidelines also explain that screening for gonorrhea and chlamydia, sometimes done with the gynecological examination, can be reliably performed using amplification assay with a nucleic acid on vaginal swabs or urine specimens collected from the sé. These tests have been shown to be highly specific and sensitive, and this technique is supported by many organizations.

In their recommendation, they add, “With the available evidence, we conclude that the controls by examination of the annual expose women to unnecessary harm and avoidable without any benefit in return (not c’è reduction of mortality,à and not to get sick less). In addition, these examinations add cost unnecessary to the health care system, which can be amplified by expenses due to additional follow-up tests, including those that arise from false positives in the test of control”.

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The ACOG replica and has expressed reservations regarding the guidelines of the ACP. In a press release says to stay on its current guidelines for the visits of healthy women, which include the regular gynecological examination. The Congress believes that the choice of performing gynecological visits be made on the basis of the individual needs, wishes and preferences of a woman.

The ACOG believes that an examination of the annual remains a useful tool, in particular for the recognition of incontinence and sexual dysfunction. The Congress emphasizes the importance of other aspects of the visit to the healthy woman, including clinical breast examination, immunizations, and information on contraceptives.

These guidelines of the ACP regarding the use of the examination as regular examination of control and apply to the women asymptomatic, non-pregnant, adult.

An analysis of the literature is focused on the potential effects of these controls, including mortality,à, morbidityà and damage, and even overdiagnosis, sovratrattamento and damages in connection with the diagnostic procedure.

A systematic analysis of the published literature in the English language from 1946 through January 2014 identified using the MEDLINE, has not shown benefits from these controls.

One study showed that 96.7% of 100% of the abnormal results of the examination in this category of women has not identified any cancer of the ovary.

A study of cancer of the ovary did not show reduction of mortalityà né to this né other cancers, associated with the controls with the gynecological bimanual for 5 years, even if made together with the research of the tumor marker CA-125 and transvaginal ultrasound.

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The harm of screening may include surgical laparoscopy or laparotomies unnecessary, fear, embarrassment, ansietà, pain or discomfort, and consequent avoidance of subsequent care necessary.

On the basis of this analysis, which has not shown evidence that routine gynaecological examination on these women offers any benefit, the ACP has concluded that to do the gynecological visit exposes women to unnecessary damage and avoidable without any benefit in return.

Then, the ACP advises against the execution of the gynaecological examination in asymptomatic women, non-pregnant, adults (recommendation strong, the qualityà of evidence moderate).

However, all women should still undergo the screening test Papanicolau, as recommended.

there is no needà to perform a gynecological examination before prescribing oral contraceptives.

The testing of urine or vaginal swabs to test for amplification with nucleic acid are sufficient for the screening of sexually transmitted infections, and not è necessary to a gynecological examination.

women with symptoms such as vaginal discharge, abnormal bleeding, pain, urinary problems and sexual dysfunction should, instead, have to undergo an appropriate assessment, including gynecological examination.

screening for cervical cancer should be limited to the visual inspection of the cervix and the pap test for the prevention of cancer and whether the research of the human papilloma virus.

The ACP is expressed currently against the execution of the gynaecological examination yearly for asymptomatic women, non-pregnant, adult.

The ACP is currently recommended that only women with symptoms such as vaginal discharge, abnormal bleeding, pain, urinary problems and sexual dysfunction should undergo a proper evaluation, including gynecological examination.


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gynecological examination annual, unnecessary in asymptomatic women.

20 October 2014