On Paps and Pelvics | For Parents of Children w/Disability and Chronic Illness

This guest blog written by femmes femmes.

While it may be true that many doctors will not prescribe hormonal birth control without a pap test and/or pelvic exam, the reality is that there is no medical basis for such a restriction. Pap tests are for cancer screening: the result of the pap test doesn’t determine whether the patient can use birth control. Neither the US Food and Drug Administration, the World Health Organization,Planned Parenthood Association, or the American College of Obstetricians and Gynecologists believe that a pelvic exam or pap smear should be required for hormonal birth control. According to WHO, a pelvic exam for contraceptives (including monthly injectables) is a Category C. That is “does not contribute substantially to the safe and effective use of the contraceptive method.” The information that a doctor gets from a pelvic and a pap is not information that is needed to safely prescribe hormonal birth control.

From this article http://www.medscape.com/viewarticle/490153

Over the past decade, questions have been raised regarding the evidence-based need for pelvic exams and Pap smears, especially in regard to the initiation of oral contraceptives. There is consensus among several prominent healthcare organizations that the pelvic exam is not required, at least during the initial visit. These organizations include the US Food and Drug Administration,[1] the World Health Organization,[2] Planned Parenthood Association,[3] and the American College of Obstetricians and Gynecologists.[4]

There are certainly many good reasons to do a pelvic exam and Pap smear, but initiation of birth control, specifically oral contraceptives, is not one of them.

See also this article:

http://www.universityofcalifornia.edu/news/article/3192

Although hormonal contraceptives are not recommended for women with some serious medical conditions, the problems that make their use unwise are effectively identified through medical history and a simple blood pressure measurement. “Hormonal contraceptives can safely be started based on medical history review and a blood pressure check. For most women no further evaluation is needed before making a decision to use them,” said George F. Sawaya, MD, UCSF assistant professor of obstetrics, gynecology and reproductive sciences and research coordinator for the UCSF-Stanford Evidence-based Practice Center.

Furthermore, requiring pelvic exams for birth control prescriptions is both paternalistic and unethical. The decision to have a pelvic exam should be the client’s: she shouldn’t be coerced into it due to a need for contraception.

2 Comments

Please help me! I have been on birth control for almost 5 years and need another refill. I have a religious objection to having an exam, and although other doctors have understood this, the last one I saw didn’t. My husband is in the military, and we are stuck with his insurance which only covered going to the clinic on base for birth control. The doctor was mean and was biased against me because I’m religious, and she did not give me any medicine. We were told she was going to draw up a waiver, but when we called back they said they legally couldn’t do it. My patient rights have been violated, and I am still without a new prescription. I had previously read the article by Heather S. Dixon, and although I took it to the office with me, the dr. (technically an FNP) ignored it and would not even look at it. I can’t afford to go to a REAL dr. off base because we don’t have much money. I have been in tears over this because I don’t know how to get my medicine refilled, and we’re in the process of moving which is putting even more stressful obligations on me all at once.

I spoke with a social worker at an army base this morning. She asked around, and what she found was essentially this:

If the nurse practitioner or doctor you are working with requires an internal exam, and that does not vary according to religious objection. However, she suggested that you might see if your base has a midwife. A midwife might be more open to talking with you about your objections to an internal exam. Also, if you are going to be transfered soon (which I know happens often in the military), you might just try the new clinic. They might be more open minded than your current one.

Two other suggestions I have for you:

1. Try the Planned Parenthood in your area. The generally provide free or sliding-scale birth control, and some of them have stopped requiring a pelvic exam for a prescription for the pill.
2. Try non-prescription birth control. Condoms, IUDs, diaphragms. There are lots of birth control options, and if the pill is not accessible to you for religious reasons, you might find something else that works just as well and is accessible to you.

Good luck, Nicole! I would love to hear back from you what you find and what you decide to do.

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