> Gynecological examination, guidelines

Dr. Molly Cook, a doctor who participated in the committee of the ACP for the guidelines, spoke with Medscape Medical News of the new guidelines. She sees the guidelines from the perspective of its role as a medical practitioner and the choices he must make in the limited time she has with patients: “Those 20 minutes are really full of things and I want to use my time in ways that are of particular benefit to women”.

The examination is commonly used as a control for the prevention of the disease in adult women, not pregnant and asymptomatic. ACP has reviewed the documentation and has determined that the pelvic exam is not; the benefit to the adult women. The recommendations advise against pelvic examination bimanual, but the recommendation for the execution of the pap test remains.

Amir Qaseem, medical in the American College of Philadelphia and colleagues, have developed the guidelines for the Medical Committee of the Guidelines of the ACP that have been published online on the first of July in the Annals of Internal Medicine.

The authors have analysed the evidence and found that the damage associated with screening through the gynecological visit outweigh the benefits. The guidelines also explain that screening for chlamydia and gonorrhea, sometimes executed with the pelvic exam, può be reliably performed using amplification tests nucleica on material from vaginal self-collected or urine. “Amplification tests nucleica on the vaginal samples self-collected or urine have been shown to be highly specific and sensitive, and this technique is endorsed by many organizations,” the authors write.

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In their recommendation, they add, “With the available evidence, we conclude that screening by examination exposes women to unnecessary harm and avoidable without the benefit (reduction of mortality,à or percentage of morbosità). In addition, these examinations add unnecessary costs to the health care system ($2.6 billion in the United States). These costs can be amplified by expenses caused by additional tests, including additional tests as a result of screening, false-positive; increased medical visits; and costs to maintain or obtain medical insurance”.

Robert Morgan, co-director of the Program for Gynecologic Cancers at City of Hope in Duarte, California, do not agree with the new guidelines and has expressed his discomfort in an interview with Medscape Medical News.

He recognized to be a medical oncologist and that his specialty influence his point of view and guide his desire to continue to do screening for cancer. “I’m seriously worried that in 10 years – has made it clear – we will see people who have abandoned their pap-test routine” (by not making the annual visit with the gynecologist, but in the screening of european the pap test does midwife, ed)

the American College of Obstetrics and Gynecology (ACOG) has reservations on the guidelines of the ACP. In a press note, the ACOG states that it remains convinced of its current guidelines for visits to the healthy women, that will include examination of the pelvis. The College believes that the choice to perform the gynaecological visits should be made on the basis of the individual needs, wishes and preferences of a woman.

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The ACOG believes that a annual pelvic exam remain a useful tool, in particular, to investigate on the incontinence and sexual dysfunction. The  College emphasizes also the importance of other aspects of the visit to the healthy woman, including clinical examination of the breast, immunizations, and discussion on contraceptive.

“we Continue to urge women to visit their health providers for annual visits, which play an important role in patient care,” said John C. Jennings, president of ACOG, in a statement. “A yearly visit to a healthy woman può help physicians promote a healthy lifestyle, healthy lifestyles, and to evaluate patients for risk factors for medical conditions, and identify medical conditions existing, opening così the door to the care. The annual visits to healthy women are important for service qualityà of the women, and the continuityà of their health.”

One of the co-authors said they have received funds and other support from the Foundation for the Medical Decisions and funds and other support from Healthwise. The other authors, Dr. Cook and Dr. Morgan have reported no financial relationships relevant.

IN ARGOMENTO:

women’s Health

Medicine for female

gynecological examination, when, how, and whyé

gynecological examination annual, unnecessary in asymptomatic women.

October 10, 2014