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

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:

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.

See also:
Heather S. Dixon, Pelvic Exam Prerequisite To Hormonal …