# How common is it for physicians to refuse to prescribe birth control without a pelvic exam? **URL:** \ **Category:** In My Humble Opinion\ **Created:** [March 30, 2015, 8:18pm UTC](https://boards.straightdope.com/t/how-common-is-it-for-physicians-to-refuse-to-prescribe-birth-control-without-a-pelvic-exam/716362 "2015-03-30T20:18:48Z")\ **Posts on this page:** 11\ **Page:** 3
**Author:** ![WhyNot](https://avatars.discourse-cdn.com/v4/letter/w/c77e96/32.png) [@WhyNot](https://boards.straightdope.com/u/WhyNot)\ **Post date:** [March 31, 2015, 5:00pm UTC](https://boards.straightdope.com/t/how-common-is-it-for-physicians-to-refuse-to-prescribe-birth-control-without-a-pelvic-exam/716362/41 "2015-03-31T17:00:52Z")
> [@aruvqan](#): > > You can ask for one of the [pediatric size speculae](http://www.wisegeek.com/what-are-the-different-speculum-sizes.htm) - they come in small, medium and horse-lover. It really doesn’t make much of a difference. It helps with the pain of the speculum going in, but then they still have to crank it open just as far to gain access to the cervix. ---
**Author:** ![Turpentine](https://avatars.discourse-cdn.com/v4/letter/t/ecd19e/32.png) [@Turpentine](https://boards.straightdope.com/u/Turpentine)\ **Post date:** [March 31, 2015, 5:50pm UTC](https://boards.straightdope.com/t/how-common-is-it-for-physicians-to-refuse-to-prescribe-birth-control-without-a-pelvic-exam/716362/42 "2015-03-31T17:50:03Z")
> [@WhyNot](#): > > A pelvic exam is a crappy way to determine pregnancy. A pregnancy test is much more accurate. > And, just so the spectrum of experience is shared here…I find both pelvic exams and PAP smears blindingly painful and they trigger panic attacks. Part of it is undoubtedly anxiety with a soupcon of PTSD, but even if you remove my emotional state (which is impossible to do in reality), the physical sensations are far beyond the proclaimed “pressure” or “a little discomfort” and straight into “motherfucking OW!” territory. I’ve never gotten through one without crying in pain and terror. This includes one done as gently as possible with the smallest speculum by my very best friend in the world who I trust more than anyone (she’s a certified nurse midwife). > > So yes, it varies…a lot. And the demand for annual pelvic exams are why I went off prescription birth control. My doctor’s pushing me for another PAP (last one was 3 years ago by my friend) and…no. Unless you’re willing to knock me out and rip out my uterus (I’m really not using it anymore), then you’re not sticking a speculum up me ever again. I mean it. I would literally rather die of undiagnosed cervical cancer than go through another PAP. Yeah, this sounds familiar. I’m fine with needles and dentists and the like, but the PAP smear causes me to sweat profusely and apparently my whole lady-region clamps shut and it’s a moderate miracle if I don’t burst into tears. It hurts terribly! But after reading some of these responses, I realize that I must have a pretty good doctor. The PAP smear is only required every 3 years where I go. Also, during my last visit where I’d had my first pap smear in three years, my doctor said “I never say no to a refill request for birth control…I don’t believe that PAP smears are relevant [to birth control].” I think he couldn’t say outright that he would refill my prescription with one, but that’s what he was saying between the lines. ---
**Author:** ![corvidae](https://avatars.discourse-cdn.com/v4/letter/c/898d66/32.png) [@corvidae](https://boards.straightdope.com/u/corvidae)\ **Post date:** [March 31, 2015, 5:55pm UTC](https://boards.straightdope.com/t/how-common-is-it-for-physicians-to-refuse-to-prescribe-birth-control-without-a-pelvic-exam/716362/43 "2015-03-31T17:55:59Z")
> [@aruvqan](#): > > You can ask for one of the [pediatric size speculae](http://www.wisegeek.com/what-are-the-different-speculum-sizes.htm) - they come in small, medium and horse-lover. Doesn’t hurt to ask but it may be too short to find the cervix with. ---
**Author:** ![JcWoman](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/jcwoman/32/2889_2.png) [@JcWoman](https://boards.straightdope.com/u/JcWoman)\ **Post date:** [March 31, 2015, 7:24pm UTC](https://boards.straightdope.com/t/how-common-is-it-for-physicians-to-refuse-to-prescribe-birth-control-without-a-pelvic-exam/716362/44 "2015-03-31T19:24:20Z")
> [@Macca26](#): > > I’ve experienced going to a GP for an ear infection and the first thing he asks is, “When was your last pap smear?”. I’m with you on most of your post. I’d like to know how many men have gone to the doctor for an ear infection or something similar and the doctor asked “when was your last prostate exam?”