How common is it for physicians to refuse to prescribe birth control without a pelvic exam?

Twice now I’ve heard women say that physicians will refuse to prescribe the pill without first giving the woman a pelvic exam so I’d like to know if this is usually the case.

Is there some causal link between a pelvic exam and the pill? They both concern female organs but are they linked in more ways?

Or is it just paternalism on the part of healthcare providers i.e.: “You want this medication. I think it’s in your best interest to get a pelvic exam so if you want me to write the prescription for the medication you’ll undergo the pelvic exam.”?

If so, are there other instances where physicians routinely refuse to write a prescription unless the patient submits to a procedure unrelated to the prescription?
What are the reasons, if any, that the pill is prescription only? Is it prescription only in other countries?
How does it feel to get a pelvic exam? How about a pap smear?

I don’t think a pelvic is required before prescribing hormonal birth control, at least not any more.

I am not so sure it was paternalism. Sometimes BC was prescribed to regulate periods, and the pelvic was to ensure there wasn’t anything else causing the irregularity. When the purpose was contraception, a pelvic was done to ensure the woman didn’t have an STD or excessive bleeding before having sex.

No doubt some OB/GYNs took a condescending attitude towards their patients, but a pelvic exam is not so unrelated to birth control prescription as you seem to think.

IANAD, nor a woman.


I don’t know if other countries require a prescription. I’ve heard the side effects argument for why it requires a prescription here; the Pill can have quite rare but significant side effects (blood clots can be one). Smoking significantly increases the risk of side effects, so it makes some degree of sense that a physician might want to see if you have a history of smoking before prescribing the Pill; another method might work as well but not be problematic for smokers.

I got the impression previously that part of the reason physicans want to get patients in and do the work-up (pelvic exam etc) is to assess whether the individual is already sexually active (thus could already be pregnant or need an STD workup), might need some other kind of work-up, etc. but I’d welcome a real medical opinion: Qadgop? DSeid? Others?

In recent years, I’ve had horrendous problems renewing my existing birth control prescription without getting an exam first. I’ve been on the Pill for years, but the doctor flatly refuses to renew my annual prescription without a full workup. The first time it happened - that she refused to even extend my prescription for a month or two until she had a scheduling spot open for an annual exam - took me unawares in 2013. It made for serious issues. I’m not sure why the change - if it stemmed from paternalism (or maternalism in her case), changes in recommendations for OB / GYNs, or something else.

Pelvic exams are mentally uncomfortable, if you’re easily embarrassed, but rarely cause physical discomfort in someone who’s not heavily pregnant, as far as my localized experience notes. Pap smears can depend a bit but mostly just feel like some brief pinching or scraping sensations and may cause a cramp or two.

Here’s some counter arguments:

The annual pelvic exam is important for screening for sexually transmitted infections, ovarian cysts, cervical cancer and other health problems, and it is a critical part of routine care for women. But it has no bearing on whether a woman should be prescribed oral contraception. And in many cases — because of scheduling problems or resistance to seeing a doctor — the exam prevents or delays women from getting birth control.

There is no established medical need for women to have the exam before receiving a prescription for birth control pills. It’s just that, traditionally, pelvic exams have been coupled with contraceptive prescriptions; in many cases, it may have simply been convenient for women to have a pelvic exam as part of their routine healthcare at the same time they were seeking a birth-control prescription.

There has been a debate to allow BC to be bought OTC. For example, currently Plan B One-Step also known as the morning after pill is sold at pharmacy counters without the need for a doctor’s prescription. So why not others?
Also there is no real risk of drug abuse, an overdose is more likely to result in vomiting than any kind of high, and most of the side effects are not serious. This article gives a lot more information about it:

That’s a good reason to have the pelvic exam. Patient wishes to solve Problem A. Problem A may be caused by a variety of problems. The physician examines different possible causes of Problem A before recommending the solution to Problem A.

This isn’t. The health problem the patient wishes to solve is avoiding pregnancy. Avoiding pregnancy and the safe use of the pill to avoid pregnancy have nothing to do with making sure the woman doesn’t have an STD or excessive bleeding before having sex.

It’s the physician who paternalistically wants to make sure the woman doesn’t have an STD or excessive bleeding before having sex and withholds birth control as leverage because Dr. Father knows best. Even a woman who knows she has no STDs or excessive bleeding during sex would have to undergo the pelvic exam and pap smear.

This is my not humble opinion:

I think it’s politically motivated in the sense that they wanted us to get our annual pap smears so the prescription was a handy carrot to dangle. Women like me would have skipped the testing, or done them every three years or something, if we can get the pill over the counter. I’m not against getting screening tests for cancer, I just have my own opinion about how often I should get the screening. “They” say the frequency of testing depends on your medical history, family history, and risk factors but in my experience (with both paps and mammograms) doctors just go for the politically correct “as frequently as we can get away with” completely disregarding my lack of risk factors or the fact that my family has no history of cancer.

I can’t imagine a doctor prescribing any kind of RX birth control to a woman without doing a pelvic exam first. Women need to be screened for all the reasons mentioned, and of course it needs to be established that she isn’t already pregnant (happens more than you’d think).

