Many clinicians require patients to have a recent pelvic exam and pap smear before starting or renewing hormonal birth control. Do women really need a pelvic exam before starting hormonal contraception? According to the WHO, FDA, and others, pelvic exams are not necessary for this purpose. Although important for cancer and STI screening purposes, pelvic exams and pap smears reveal little that would exclude a woman from safely using contraception.

Required pelvic exams can pose a significant logistical/financial barrier for patients, particularly adolescents. Scheduling the exam may mean a longer wait for contraception, increasing the risk of unintended pregnancy during that interval. Research shows that delaying a pelvic exam does not jeopardize patients’ health and has the added benefit of being preferred by women who want to start contraception sooner.

Consider decoupling pelvic exams and birth control in your own practice – and make sure that your receptionists and nursing staff know about this change. It’s a safe and easy way to improve your patients’ health.

We appreciate your feedback! Please write us at pearls@reproductiveaccess.org with any questions, comments or additional resources to add to our list.

Helpful Resources

Breaking the Contraceptive Barriers from the Association of Reproductive Health Professionals

Medical Eligibility Chart for Initiating Contraception

Your Birth Control Choices

Sources

Harper C, Blistreri E, Boggess J, Leon K, & Damey P., Provision of Hormonal Contraceptives Without a Mandatory Pelvic Examination: The First Stop Demonstration Project. Family Planning Perspectives. 2001. 33(1):13-18.

Nelson A., The Pill at 40 – A New Look at a Familiar Method: Whose Pill is it, Anyway? Family Planning Persepctives. 2000. 32(2):89-90.

Stewart F, Harper C, Ellertson C, Grimes D, Sawaya G, & Trussell J., Clinical Breast and Pelvic Examination Requirements for Hormonal Contraception: Current Practice vs Evidence. JAMA. 2001. May;285(17):2232-2239.

Armstrong K, & Stover M., Smart Start: an option for adolescents to delay the pelvic examination and blood work in family planning clinics. Journal of Adolescent Health. 1994. 15(5):389-395.

Pharma-free

The Reproductive Health Access Project does not accept funding from pharmaceutical companies. We do not promote specific brands of medication or contraception. The information in the Contraceptive Pearls is unbiased, based on science alone.