It is not medically necessary to have a pap and pelvic exam to get a prescription for birth control. The only medically necessary procedure is a blood pressure test. Yet in the US, women are routinely forced to endure a yearly pap and pelvic exam in order to renew the prescription. A recent study shows that 33% of doctors always require the exam and 44% regularly require the exam (from Time article).
In my personal experience, I was literally shouted at over the phone by a nurse practitioner when I requested a month extension on my prescription because I had to change my exam appointment. The woman told me that I had already waited too long to see the doctor and absolutely refused to provide the one month extension (it has been about fourteen months since my previous exam, completely within medical guidelines for the pill). When I shared my experience with the doctor, she sounded surprised and said I should have been given the prescription, but she was not overly concerned about the incident and had no interest in further investigation or remedy.
The proponents of requiring pap and pelvic exams for birth control prescriptions argue that while it may not be medically necessary, these exams are important and women should have them done. In essence, requiring women to have a pap and pelvic exam in order to get a birth control requires testing that should be optional– it is a way to force women to have exams that they otherwise might elect to forgo.
Birth control guidelines in the UK are drastically different in recommendations on when and how often to have pap and pelvic exams–it is not recommended as a yearly exam or connected with birth control refill subscriptions at all. For women who are in monogamous relationships (and therefore have no concerns about STDs) and are not trying to get pregnant, exams in Europe are generally recommended every three to five years.
Papanicolaou (pap) smears test for cervical cancer, but the risk is very low (1% +/-) and the rate of false positives is very common (65-95% depending on the frequency a woman is tested). The rate of false positives being so high leads to higher frequency of testing and numerous follow-up procedures, including colposcopies and biopsies–expensive, time consuming tests that are unpleasant or painful and create anxiety about possible findings. Cervical cancer is caused by the HPV virus (human papillomavirus) and can be prevented by means other than pap smears; getting the vaccine, safe sex practices, regular STD screening for those at risk and eliminating smoking. For a woman who is not at risk for STDs, got the vaccine and doesn’t smoke, it is overkill and down right absurd to require a yearly pap smear. There is a very interesting article, “Should We Abandon Pap Smear Testing”, which explores the idea of eliminating the pap smear test all together due to the of the rate of false positives and the potential for law suits.
There is also a disconnect between the women who have pap and pelvic exams regularly and the women who are at high risk and who need the exams but rarely, if ever, get them. This goes to a break down in our health care system that allows for people who can afford medical care unnecessary testing and the people who actually need the screening but cannot afford it, to go by the way side. In our failing and bankrupt system, it seems logical to encourage necessary medical screening and treatment while ceasing medically unnecessary practices, like linking birth control to pap and pelvic exams.
There are two perfidious underlying assumptions in requiring pap and pelvic exams in exchange for birth control. One is that women cannot be trusted to have exams that are important for their health unless they are forced to do so (of course this only applies to women who can afford the treatment). The other is the negative stigma associated with birth control–women should not need birth control because they should only be sexually active within marriage and if married they should want children. This very archaic view of women and sex is still very prominent in contemporary society, not necessarily loudly touted, but rather communicated in traditional practices like requiring pap and pelvic exams in exchange for birth control–which deters and eliminates women from having access and using birth control.
All forms of birth control need to be made more readily available. This extends to stores that put condoms behind a counter that must be specifically requested to pharmacists who take it upon themselves to cast a moral judgment upon a person’s request for Plan B or other drugs that may or may not be used after an abortion, to the accessibility of birth control, either through prescriptions or availability over the counter. Women should not be coerced into medical screenings to receive unrelated prescriptions.
Kimberly is a law student at the University of Denver Sturm College of Law. When not studying or writing, she can be found devouring video games and books. She is commonly caught muttering under her breath a critique of the consumeristic mechanism that constantly insists on bombarding her personal space.