Pelvic Examinations and Access to Oral Hormonal Contraception

Abstract

OBJECTIVE Requiring a pelvic examination before prescribing oral contraception poses an unnecessary barrier to contraceptive access. Medical guidelines have outlined the safety of oral contraception provision without a pelvic examination, yet little is known about the practices of clinicians providing reproductive health care. Our purpose was to investigate clinicians′ requirements for pelvic examination and what may account for practice differences. METHODS We administered a mailed survey to a national probability sample of obstetrician–gynecologists (ob-gyns), family medicine physicians, and advanced practice nurses specializing in obstetrics and gynecology and women′s health or family medicine in 2008–2009 (N = 1,196), with a response rate of 65.3% RESULTS Nearly one third of ob-gyns and family medicine physicians reported always requiring a pelvic examination when prescribing oral contraception (ob-gyns 29%; family medicine 33%). A higher proportion of advanced practice nurses in primary care (45%) and a markedly lower percentage of advanced practice nurses in reproductive health (17%) reported always requiring the examination. In adjusted analyses, older clinicians were more likely to require the pelvic examination (odds ratio [OR] 1.03, P<.01) and clinicians serving a higher proportion of Medicaid patients more likely (OR 1.62, P<.05). Providers in private practice were more than twice as likely as those working in family-planning or community clinics to require pelvic examinations (OR 2.30, P<.01). CONCLUSION One third of clinicians we surveyed require pelvic examinations before provision of oral contraceptives, despite guidelines indicating they are unnecessary and research suggesting they can pose a barrier to contraceptive access.

Cervical Cancer Screening Among Young Adult Women in the United States

“…Usual source of healthcare and current birth control use as significant variables impacting cervical cancer screening frequency has also been supported by previous research (36, 43, 44). Pap tests and pelvic exams often are used as a prerequisite for birth control prescriptions, despite guidelines indicating they are unnecessary (45, 46). The relationship between birth control use and Pap test receipt among young adults is significant, considering 36.6% of all women ages 18–29 years in the 2010 NHIS (data not shown) and 41.3% of this study sample report current birth control use.…”

A Systematic Review of the Bimanual Examination as a Test for Ovarian Cancer

“…6,7 It is also no longer recommended as a requirement before receiving oral contraceptives. 1,8,9 Although many women have had an annual pelvic examination in association with screening for cervical cancer, the interval for this screening has increased to 3-5 years for averagerisk women, calling into question the need to perform an annual bimanual pelvic examination that is not accompanied by a Pap test. 7 In fact, the knowledge that an annual health maintenance visit is likely to include a bimanual pelvic examination, which many women view as invasive and uncomfortable, can cause anxiety 10 and may actually discourage attendance.…”

Women’s recall of requirements for oral contraception prescription in Italy

“…GPs seemed to require it less often because most GPs in Italy do not perform bimanual pelvic examination. In contrast, for example in California one-third of clinicians reported that they always require a pelvic examination when prescribing OCs 5. In that report, a similar proportion of gynaecologists and family physicians reported that they always required a pelvic examination when prescribing OCs, but advanced practice nurses specialising in reproductive health were less likely to require the examination 5…”