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. The national 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 25-29 year olds.(3) Furthermore the survival rates for cervical cancer in the UK are worse than other European countries. (4) Late diagnosis is the major contributor to poor cancer survival in the UK and it is therefore important that health care professionals are vigilant to the presentation and early diagnosis of cervical cancer. (5)
Good medicine involves a thorough history, physical examination, and investigations. This provides 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.
John Butler (Specialist Registrar), Desmond Barton (Gynaecological Oncologist), John Shepherd (Professor of Gynaecological Oncology) (Royal Marsden Hospital, London)
Sean Kehoe (President of the British Gynaecological Cancer Society, Oxford Radcliffe Hospitals)
1. From The Frontline: Bad medicine: gynaecological examinations Des Spence BMJ 342:doi:10.1136/bmj.d1342
2. Referral for suspected cancer NICE, 2005
3. Profile of Cervical Cancer in England, NCIN/Trent Cancer Registry, 2011
4. Abdel-Rahman M, Stockton D, Rachet B, Hakulinen T, Coleman MP What if cancer survival in Britain were the same as in Europe: how many deaths are avoidable?
5.Richards MA. The size of the prize for earlier diagnosis of cancer in England. Br J Cancer. 2009 Dec 3;101 Suppl 2:S125-9.
Competing interests:
No competing interests
15 March 2011
John Butler
Specialist Registrar
Des Barton, John Shepherd, Karina Reynolds, Sean Kehoe
Rapid Response:
Good medicine: Gynaecological Examinations
Painless vaginal discharge is not only a common benign symptom but also a cardinal symptom of cervical cancer and genital tract malignancy. The national 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 25-29 year olds.(3) Furthermore the survival rates for cervical cancer in the UK are worse than other European countries. (4) Late diagnosis is the major contributor to poor cancer survival in the UK and it is therefore important that health care professionals are vigilant to the presentation and early diagnosis of cervical cancer. (5)
Good medicine involves a thorough history, physical examination, and investigations. This provides 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.
John Butler (Specialist Registrar), Desmond Barton (Gynaecological Oncologist), John Shepherd (Professor of Gynaecological Oncology) (Royal Marsden Hospital, London)
Karina Reynolds (St Bartholomew's Hospital, London)
Sean Kehoe (President of the British Gynaecological Cancer Society, Oxford Radcliffe Hospitals)
1. From The Frontline: Bad medicine: gynaecological examinations Des Spence BMJ 342:doi:10.1136/bmj.d1342
2. Referral for suspected cancer NICE, 2005
3. Profile of Cervical Cancer in England, NCIN/Trent Cancer Registry, 2011
4. Abdel-Rahman M, Stockton D, Rachet B, Hakulinen T, Coleman MP What if cancer survival in Britain were the same as in Europe: how many deaths are avoidable?
5.Richards MA. The size of the prize for earlier diagnosis of cancer in England. Br J Cancer. 2009 Dec 3;101 Suppl 2:S125-9.
Competing interests: No competing interests