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

Responses: 45


Updated April 21, 2011

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?

Share Your Experience

You are Your Own Advocate

I am 19 years old and just went in for my second gynecological exam because I wanted to renew my pill prescription. My doctor did not give me the choice to decline the pelvic exam and the pap smear. I have to admit, I just assumed I had to have these done, so I didn’t ask. My doctor is very sweet, so I would feel comfortable talking to her about these things. I don’t mind having these procedures done as I look at them as being important preventative measures. Even if they were not required for my pill prescription, I would still have a pap and pelvic exam done each year. But, I realize everyone is different. If you think your doctor is trying to take advantage of you by requiring these procedures, speak up or find another doctor. You are your own health care advocate!
—Guest Kamryn

Hold Your Ground!

I actually did ask my doctor if I could decline a Pap smear and pelvic exam for my pill prescription. Though my doctor did not require it, he certainly tried to pressure me into having these tests done. I had to sign a waiver confirming that I understand the risk I am taking by declining to have these procedures. I don’t understand how birth control pills got wrapped up with pap smears and pelvic exams in the first place… perhaps as way doctors could charge more to insurance companies when all their female patients really want was to be able to use the pill. I do try to have these exams done every few years. Even though my doctor was a bit of a pain about it, at least I still get my pill prescription each year, and so far, I have been baby free!
—Guest Kendall

Not Required But Definitely Needed

A physical exam & medical history review is a part of providing good, sound medical care. It's easy & only takes a few minutes. It's the providers decision to give BCP w/wo a H & P. HPV is the #1 reason for the pap as well as providing results of STDs, yeast, & BV. BCP helps with some issues but isn't a cure...HPV is so prevalent & silent & can be transmitted w/o intercourse. It's contracted via oral, anal, & same sex partners. It's a virus so just b/c 1 pap came back normal doesn't mean future ones will. I know plenty of people who wouldn't get exams if they didn't have to come for BCP refills. The goal of any provider should be to give sound care to all & this can't be done w/o a H&P. Also things change from year to year...most people are not aware of all contraindications to BCP & may find themselves in life-threatening situations if they take them. The exam checks for fibroids, cysts, & cancers that you may not be aware of w/o it. Yrly exam, pap 3 yrs if prior 3 were normal=35yo or
—Guest Nurse, Mother More

Prescribed for cysts without pap smear

At 15 my pcp wanted to put me on BC to regulate my cycle & I refused d/t fear of being labelled a 'slut' etc. I also had read that pap smears were required & there was no way that was going to happen. So, I avoided a medication I likely needed for 8 years. At 23 I began seeing my new pcp after many years of no visits & he suggested BC. I wanted to take it but still did not want the exam. The exam was never brought up. I believe this was at least partially due to my abstinence. When I switched practitioners at the same clinic, the prescriptions were again written without mention of a pap smear, but my sexual activity was never brought up either. I have since moved & I need a new prescription and hoping that I can again skip the Pap smear. I don't see any reason for me to have it; 2 people who have only been with one another are not at risk. I'm considering calling my old PCP to ask if they will call in a prescription for me, because I don't know how to find one who wont require it.
—Guest cyst girl

follow up

my doctor required a 5 min. follow up which insurance did not cover. Annual was already used. Refused to prescribe bc if I did not come in for the follow up. Am I obligated to pay the $120 to dr. billed me for this required 5min. follow up visit? I think it is unethical!
—Guest sharlene

I refuse to get one!

I want to bet on BC. I have called at least 3 different places and they all want me to get a pap smear done. I am not interested in it. I just want BC so I don't have to worry about getting pregnant when I am not ready for it and move on with my life. My husband has been the only sexual partner I have had. And I should not have to fight for BC. It is outrageous. If I don't want to get naked in front of a doctor, that is how I am raised. It is my religious belief and I want it respected! I am a smart educated woman and I can make my own decisions!
—Guest Sam

Get Over It

Everyone is taking a simple Pap/Pelvic examine and blowing it out of porportion. How one feels violated, molested, and abused is beyond me. What kind of doctors do you all see? Sure, paps are not exactly the funniest thing to, but health wise, it is beneficial to have. Why would anyone assume it is OK for a doctor to just hand over a prescription without an examination? One person mentioned that they ended up with an unwanted preganacy and was forced to go through the horrible experience of getting an abortion. Well, that right there for one is just stupid! Terminating a pregnancy is OK but not getting the stupid pap is wrong? I guarantee you, if you just got that pap, it would not have been a horrible thing. If people refuse to get an annual examination, then simply keep your legs closed!

I held my ground

I'm a 26 year old virgin who has never engaged in ANY sexual activity with another person, I don't smoke, and have no family history of cervical cancer. When my GP mentioned that I needed to have a pap smear, I refused, and instead of talking to me, he immediately threatened to not fill my birth control (I use it for endometriosis). I left his office crying, and in the following weeks couldn't get him to return my phone calls. I'm not going to go into the reasons why I personally don’t want to have this test, but it should absolutely be my RIGHT to refuse ANY test should I not want it! I decided I was done with my GP and am never going back. I thought I was going to have to start buying pills online, but decided to try Planned Parenthood first. PP was a godsend!! They reassured me that they would never withhold my medication because I didn’t want to go through with tests or exams. I walked out of PP with a year’s supply of my medication and my hope restored in medical practitioners!
—Guest PianoGirlO

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


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)

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

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