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Letters.
Pelvic Exams in Older Women
Articles on the new guidelines for Pap exam are usually written in such a way that older women are led to believe that they no longer need pelvic exams ("New Pap Smear Guidelines Issued," Dec. 15, 2002, p. 1).
A Pap smear is only one of many invaluable tests that are performed during each pelvic exam. Dermatologic exams are performed on the perineum, vagina, anal area, and buttocks. I guarantee that dermatologists will not do these. I have seen two women die of squamous cell cancer of the vagina after being told that they no longer needed Pap tests because they had had hysterectomies.
Exams for STDs are performed during all phases of the pelvic exam. Cellular samples are taken of the endometrium at the same time the Pap test samples are taken, and I have diagnosed early endometrial cancer in five patients with this study The ovaries and adnexa are palpated, and a rectal exam is performed. There are varying degrees of health risk for each of these areas, depending on the patient's background.
The risk of cervical cancer decreases only with time following exposure to human papillomavirus. Any new sexual contact starts that timeline all over again.
Linda L. Mendoza, M.D.
Chico, Calif.
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