. I also have a huge issue with how readily the medical community is to perform invasive tests on women - much more than men. At the risk of sounding hysterical (ahah, I kill me!) I think there’s a certain amount of systemic misogyny in our society that allows this. These things aren’t just invasive, they’re also rather humiliating. I have only ever had mild discomfort with pap smears, so my issue isn’t pain. But I want the men to visualize going to the doctor, being told to strip, put your feet in the stirrups, spread your knees and let the doc put his hand inside your anus for a minute or two. Now submit to this every year or two. Similar for mammograms - not as bad as I feared before I had my first one, but still somewhat painful. They press your breast as flat as you will tolerate which means if you don’t squeal, they’ll smash it a quarter inch thick. But first, they use their hands to pull all of your breast in between the cold plates, even the parts that are more armpit than breast. They do this at two or three angles on each breast. Imagine what it’s like to stand with a sensitive body part smashed flat inside a machine, your arms out in odd directions and your chin awkwardly turned to the side up against a plastic plate to keep it out of the machine’s visual field. I feel pretty silly standing there like that. It’s interesting that there’s no similar smash-the-testicle test for testicular cancer. Is it because no man would willingly submit to that? ---
**Author:** ![Poysyn](https://avatars.discourse-cdn.com/v4/letter/p/f4b2a3/32.png) [@Poysyn](https://boards.straightdope.com/u/Poysyn)\ **Post date:** [March 31, 2015, 7:58pm UTC](https://boards.straightdope.com/t/how-common-is-it-for-physicians-to-refuse-to-prescribe-birth-control-without-a-pelvic-exam/716362/45 "2015-03-31T19:58:31Z")
> [@Macca26](#): > > . I’ve experienced going to a GP for an ear infection and the first thing he asks is, “When was your last pap smear?” Completely unrelated - we had a “Old Dinosaur” Warrant Officer on my Basic Training course and every medical complaint from a female was met with the following: “Are you on your period?” followed by “Have you had a bowel movement today?” Apparently all health complaints can be filed under one of those two categories. Hijack over 🙂 ---
**Author:** ![gallows\_fodder](https://avatars.discourse-cdn.com/v4/letter/g/8c91f0/32.png) [@gallows\_fodder](https://boards.straightdope.com/u/gallows_fodder)\ **Post date:** [March 31, 2015, 8:00pm UTC](https://boards.straightdope.com/t/how-common-is-it-for-physicians-to-refuse-to-prescribe-birth-control-without-a-pelvic-exam/716362/46 "2015-03-31T20:00:32Z")
While I’m not **glad** WhyNot and Turpentine have a shitty time with Pap smears, I’m glad I’m not the only one who fucking hates them and it’s not like every other woman out there thinks they’re a blast. The dilation of the speculum feels like someone is putting out a lit cigar on my vulva. The pain is unbearable. So I’ve only had four in my life, last one in 2009. Every time I go to the doctor I get bugged about getting another one, and I always lie and say I’ll make the appointment later. E: forgot to mention! I too have had to have pelvic exams when I wanted a birth control prescription renewed. That’s one of the reasons why I’m not on the Pill anymore. ---
**Author:** ![psychobunny](https://avatars.discourse-cdn.com/v4/letter/p/54ee81/32.png) [@psychobunny](https://boards.straightdope.com/u/psychobunny)\ **Post date:** [March 31, 2015, 10:50pm UTC](https://boards.straightdope.com/t/how-common-is-it-for-physicians-to-refuse-to-prescribe-birth-control-without-a-pelvic-exam/716362/47 "2015-03-31T22:50:48Z")
As a primary care physician who routinely prescribes birth control, let’s clarify the actual recommendations here. From the American Cancer Society: > [@](#): > > All women should begin cervical cancer testing (screening) at age 21. Women aged 21 to 29, should have a Pap test every 3 years. HPV testing should not be used for screening in this age group (it may be used as a part of follow-up for an abnormal Pap test). > • Beginning at age 30, the preferred way to screen is with a Pap test combined with an HPV test every 5 years. This is called co-testing and should continue until age 65. > • Another reasonable option for women 30 to 65 is to get tested every 3 years with just the Pap test. > • Women who are at high risk of cervical cancer because of a suppressed immune system (for example from HIV infection, organ transplant, or long term steroid use) or because they were exposed to DES in utero may need to be screened more often. They should follow the recommendations of their health care team. > • Women over 65 years of age who have had regular screening in the previous 10 years should stop cervical cancer screening as long as they haven’t had any serious pre-cancers (like CIN2 or CIN3) found in the last 20 years \ > • Women of any age should NOT be screened every year by any screening method Now we need to differentiate between a PAP smear, which is a scraping of the cervix for abnormal cells, and a pelvic exam, which allows the doctor to feel the organss, sometimes swab for sexually transmitted disease, etc. From the American College of Obstetrics and Gynecology: > [@](#): > > The College guidelines recommend that a pelvic examination be performed on an annual basis in all patients aged 21 years and older (2). No evidence supports or refutes the annual pelvic examination or speculum and bimanual examination for the asymptomatic, low-risk patient. An annual pelvic examination seems logical, but also lacks data to support a specific time frame or frequency of such examinations. The decision