Readers Respond: Does Your Doctor Require a Pap Smear and Pelvic Exam for Your Pill Prescription?

In order to buy regular birth control pills, you must have a pill prescription. Many women may want to use the pill, but don’t because they are afraid of having a pelvic exam and a pap smear. Though these are important diagnostic procedures for maintaining your gynecological health, guidelines put forth by the World Health Organization and the American College of Obstetricians and Gynecologists suggest that birth control pills can be safely prescribed on careful review of your medical history and blood pressure measurement -- without a pelvic exam, breast exam or pap smear.

Even so, many doctors may refuse to prescribe birth control pills without a pelvic exam/pap smear. What has been your experience? Have you been able to get a pill prescription without these procedures? Did you request not to have a pelvic exam/pap smear done? Was your doctor open to the idea, or was he/she insistent on the exam? If your doctor didn’t require these exams for a pill prescription, would you still get them done? What tips do you have for other women who may want to broach this topic with their doctors?

Don't Trust Doctors

I use birth control for acne only. I was denied prescription when I turned 21 because I didn't want to do the pap smear. As a result I had major acne, which left scars for years. I finally did do the pap smear just to get the pills even though I had never had sex before. It was one of the worst and most painful experiences of my life. The doctor actually laughed during this exam. It took almost an hour. A bigger speculum was used first before she had to switch to a smaller one. I was in pain for weeks. I lost about 10 lbs in the 2 months after this appointment mostly due to being upset. I am very depressed because of this and I have even considered suicide. I will avoid any doctor as much as I possibly can in the future and I will never do another pap smear again even though I will not be able to get the medicine I need. Also, what makes me more angry is that young women who have never had sex are not really even at risk for cervical cancer and I could have had a false positive.

—Guest Daisy

Hurt

I was forced to have a pap smear to get birth control that I use for acne only. I was told if I didn't I would not be able to get it. I have never had sex before. The pap smear was extremely painful. I told the doctor and asked if it had to be done. She said it did if I wanted the pills. I was offered valium but I declined. After a while of trying she switched to a smaller speculum. It was still extremely painful. She basically forced it so the test could be completed. I was in pain for weeks afterwards. In the following month or so I was very upset and lost ten pound, bringing me to just under a hundred pounds. I think my doctor forced me to do this test just to bill for it (I was actually double billed for the exam.) I have been to two other appointments to get checked out to see if I am okay but I got scared of getting hurt again and left. I have filed a complaint with the medical board and with my insurance about this doctor. No pap smears for me ever again.

—Guest Anonymous

Forced off BC pill

I went the dr office to get bc and was refused because I had a pap smear 14mos ago. I told staff the recommended guidelines had changed to 3-5yrs (5yrs if with HPV exam) or after 3 consecutive negative results done 2yrs apart (ICSI only). In either case, I'm well within the 2yr mark. The so-called-educated staff of professionals said they never heard of it, and the doctor on staff (which was not my doctor) also refused because my pap smear was 4mos over the yearly mark. I am now off BC because I refused, can't, and shouldn't have to pay $440 a year just to pay another $360 a year on top of that for BC. I got on BC after an abortion and I'm now deathly afraid of getting pregnant again. I feel like I'm being wrongfully punished, and I am! My only hope is that tomorrow when I talk to my dr (not just one in that office) he'll honor the recommended guidelines. It's sad and infuriating that pap/bc cost $800/yr but an abortion $500. What a way to reward responsibility.

—Guest Blossom

Be careful in your choice of Dr

"Pelvic exams are not dangerous" says Dr Mike....incorrect. "Frequent, routine pelvic examinations may partly explain why U.S. rates of ovarian cystectomy and hysterectomy are more than twice as high as rates in European countries, where the use of the pelvic examination is limited to symptomatic women. Observes Dr. Westhoff" http://www.mailman.columbia.edu/academic-departments/epidemiology/research-service/routine-pelvic-examination-obsolete Guidelines are not laws, if an Australian doctor "forced" a woman to have cancer screening to get the Pill or sacked her for exercising her legal right not to screen, they'd be in serious trouble. Also, does Dr Mike take full responsibility for all of the women who are harmed by false positives and over-treatment who may end up with damage that can mean a premature baby, miscarriage or c-section etc I think the thinking is skewed and highlights a major problem with the way women are viewed and treated by the medical profession.

—Guest EEB

Fight...never give in.

Yes, couldn't find a doctor who'd give me BC without the excess. I get my Pills while I'm working overseas with a blood pressure test. It's unacceptable that women are forced into unnecessary exams that risk our health and interfere with our happiness and lives. I consider these exams an assault as they're not clinical required or even relevant. Where is the protection for women both from doctors and unplanned pregnancy? I'll never give in to these demands, I'll keep getting my pills overseas and avoid our whatever they are completely, I can't call them doctors because they're harming women and that's not something a real doctor would do...fight the system.

