Why patients no longer trust urogynecologists… and more

For this reason, I do not believe that we can rely on annual FRAX assessment alone in women with low bone mass to determine who would benefit from therapy. For menopausal patients with osteopenia, if a follow-up DXA scan after several years demonstrates a loss in bone density that exceeds the least significant change, one might consider a workup for secondary causes of bone loss and consider medical therapy.

Frank Bonura, MD
Smithtown, New York

“YOUR AGE-BASED GUIDE TO COMPREHENSIVE WELL-WOMAN CARE”
ROBERT L. BARBIERI, MD (OCTOBER 2012)

Seeking clarification of Pap test interval

I believe that recommendations regarding the Pap test interval have changed, requiring testing every 5 years rather than every 3 years in low-risk women. Also, aren’t we supposed to give patients the option of a clinical breast exam rather than perform it routinely?

Jerome Klobutcher, MD
Ashland, Ohio

Well-woman guide is an excellent resource

Thank you for the excellent article! It will greatly aid me in providing standard-of-care necessities for each age group.

Kelly Shrum, DO
Monticello, Arkansas

Dr. Barbieri responds

I thank Dr. Klobutcher and Dr. Shrum for taking time from their busy schedules to share their perspectives. I am pleased that Dr. Shrum will use the well-woman guide in her practice.

Dr. Klobutcher raised the issue of which cervical cancer screening interval to use. For women 21 to 30 years of age, the recommendation is to perform cytology screening for cervical cancer every 3 years. After 30 years of age, either cytology screening every 3 years or cytology screening plus HPV testing every 5 years is acceptable.

Dr. Klobutcher also wondered about the role of clinical breast examination (CBE) in screening for breast cancer. It is difficult to provide definitive advice regarding CBE because the quality of data from clinical trials is suboptimal. Many experts recommend that CBE be performed at a regular interval, such as every 1 or 2 years if mammography screening is being recommended.

CBE occasionally finds lesions not detected by mammography. In one clinical trial of breast cancer screening, with breast cancer mortality as an endpoint, CBE alone and mammography plus CBE were equally effective in reducing mortality.¹

“UPDATE: PELVIC FLOOR DYSFUNCTION”
AUTUMN L. EDENFIELD, MD, AND CINDY L. AMUNDSEN, MD (OCTOBER 2012)

Atrophic vulvar tissue is sensitive to irritant agents

When patients report dysuria or irritative voiding or vulvar symptoms, I always ask what soap they use for bathing. They often respond with the name of a harsh deodorant soap, assuming such a product is good for hygiene. Many patients also scrub the perineum with a washcloth.

I advise all postmenopausal patients—as well as premenopausal patients who have symptoms—to use plain baby bath (no added aloe or other ingredients) and to wash gently and rinse well. Atrophic vulvar tissue is much more sensitive to contact irritants than normal tissue is, and soaps often contribute to dysuria, vulvar irritation, and other problems.

As for probiotics, it is my experience that they are more helpful for chronic vaginitis than for urinary tract infections.

Lisa Rogers, MD
Jackson, Tennessee

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