whether or not to perform a complete pelvic examination at the time of the periodic health examination for the asymptomatic patient should be a shared decision after a discussion between the patient and her health care provider. Putting it all together, while there is no need for a yearly PAP smear, and no data supporting yearly pelvic examinations, there is a recommendation by the ACOG that yearly exams be done. My personal feeling: If I am prescribing birth control pills to somebody who has not had a normal exam and PAP in 3 years then I like them to have an pelvic exam. More important, however, is that they come in and have a blood pressure check and general assessment as well as a discussion of the risks and benefits of BCPs (and yes, I assess them for a risk of pregnancy-have almost been burned many times in the past by teenagers who think that BCPs will work if they are already pregnant). I like patients to check their blood pressure once yearly on BCPs. Patients with multiple sexual partners and who do not use condoms regularly should be screened for STDs yearly. PAP smear should be done at minimum as per the ACS requirements. I generally do a pelvic exam when I do a PAP unless the patient has symptoms. I will generally do a yearly pelvic exam if a patient wants it because “my last doctor always did it every year” but I won’t do a PAP unless it is indicated as above. I don’t do pelvic exams to earn extra money; I don’t get paid any more for doing a pelvic/PAP then I do for a visit without it, it takes extra time and I don’t like causing discomfort. As you can see, the guidelines for exams are somewhat flexible. I would say, that if a doctor has done an exam ad a normal PAP within 3 years and refuses to prescribe BCPs without another exam, you may want to question them on what data they are using to justify this decision. (Insert additional rant here about OB/Gyns who are all gung-ho about doing yearly PAP smears on everybody but when a patient has actual symptoms or an infection suddenly have no appointments available and tell the patient to go to the PCP. Additional bad karma points if they treat the patient over the telephone for a UTI or yeast infection without actually doing an adequate assessment and when the symptoms don’t resolve then pack her off to the PCP to actually diagnose her STD). ---
**Author:** ![Qadgop\_the\_Mercotan](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/qadgop_the_mercotan/32/83_2.png) [@Qadgop\_the\_Mercotan](https://boards.straightdope.com/u/Qadgop_the_Mercotan)\ **Post date:** [March 31, 2015, 10:52pm UTC](https://boards.straightdope.com/t/how-common-is-it-for-physicians-to-refuse-to-prescribe-birth-control-without-a-pelvic-exam/716362/48 "2015-03-31T22:52:41Z")
**psychobunny** is wise. ---
**Author:** ![MichaelEmouse](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/michaelemouse/32/101_2.png) [@MichaelEmouse](https://boards.straightdope.com/u/MichaelEmouse)\ **Post date:** [March 31, 2015, 11:02pm UTC](https://boards.straightdope.com/t/how-common-is-it-for-physicians-to-refuse-to-prescribe-birth-control-without-a-pelvic-exam/716362/49 "2015-03-31T23:02:23Z")
> [@psychobunny](#): > > My personal feeling: > > If I am prescribing birth control pills to somebody who has not had a normal exam and PAP in 3 years then I like them to have an pelvic exam. More important, however, is that they come in and have a blood pressure check and general assessment as well as a discussion of the risks and benefits of BCPs (and yes, I assess them for a risk of pregnancy-have almost been burned many times in the past by teenagers who think that BCPs will work if they are already pregnant). That you like them to have a pelvic exam is quite fine. That you recommend it and provide your patients with data and arguments to convince them is also quite fine. But is it a “no poke, no pill” deal? ---
**Author:** ![psychobunny](https://avatars.discourse-cdn.com/v4/letter/p/54ee81/32.png) [@psychobunny](https://boards.straightdope.com/u/psychobunny)\ **Post date:** [April 1, 2015, 7:05pm UTC](https://boards.straightdope.com/t/how-common-is-it-for-physicians-to-refuse-to-prescribe-birth-control-without-a-pelvic-exam/716362/50 "2015-04-01T19:05:07Z")
No-they do not need a pelvic exam. Specifically, if they decline my suggestions, I won’t do it and certainly do not require it. ---
**Author:** ![MichaelEmouse](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/michaelemouse/32/101_2.png) [@MichaelEmouse](https://boards.straightdope.com/u/MichaelEmouse)\ **Post date:** [April 1, 2015, 7:08pm UTC](https://boards.straightdope.com/t/how-common-is-it-for-physicians-to-refuse-to-prescribe-birth-control-without-a-pelvic-exam/716362/51 "2015-04-01T19:08:56Z")
> [@psychobunny](#): > > No-they do not need a pelvic exam. Specifically, if they decline my suggestions, I won’t do it and certainly do not require it. Ah, you shall henceforth be known as reasonablebunny. Can you enlighten me as to the habit of requiring it, though? What is behind that? [Previous page](https://boards.straightdope.com/t/how-common-is-it-for-physicians-to-refuse-to-prescribe-birth-control-without-a-pelvic-exam/716362.md?page=2)