Welcome to the latest installment of “Over 90 Percent of What Planned Parenthood Does,” a series on Planned Parenthood Advocates of Arizona’s blog that highlights Planned Parenthood’s diverse array of services — the ones Jon Kyl doesn’t know about.
I remember sitting in the exam room, fidgeting with my paper gown and nervously explaining to the doctor that my boyfriend and I had come very close to having sex already, and I would please like to be on birth control pills when it actually happened.
“Sure,” he said, swinging open the stirrups. “Just as soon a we do a pelvic exam.”
I didn’t want one. I really didn’t want one.
While it’s common for health care providers in the United States to require or routinely perform a pelvic examination — with or without a Pap test — prior to prescribing hormonal birth control, several health organizations state that a pelvic exam isn’t necessary in order to be safely prescribed hormonal contraceptive pills, patches, shots, or rings. For instance, the American College of Obstetricians and Gynecologists advises, “A pelvic exam is not needed to get most forms of birth control from a health care provider except for the intrauterine device (IUD), diaphragm, and cervical cap.” In such cases, HOPE (Hormonal Option without Pelvic Exam) may be an appropriate alternative.
This is not because pelvic examinations are unimportant in themselves, but rather because evidence-based medicine generally does not support them as a prerequisite for safely and effectively using hormonal contraception. According to the Centers for Disease Control and Prevention’s U.S. Medical Eligibility Criteria for Contraceptive Use, the main conditions that present questionable or unacceptable health risks for combined hormone contraceptives (those containing both estrogen and a progestin) are if the individual:
- is a smoker over age 35
- has hypertension (high blood pressure)
- has a history of or is at increased risk for blood clots
- experiences migraine with aura
Most progestin-only contraceptives (save the IUD, which does require a pelvic examination for safe insertion) come with fewer contraindications. Moreover, most contraindications would be found by taking a patient’s medical history and checking their blood pressure rather than via pelvic exam.
This is not to suggest that one should never have a pelvic exam, or that using hormonal contraception means it’s a smart idea to ignore all other safer sex practices (including STD screening) or gynecological care. As this editorial from the American Family Physician pointed out, “Periodic Papanicolaou tests are important preventive measures but are unrelated to the use of hormonal contraception. Screening for sexually transmitted diseases also is important, but performing these tests or waiting for results should not delay a prescription for hormonal birth control.” For some people, it makes a lot of sense to choose to take care of all of these sexual health care needs at a single annual visit.
However, others may have a decided incentive to decouple some of these tests and examinations from their prescription for birth control pills. For instance, one person may have never had partnered sexual contact and may be uncomfortable with the idea of a health care provider inserting fingers into their vagina. Others — such as survivors of sexual abuse or assault or people who are genderqueer and/or trans* — may find pelvic exams dissociative, traumatic, and triggering.
For people in these situations, the negative consequences they experience from the exam can outweigh the benefit they’d get from it, even if one of those benefits is obtaining their annual prescription for birth control pills. In some cases, this fear and anxiety may be enough to avoid a pelvic exam at any cost, even if one result is that they forgo birth control pills, possibly ending up at increased risk for pregnancy.
I know that for me, sitting in that exam room nearly two years after I was raped, having a doctor prod my genitals seemed like the worst thing that could happen to me that day. I sat through it, first because I couldn’t figure out how to say no, then because I dissociated. I did get my prescription for birth control pills. However, I didn’t see another health care provider for an “annual” exam for another four years. In that time, I made contraceptive compromises I wish I hadn’t. It’s not as simple as the trauma coming solely from that unwanted exam, of course, but I didn’t have a working relationship with a health care provider of any kind.
Even now — um, 10 years later? — my annual exam is a big deal. Not “big” as in, “You know, scheduling time off work is really annoying, and the process is a little awkward and uncomfortable.” But “big” as in, “Is this going to be the time when I dissociate or end up sobbing on the exam table?” I haven’t actually done either of those in years, but each pelvic exam leaves me feeling like those responses are never very far away.
I wish I’d heard about HOPE then. I wish I’d known to ask — or that my health care provider had known to offer.
If you’re interested in learning more about the possibility of obtaining hormonal contraception without a pelvic exam, you can contact your local Planned Parenthood health center to see whether they offer the service.
*According to queer.williams.edu, “Trans* can be used as an umbrella term for people who transgress or transcend our normative notions of gender. This term includes but is not limited to those who identify as transgender, transsexual, bigender, gender queer, gender fluid, two spirit, cross dressers, and gender benders.”