For Oral Contraceptives, No Exam Necessary

You don't need an exam for this baby.

When a woman goes to see a doctor or nurse to get a prescription for the Pill, the odds are very high, 1 in 3, that she’ll have to have a  pelvic exam.  The thing is, if she’s only going in for the script, she doesn’t need the exam.

Why are women getting these exams when all they want is oral contraception?  Researchers think it’s because health care providers are used to giving pelvic exams. In other words, it’s because of tradition, not need.

Recently, Madeline wrote about CDC findings that estimate 4.5 million women of childbearing age don’t use contraception properly or at all.   Those “accidental” pregnancies aren’t exactly accidents if there was no contraception around. Which means that many health care providers are spensding their five to ten minutes of insurance-covered time with patients all wrong. What women need when they ask for birth control  is counseling, not an exam.

According to the experts, there’s no explicit danger in getting an extra pelvic exam, except if you get a false positive, which would lead to more tests, which would turn out to be unnecessary, expensive and crazy-making.  This happened to me during my routine pap smear last year.  I had a false positive which required a follow up endometrial biopsy, which, for the record, is approximately as uncomfortable as it sounds.  Plus, I did not enjoy spending two weeks wondering if, in fact, I was one of the sliver of women (percentage wise) who develop endometrial cancer before menopause.

Now, after the pap smear results, I had asked for that biopsy, and I had needed the initial exam. But if I’d gone in for birth control pills and ended up with an endometrial biopsy two weeks later I would have been seriously put out.

The other danger that the experts don’t mention is that many insurance plans won’t cover a second exam in a 12 month period.  So, if you call your health care provider or go to your clinic to get a prescription for birth control (for you or your daughter) and if someone says you need to set up an appointment for a full exam, ask why.

During pregnancy and childbirth there are many, many times when women have to be their own best advocates when it comes to testing.  And it’s hard. It’s hard to ask a fully clothed doctor or nurse why something is happening when you’re undressed and nervous.  But it matters, and until traditions change, you have to keep doing it.

Have you had to advocate for yourself with a doctor or nurse practitioner? Can you share your story?

NB: Updated to delete a reference to Beyonce and her rumored pregnancy.  I didn’t know it was a false positive!

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