• Tue, Nov 23 2010

Study: Doctors Shouldn’t Be Making Women Get Pelvic Exams To Get An Rx

Did you know that pelvic exams are not required before acquiring birth control from an OBGYN? Probably not, considering that 44% of health care workers usually make women get a pelvic exam before they’ll write a birth control prescription. But the two things are mutually exclusive, and according to the World Health Organization, the number of doctors who confuse the two is “disappointingly high.”

Here at Crushable, this topic has divided the office a bit. Most of us didn’t know you could even get birth control pills without submitting to a pelvic exam. What do you think?

According to this new study by the journal Obstetrics & Gynecology, the two have nothing to do with each other, and “the key problem with mandatory pelvic exams is that it puts up an unnecessary hurdle to women seeking effective birth control.”

In a survey of 1,200 U.S. doctors and nurses, the study found that one-third said they always required women to get a pelvic exam before prescribing birth control. 44% usually require one. Of course, doctors often perform Pap tests and other important screenings while doing a pelvic exam. But the point here seems to be that mandatory pelvic exams put a barrier between women and their birth control preferences.

Other than tradition, there’s one reason that pelvic exams have become so intrinsically linked to getting birth control prescriptions: insurance payments. Health insurance pay doctors upwards of $75 to give a pelvic exam. Writing a scrip, on the other hand, does not always lead to a reimbursement.

OBGYN Dr. Andrew M. Kaunitz tells MSNBC:

“The two just became linked.” But while there is nothing wrong with that, he said, “women also deserve the option of un-linking those two services.”

The main issue seems to be that pelvic exams are being used as a hurdle to acquiring birth control. But is there a downside otherwise?

Here at Crushable, we’re a bit torn. Some of us think that you should be able to get birth control whenever you want it. Others think mandatory STD and pelvic checks every few months are just good protocol. What do you think?

Sorry! This poll is now closed.

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  • Jamie

    Shouldn’t your doctor want to do everything in his or her power to ensure you’re taking your medication properly? What if you have no insurance and can’t currently afford a pelvic exam? And if you can’t afford a $100 doctor visit, you surely can’t afford to get pregnant. Boo to this practice.

  • Molz

    Why doesn’t this study mention STDs? Shouldn’t your doctor care about whether you have those?

  • Palmer Huff

    Most young women don’t get birth control just to control pregnancies, but to regulate or lessen the pain of menstruation….that could be not just a problem needing birth control but maybe something more serious? What if the doctor just required a pelvic exam if you were having horrible horrible cramps.

  • Elizabeth

    Also, STD’s – if you’re at risk – all you need is a urine and/or blood test and in some cases, our doctors might ask you to take a cervical swab. (the woman does that herself)
    There is no need for stirrups or pelvic exams to check for STD’s.

  • Elizabeth

    These exams are not even recommended in Australia and the UK.
    I’m middle aged and have never had a routine pelvic, breast or rectal exam.
    The clinical evidence is clear – pelvic exams are of poor/low clinical value in the absence of symptoms and expose you to risk. (more unnecessary testing even surgery)
    Clinical breast exams – no evidence they bring down the death rate, but they cause biopsies.
    Our doctors don’t use stirrups in the consult room either…
    The only things required for the Pill is your medical history and a blood pressure test.
    Pap tests are a cancer screening test, entirely optional and require your informed consent. It’s an intrinsically unreliable test and produces lots of false positives – and this usually leads to colposcopy/biopsies – some women are left with damage after unnecessary biopsies/treatments. (which can cause infertility, miscarriages, high risk pregnancy, premature babies, psych issues)
    You all test far too often and too early – Finland has the lowest rates of cc in the world and sends the fewest women for colposcopy/biopsies (fewer false positives) – they offer 5 to 7 tests – 5 yearly from age 30.
    An unscreened high risk woman has a 0.65% lifetime risk of getting cervical cancer, low risk – a tiny risk, less than 0.65% – whereas annual screening carries a 95% lifetime risk of referral, 2 yearly 78%, 3 yearly – 65% – almost all are false positives – the cancer simply doesn’t occur that often, it’s rare!
    As a low risk woman I have always declined cervical screening and more recently declined mammograms. The latter carry risk to your body as well – I’d recommend all women read “The risks and benefits of mammograms” at the Nordic Cochrane Institute website before having breast screening. It’s a rare, unbiased summary…
    I think American women would enjoy their lives a lot more by limiting these exams, if you decide you need them at all… you’d all be healthier as well.
    A staggering 1 in 3 will have a hysterectomy by age 60, a whopping 600,000 a year. The amount of excess biopsies and treatments after false positives is also extremely high…
    Take control, make informed, evidence-based decisions and protect your healthy body from unnecessary, harmful or/an excessive testing/exams.

