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Am Fam Physician. 2003;68(2):223-224

to the editor: I read with some interest the editorial1on the American Cancer Society guidelines for the early detection of cervical cancer in American Family Physician and found it generally well written. However, the following statement caused me some concern: “…vaginal cuff smears after hysterectomy for benign conditions appear to be a common clinical practice, accounting for untold medical costs and patient discomfort.” Does this imply that after hysterectomy, no further pelvic examinations are necessary because they are the painful part of the procedure rather than the swab of the cuff with a tongue blade, cotton-tipped swab, or brush? I do not believe that the smear accounts for “patient discomfort,” but if this has been clinically documented I would appreciate the appropriate literature references.

I do not believe there is any support for implying that the pelvic examination, including the speculum examination of the vagina and the bimanual examination, should be discontinued after total hysterectomy, with or without ovaries present.

in reply: If the hysterectomy was completed for a benign indication, the yield from vaginal cuff smear is exceedingly low, and is, in fact, exceeded by issues of false positive work-ups and patient discomfort. This is the basis for our recommendations. There are no data to support utility (or lack thereof) from bimanual examinations in this subset of patients, and I would defer to clinical judgment.

Email letter submissions to afplet@aafp.org. Letters should be fewer than 400 words and limited to six references, one table or figure, and three authors. Letters submitted for publication in AFP must not be submitted to any other publication. Letters may be edited to meet style and space requirements.

This series is coordinated by Kenny Lin, MD, MPH, deputy editor.

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