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Getting Examined to Get the Pill

For more information about contraceptives, check out WebMD's Women's Health board moderated by Jane Harrison-Hohner, RN, RNP. continued...

Jonathan S. Berek, MD, believes doctors don't need to do a physical exam in order to prescribe oral contraceptives "particularly for young, healthy, nonsmoking women. The risks associated with unwanted pregnancy are considerably higher than any of the exceedingly rare complications of hormonal contraception in that group of women." Berek is professor and chair of the College of Applied Anatomy at the UCLA School of Medicine and chief of the Division of Gynecologic Oncology.

However, there are people who disagree.

Janet Pregler, MD, believes while it may not be scientifically necessary to have a pelvic exam on the same day you get your prescription for birth control pills refilled, there are very good reasons for doing so. "It's in your interest to have these exams done. From a convenience standpoint, most women want to get as much done in one visit as possible, so I don't see any reason to separate these two things." Pregler is the director of the Iris Cantor-UCLA Women's Health Center and center director for the UCLA National Center of Excellence in Women's Health.

One important part of the pelvic exam is the Pap test, which Pregler calls "the most effective cancer screening test we have, because we actually sample cells on the cervix. This form of cancer grows slowly, so we can essentially guarantee a women if she gets this test done regularly, she won't die of that form of cancer."

Those who support the new approach to contraception are concerned about the substantial number of teenage unplanned pregnancies.

"It is difficult for some young, sexually active women to come to terms with this issue and deal with it in a mature way," Thacker says. "Hopefully this new approach will make hormonal contraception more available."

Support for prescribing birth control pills without a physical exam is part of an ongoing effort to eventually make them available over the counter, Berek says. "Ultimately it will lead to sales without any prescription, which in my opinion would be appropriate, based on the evidence."


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