Letters Gynaecological examinations

Good not bad medicine

BMJ 2011; 342 doi: https://doi.org/10.1136/bmj.d1760 (Published 23 March 2011) Cite this as: BMJ 2011;342:d1760
  1. John Butler, specialist registrar1,
  2. Desmond Barton, gynaecological oncologist1,
  3. John Shepherd, professor of gynaecological oncology1,
  4. Karina Reynolds, consultant gynaecological oncologist2,
  5. Sean Kehoe, president3
  1. 1Royal Marsden Hospital, London, UK
  2. 2St Bartholomew’s Hospital, London, UK
  3. 3British Gynaecological Cancer Society, Oxford Radcliffe Hospitals, Oxford, UK
  1. john.butler{at}cancer.org.uk

We read with interest Dr Spence’s article “Bad medicine: gynaecological examinations” and agree with the assessment of the low sensitivity and specificity of bimanual pelvic examination and the importance of ultrasound imaging for patients with pelvic or abdominal symptoms.1

We read with great concern, however, the recommendation that speculum examination of the cervix is unwarranted in cases of painless vaginal discharge. Painless vaginal discharge is not only a common benign symptom but also a cardinal symptom of cervical cancer and genital tract malignancy. NICE guidelines for the assessment of cancers rightly recommend a speculum examination in the assessment of women with vaginal discharge.2 A recent report highlighted increasing incidence and mortality from cervical cancer in England, particularly in women aged 25 to 29.3 Cervical cancer survival rates in the UK are worse than in other European countries.4 Late diagnosis is the major contributor to poor cancer survival in the UK and it is therefore important that healthcare professionals are vigilant to the presentation and early diagnosis of cervical cancer.5

Good medicine involves a thorough history, physical examination, and investigations, which provide not only the reassurance of common benign diagnoses, such as a physiological discharge, but also the assessment of uncommon but potentially fatal conditions. Cervical examination is neither “illogical” nor “unscientific” and should be part of the assessment of all women with vaginal discharge to improve the early diagnosis of cervical cancer.


Cite this as: BMJ 2011;342:d1760


  • Competing interests: None declared.


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