Intra‐vesical foreign body: an unusual cause

Abstract

CORRESPONDENCE Is cervical cytology screening of teenagers worthwhile?Sir, In response to the commentary by Olamijulo and Duncan (Vol 102, July 1995)': my own practice includes a family planning trained female doctor and two family planning trained female nurses. We undertake a substantial family planning function for the neighbouring high school and have encountered three recommendations, by the cytology laboratory, to refer girls under the age of consent for colposcopy within the last 5 years. Before cytological screening in the under 20 age group is abandoned completely I feel a slightly wider debate is required. It is commonplace, for example, that age at first intercourse continues to fall and therefore the figures quoted by Olamijulo and Duncan should be accorded limited prospective value.Though now questioned, it has been widely regarded as desirable to offer pelvic examination to all those taking, or even planning to take, hormonal preparations. There are potential liability issues implicit in the wording of data sheets. Though preventative care is at the forefront of most medical activity and public consciousness, the worried will accept a wide range of procedures intended to detect presymptomatic disease, the woman who views pelvic examination or smear with the same avidity as other examinations is surpassingly rare-I can recall three.Routine first pelvic examinations which I have undertaken in asymptomatic under twenties have disclosed the following: vaginal septum, vaginal cysts, Bartholin's cysts, sebaceous cysts, barber's rash (sic), dermatitis, psoriasis, Nabothian follicles, previously undisclosed anxieties about normal variations in vulval morphology or pigmentation or vaginal rugae or carunculae hymenale, vulval varicosities, vaginal warts, ovarian cysts, polycystic ovaries, retroverted uterus with subsequently disclosed dyspareunia, gross constipation, anxieties about or presence of STDs, anxieties about physiological discharge and variations of it, cervical erosions/ectopy, cervicitis, pelvic inflammatory disease, common vaginal infections, urinary incontinence, dyspareunia or apareunia due to rigid hymen or episiotomy repair and, of course, pregnancy.My own approach is changing in an attempt to facilitate access to contraceptive care for young people by downplaying the most unwelcome element: pelvic examination and smear. Whereas I used to be quite uncompromising about examination at or soon after the initiation of hormonal treatment, I have adopted a process of gently recommending examination at each treatment review but not pressing the issue, in the absence of symptoms, until a year or two has elapsed. Is this causing me to miss things which earlier examination would allow to be resolved? Those who do volunteer at an early stage I praise warmly and urge to inform their friends of the benign nature of the procedure. I also encourage them to bring a friend-very occasionally a boyfriend will act as moral support.The youngest regularly sexually active female that I have encountered was just u...