The other day I wrote a post about whether keeping oral contraceptive pills (OCPs) available by prescription only constitutes extortion on the part of medical providers. (It doesn’t.) In that post I conceded that some doctors may tie refilling OCPs to an annual pelvic exam in an effort to get more women to have the latter done, and that this is a coercive practice that should be reconsidered. While I think annual check-ups for OCP maintenance are a good idea, if only to make sure they’re well-tolerated and the patient’s blood pressure remains in healthy range, there’s no medical reason that a pelvic exam should be required. Indeed, since pelvic exams yield little clinical benefit for asymptomatic patients under age 21, I rarely do them at all.
Anyhow, there are new recommendations regarding how frequently women should have screening pelvic exams. It had been the recommendation that all sexually active women have a pelvic exam shortly after sexual debut (a more genteel way of saying “losing their virginity”), and have them repeated annually. This yielded a lot of transiently abnormal Pap smears for adolescent girls, with a bunch of needless and potentially harmful follow-up care. The recommendation that women under 21 have a Pap smear at all has been essentially abandoned for years, and the new recommendations are that women of reproductive age have Pap smears only every three years. This will spare women from getting aggressive follow-up for problems that are likely to resolve on their own.
I realize that this is probably of little interest to most of you. [Insert sound of crickets chirping here.] I mention it only to lend a bit more emphasis to my somewhat more diffident opinion from before. Requiring an annual pelvic exam as a prerequisite for prescribing or renewing contraceptive medication has no valid medical basis. At best, it was well-intentioned but coercive. Given the new recommendations, there is no justification for this practice at all. It should be abandoned.
I apologize for going off topic. But can I just say how much I love the phrase “sexual debut”? It makes me think of footlights and tap shoes and jazz hands.
Well, in some cases perhaps that mental image is accurate.
And I say, “Aw come on now
You know you know about my debutante”
And she says, “Your debutante just knows what you need
But I know what you want”