Commentary: Best practice in primary care

A well done (though necessarily unblinded) trial from the United States shows that women attending for cervical smears feel less vulnerable and have less physical discomfort if a method that doesn't require stirrups is used.1 The quality of the smears did not differ, and around half the women were from ethnic minority groups. This trial should change practice in the United States, where many women may be unaware that there is an alternative to using stirrups in cervical screening.

By contrast, in the United Kingdom most speculum examinations for routine cervical smears are done in general practice or family planning clinics and stirrups are not used. Use of stirrups is mainly confined to hospital …