Summers A, Winkel LA, Hussain HK, DeLancey JOL. The relationship between anterior and apical compartment support. Am J Obstet Gynecol. 2006;194(5):1438– 1443.
In women who have anterior vaginal prolapse (cystocele), approximately half of the prolapse might be explained by a defect in apical attachment. In addition, consider performing prophylactic McCall’s culdoplasty or uterosacral cuff suspension at the time of all hysterectomies, by all routes—even in the absence of prolapse.
Perform fewer, but better-timed, Pap tests.
Sawaya GF. Cervical-cancer screening—new guidelines and the balance between benefits and harms. N Engl J Med. 2009;361(26):2503–2305.
ACOG Practice Bulletin No. 109, December 2009. Cervical cytology screening. Obstet Gynecol. 2009;114(6):1409–1420.
New guidelines for cervical cancer screening that were issued by ACOG in November 2009 are meant to maximize benefit and minimize harm. The guidelines are summarized in the TABLE.
ACOG’s 2009 guidelines for cervical cytology screening
| Age (y) | Recommendation |
|---|---|
| Under 21 | Avoid screening |
| 21–29 | Screen every 2 y |
| 30–65 (or –70) | May screen every 3 y* |
| 65–70 | May discontinue screening† |
| *Applies only to women who have had three consecutive negative cytology tests; exceptions include women who have human immunodeficiency virus infection, compromised immunity, a history of grade-2 or -3 cervical intraepithelial neoplasia, or were exposed in utero to diethylstilbestrol. | |
| †Applies only to women who have had three or more consecutive negative cytology tests and no abnormal tests in the preceding 10 years; exceptions include women who have multiple sexual partners. | |
| Discontinue routine cytology in women who have had a total hysterectomy for benign indications and who do not have a history of high-grade cervical intraepithelial neoplasia (CIN). | |
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