  • amanda

    stds are or “Should” be tested for using blood and urine tests…The only reason for the pelvic in asymptomatic women is financial …

  • Elizabeth (Aust)

    “Others think mandatory STD and pelvic checks every few months are just good protocol. What do you think?”
    Men are not required to have mandatory std checks, we are all adults and should be permitted to make that assessment for ourselves. Women are not children and doctors are not our guardians. Anyway, an STD check does not require a pelvic exam – blood and urine samples are usually enough and sometimes a self-collected swab.
    As for routine pelvic exams – please do your reading!
    Heather Dixon has written a great paper on “The pelvic exam requirement for birth control” – on line. Also, assess your level of risk before having pap tests (if you want them) – “no country has ever reported a decline in the incidence of or the mortality from cervical cancer in women under 30, irrespective of cervical cancer screening. Many countries do not perform cervical screening on women under 30.” Taken from “Cervical cancer screening” – a pull-out feature for doctors in “Australian Doctor” 2006 by Assoc Prof Margaret Davy, Director, Gyn-oncology, Royal Adelaide Hospital and Dr Shorne, GP. (online, a download)
    There is some great discussion over at Dr Joel Sherman’s medical privacy forum under women’s privacy issues – in the side bar, see research by Angela Raffle, Richard DeMay and others. Also, see Blogcritics and Unnecessary Pap smears – over 3500 posts from concerned women many harmed by screening and well-woman exams.

  • Eliz52 (Aust)

    Since my last post the truth is starting to emerge in the States. Try searching “Are routine pelvic exams obsolete” and also comments made by Dr Carolyn Westhoff in “Questioning the value of the routine pelvic exam”.
    The only things clinically required for the Pill is your medical history and a blood pressure test. The well-woman exam in unnecessary and unhelpful in asymptomatic women.
    The pap test – well that depends on your assessment of risk v benefit having regard to your risk profile- if you want them, less is more! Otherwise take yourself straight to the day procedure center for a biopsy or LEEP. Over-screening increases the risk of a false positive and unnecessary and harmful procedures.
    Never allow over-screening or inappropriate screening.
    Dr Robert Hatcher from the Managing Contraception site has had some stern words for doctors who refuse a woman the Pill until she has unnecessary pelvic and breast exams or optional cancer screening.
    It’s great that American doctors are finally feeling pressured to come clean with you – the consequences of the coercive regime called women’s health care harmed SO many women. Dr Hatcher’s article- search Dr Hatcher, pelvic exams and birth control and the article should appear….
    Now it’s up to every woman to avoid doctors who continue to use coercion on women, do unnecessary and potentially harmful exams or try to force a voluntary cancer screening test on you – once doctors see women have a choice and they will lose revenue, their attitudes will change very quickly.

  • Toni

    “OBGYN Dr. Andrew M. Kaunitz tells MSNBC:

    “The two just became linked.” But while there is nothing wrong with that, he said, “women also deserve the option of un-linking those two services.”

    Oh there’s nothing wrong with that is there? How appallingly disrespectful. We’re talking about an intimate and invasive exam that isn’t even necessary and it doesn’t bother Dr Andrew M. Kaunitz. Of course it doesn’t! He knows HE”LL never have to be subject to one. The likes of Dr Kaunitz are the reason why women are treated paternalistically and disrespectfully.

  • Jill

    I’ve heard a few American doctors say men would never put up with doctors acting as gatekeepers of the Pill – women having to beg for scripts and do whatever the doctor thinks is a good idea. It’s open season on women…it’s no different to legal assault. Doctors are apparently above the law.
    Not one medical association says breast or pelvic exams or pap tests are “required” for the Pill – only your medical history and a blood pressure test, YET not only do most doctors require these things, they deny women the Pill if they refuse – they actually deny women reliable birth control.
    Which means we have as many contraceptive options as our grandmothers. Unless we agree to a coercive relationship with doctors and do as we’re told like children, we’re locked out of reliable birth control and often all medical care.
    It is shameful and disgusting that this is life for an American and Canadian woman. No wonder more women are getting BC over the net or while on vacation in countries that respect women’s rights. After decades of research the Pill has been proven safe – there are far more dangerous things that can be purchased OTC – time to take BC pills off script. Doctors will fight it, they have always used women as money-generating objects and won’t give up control easily. I’d suggest all women avoid doctors who don’t treat them like an adult – let’s put them out of business. Don’t give in to these doctors or we’ll never rid ourselves of coercion.

  • EmmaleighSwanson

    I was on birth control pills for my cycles for about a year before a few doctors tried to FORCE me into a full GYN exam, no health org says it’s required for BCP.

    I’m allergic to latex, so condoms are useless. My only partner (been with him 4 years) and I have been buying my BCPs from India and yes they’re the real deal. However, since the US cracked down on out-of-country pharmacies, I’ve found myself screwed.

    8 months off my BCP and I’ve found out I’m pregnant. I also have 1 kidney. My risk of serious life-threatening problems due to the pregnancy far outweigh my risk of any cancer. Yet, here I am, 15 weeks pregnant because I chose NOT to blame this child and terminate. Thank you America for turning into a country worried only about bikini medicine.

    Some of us are more informed than others. I have refused ALL GYN exams for the last 3 years (including prenatal). If they want to test me for STDs, take my blood or urine, but you won’t find anything; I’ve been in a faithful relationship for 4 years with the same guy.