—Guest Jill

Progress...at last.

Wonderful news that ACOG now say the Pill should be available over the counter. So pleased for American women who have suffered dreadfully with medical coercion. I'm not surprised that unplanned pregnancy make up half of all pregnancies with harmful medical barriers in place...freeing up access IMO, will improve women's lives, health and well-being.

—Guest EEB (Aust)

Screening is your choice

Dr Mike should understand it is not for him to tell women how they should feel. IMO, it's an assault to coerce or force a woman into cancer screening, or present it as "necessary" and it's unethical without informed consent. A "requirement" for women is not a law, all cancer screening is our choice to accept or decline as we see fit. Any doctor refusing care UNTIL you submit should be challenged and reported, and giving women orders is paternalistic - find another doctor. Routine pelvic exams are not recommended in Australia, the UK and in many other countries, they are of poor clinical value and expose you to RISK, even unnecessary surgery. Beware of any doctor selling routine pelvic or breast exams. The latter - no evidence of benefit, but they lead to excess biopsies. It's time doctors stopped telling women what to do, women should be provided with all information and left to accept or decline screening. I made an informed decision as a low risk woman not to have pap testing.

—Guest EEB (Aust)

forcefull punishment

I do agree that these exams are a punishment to girls and women. I am 16 and am smart, a good girl and I refuse to be treated lik the scum my doctor acts like I am. I have been forced into terrible sexual things by adults for 4 years (not molestation) but other very scarring things, these exams hurt me and I cry about them weeks before and have night mares all of the time. I hope planned parenthood really doesnt require an exam...i cant take the emotional toll it puts onto me.

—Guest Scared and angry

Ashley on Depopovera

I was on hoosier health wise. I had already had 3 ovarine cyst surgerys and I was 13. Ussual I would end up in er as they would hit quick. One time I got one and went to medcade drs. Well she told me I had have pelvic exsam. I was 13 I was scared to death. I bleed so bad for days and cryed and could not walk. Due to how bad it was surgon put off surgery. Plus gave me dermal shot 2 hours latter after as I had my ultrasound then dr sent me to surgon right away. My parents had hard time as dad was out job got me into obgyn paid full price after as clinic refused send me to obgyn with all cyst. I was told need exsam at 18 or 21. Chose 21 to pase time. But I need talk to my dr . As I rather be cut open mutple more times. As surgery pain was less painfull. It was worse pain ever. Worse bleeding ever. I wont ever forget my pelvic exsam. If want do exsam their going have knock me out first plus give me pain meds ever befor I would ever agree. As surgery was less painfull.

—Guest Ashley

Should not be required

I don't think it should be required to have a breast and pelvic exam to get on the pill, but I prefer to have them. I don't have a lot of hangups about my doctor giving me those type of exams. Nudity in a medical setting is not the most comfortable thing in the world, but sometimes it's necessary. He gives them to women all day. Nudity in a medical setting is not the most comfortable thing in the world, but sometimes it's necessary. Besides, he's examining women all day, so it's not like I have anything he hasn't seen a few thousand times.

—Guest Jenny J

virginal text

Am 25 years old, today my boyfriend called from work that he had make an appointment for me to see the doctor for pill prescription.... And he said something like i have to clean up cuz the doctor will like to check my virginal to know the right pill to prescribe. i wanna know does that really matter? or they are into something else i dunno about i thought taking monthly pill should have be test by blood not by virginal..

—Guest Debbie

Its not just for BC

I am being told that I have to have a pap and exam just to be able to continue being seen by the doctor for nonBC related stuff(like blood pressure and leg cramps) I do not take BC, I am not sexually active. Why can't I have a choice about my body and my health care?

—Guest Mm

Misguided

Many of the comments are misguided. First from the standpoint of fellow physicians, PAP smears are not needed for birth control as they do not significantly affect cancers period other than being protective against ovarian and endometrial cancers. That said the comments about PAPs being equivocal to sexual assault are over the top and dangerous. PAP smears are a necessary medical screening test and should be performed per guidelines. THey are not the most pleasant test (they should not be overly painful if done correctly however) but neither is a colonoscopy and that is encouraged as well. There is nothing sexist about suggesting a PAP. If your provider forces you to have a PAP to remain a patient and its not within the guidelines, you are better off finding a new provider who knows evidenced based medicine. However if the suggestion is based on health and the provider is not comfortable with a patient who is not actively protecting themselves it is their right to refuse services. Additionally do NOT mistake a pelvic exam for a PAP. They are not one in the same. Pelvic exams check for ovarian masses, ligamentous nodularity, etc. should still occur annually; it is only the PAP guidelines that have changed. Pelvic exams are NOT dangerous, in that regard neither are PAPs. The danger comes from biopsies which can potentially complicate pregnancies.

—Guest Dr Mike