Stirrups or no stirrups for routine speculum examinations?: ... but we do not need to do a trial of smear quality

doi:10.1136/bmj.333.7562.305

BMJ 2006;333:305 (5 August), doi:10.1136/bmj.333.7562.305

Letter

Stirrups or no stirrups for routine speculum examinations?

... but we do not need to do a trial of smear quality

The first 150 words of the full text of this article appear below.

EDITOR—Predictably, in this age of evidence based medicine,Spaar and Puhan (previous letter) have called for a randomisedtrial to determine whether using different positions for takingcervical smears makes a difference to smear quality.¹ A verylarge trial would be necessary to be confident that no differencehad been missed. This would comprise a wasteful and unnecessaryuse of resources.

As family doctors inseveral countries routinely use stirrups—notably,the United States and Canada—while those in others, suchas the United Kingdom and Australia, routinely use feet on thecouch positions, a simple ecological study to determine whethersmear quality differs substantially between those countrieswould be sufficient. Perhaps the more important outcome (althoughmore difficult to assess) would be effectiveness of the nationalcervical screening programme, since extra discomfort may reducethe willingness of many women to attend for smear testing. Inthat case, even if the . . . [Full text of this article]

James A Dickinson, professor of family medicine

University of Calgary Medical Clinic, 1632 14th Avenue NW, Calgary, Alberta, Canada T2N 1M7 dickinsj@ucalgary.ca

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