Yes, it’s embarrassing, but it’s no big deal.

I could see maybe giving a woman a refill without one if she isn’t having any GYN problems and isn’t “due” for another Pap smear (yes, I know about the newer rules) but for an initial screening? DEFINITELY! Not doing it is malpractice!

NWH, R.Ph.

Can you explain to me how not requiring a pap smear before prescribing the pill to a woman who is due for a pap smear is malpractice? That sounds like a very, very broad conception of malpractice.
When I’ll be middle-aged, do you believe non-prostate cancer-related prescriptions should be withheld from me until I consent to a prostate exam?

I’ve been on the pill in Ireland and Italy. Never ever was I asked for pelvic exam. I’d be angry if it was required, as it is my business only which exams I want, unless the exam is directly related to the medication. If the doctor wishes, they can recommend it, although no one ever has.

Here in the US, I’ve never been required to get a pelvic exam before getting a prescription of birth control.

It would annoy me if I were required to do so. It’s my choice which medical exams I want to have performed unless it has a direct impact on the medication being prescribed. (For instance, I can see why they would require a blood pressure test before prescribing hormonal birth control since it is dangerous to use if you have high blood pressure.)

The results of a pelvic exam have nothing to do with birth control though so I don’t see why it would be required any more than I should be required to have any random medical test at the same visit.

I thought that you couldn’t get birth control pills if you had high blood pressure or smoke, as it can lead to blood clots. So that explains the condition of getting an exam, though not necessarily a pelvic exam.

My insurance company has recently notified me that at my advanced age (48), I don’t have to get a pelvic exam yearly anymore. The new recommendation is every other year. I wonder if they’d allow bc to be prescribed for 2 years then. (I’m not on bc, so I don’t know. I’ll try to remember to ask the next time I’m in for my (bi)annual.)

BTW, here in Ohio, you cannot get new glasses with an old prescription either. You have to have a prescription within the last 2 years for eyeglasses and within 1 year for contacts. That also seems odd to me. I mean, a person having issues with their eyes or sight would go to the eye doctor without being prompted, wouldn’t they?

And if they say that examining your eyes is good for one’s health, then I’m mystified as to why they don’t require annual or biennial eye exams for everyone, not just people who wear glasses or contacts.

Here in the United States, in twenty years of taking them, I have never met a provider who would give me a prescription for birth control pills or a write refill without a pelvic exam.

For eighteen months I saw a provider who said that if you’d had at least X previous pap smears (I can’t remember how many) that were all normal, she’d let you skip every other year. Then she moved across the country. Now I’m back to having pelvic/pap smears every year.

Do men have to get annual prostate exams to get Viagra?

Here in the United States too.

IANAD, but a pelvic exam actually doesn’t have much to do with making sure the woman doesn’t have an STD either. While a doctor might notice symptoms of some STDs during a pelvic exam, checking for STDs normally involves a blood or urine test.

Pelvic exam - lots of stretching - they must be opening that speculum pretty wide! It’s uncomfortable and hard to relax. When they poke from the outside at your organs - that’s kind of annoying. Pap smear hurts. They’re scraping cells off your cervix, from as far in as they can get and it does not feel good. I always have cramping for several hours after. Plus all the slime because they (thankfully!) are generous with the lube.

I don’t have much to say about the topic at hand since I don’t prescribe birth control pills, but most of the time presciptions (and refills) are valid for 12 months. Most responsible providers will not refill an Rx if they haven’t seen you in that whole time. Not that it requires pelvic exam to be done, except that it is a routine part of a woman’s annual physical.

But I really wanted to respond to the above quoted post. STD screening in females absolutely does require a pelvic exam and swabs to be taken. Where would you get the idea it doesn’t?

What about men? I asked a clinic to screen me for all the STDs they could and all I got was questions, a blood test and a urine test. No one looked at or touched my genitals.

Not smoking, nope. Maaaaybe if you’re over 35. But I smoked from 18-32 and was on BCP the whole time. I got a lot of warnings but no one hesitated to prescribe The Pill for me. I did make a concious effort to quit before 35 because all of the literature says “especially for women over 35.” Cuz I’d rather have my hormones and not get pregnant than smoke (which is a tough decision to make!)

I’ve never taken advantage of their services, but I’m pretty sure I could go by the local department of public health tomorrow and get tested for most STDs without having a pelvic exam. AFAIK only HPV testing requires a physical exam. A quick Google turned up the Mayo Clinic site on STD testing, and I’m not seeing anything except HPV listed there that couldn’t be detected with a blood or urine test.

More importantly, an annual pelvic exam is not an STD screening. I can’t remember ever even being offered any testing beyond a pap test when I went in for my pelvic. If a woman is concerned about STDs she needs to ask to be tested and not assume that a normal pelvic exam and pap test mean everything is fine.

That’s because chlamydia and GC will happily live in your urethra (and mainly in your urethra) where they can be peed out and found. A woman’s urethra may be free of those organisms while her cervix is harboring mucho chlamydia and/or GC. A swab of the cervix (and often the vaginal mucosa) is needed to test for those infections.

And this site clearly says