Provision of Hormonal Contraceptives without a Mandatory Pelvic Examination: The First Stop Demonstration Project

Harper, Cynthia C.; Balistreri, Elizabeth; Boggess, Jane; Leon, Kathleen; Darney, Philip D.

doi:10.2307/2673737

Cited by 47 publications

(26 citation statements)

References 4 publications

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“…Demonstration projects have shown that providing hormonal contraceptives without requiring a pelvic examination increases access to contraception and reproductive health services. Moreover, a majority of participating women feel that it is important to be able to begin contraception quickly and admit they associate pelvic examinations with fear and embarrassment [11].…”

Section: Discussionmentioning

confidence: 99%

Obstetrician-gynecologists’ beliefs on the importance of pelvic examinations in assessing hormonal contraception eligibility

Henderson

Harper

et al. 2014

Contraception

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Objective: To describe obstetrician-gynecologists' beliefs regarding the importance of pelvic examination (including external genitalia inspection, speculum examination, bimanual examination) in assessing hormonal contraception eligibility. Methods: In a national probability survey, 1020 obstetrician-gynecologists drawn from the American Medical Association's Physician Masterfile rated importance of the examination in four categories: very, moderately, a little and not important. Results: The response rate was 62% (n= 521). Seventy-nine percent considered at least one exam component to be of some importance (very, moderately, or a little importance). Bimanual examination was rated more often than external examination in each level of importance (pb.001). Physicians who believed no component of the examination was important were more likely to be younger, female and in practice settings other than private practice. Conclusions: Despite guidelines stating that pelvic examinations are unnecessary in assessing hormonal contraception eligibility, most obstetrician-gynecologists believe that they are of some importance. These attitudes may pose a barrier to contraception provision.

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Section: Discussionmentioning

confidence: 99%

Obstetrician-gynecologists’ beliefs on the importance of pelvic examinations in assessing hormonal contraception eligibility

Henderson

Harper

et al. 2014

Contraception

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“…However, the routine pelvic examination is of limited utility as a screening test for ovarian cancer [26], and it is not recommended by the USPSTF [27]. In addition, results from demonstration projects indicated that women would value having this requirement waived [8,28]. …”

Section: Discussionmentioning

confidence: 99%

Reproductive health preventive screening among clinic vs. over-the-counter oral contraceptive users

et al. 2012

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Background Interest is growing in moving oral contraceptives over-the-counter (OTC), although concerns exist about whether women would continue to get preventive health screening. Study Design We recruited cohorts of US-resident women who obtained oral contraceptives from US family planning clinics (n=532) and OTC from pharmacies in Mexico (n=514) and interviewed them four times over 9 months. Based on self-reports of having a Pap smear within 3 years or ever having had a pelvic exam, clinical breast exam and testing for sexually transmitted infections (STIs), we assessed the prevalence of preventive screening using Poisson regression models. Results The prevalence of screening was high for both groups (>88% for Pap smear, pelvic exam and clinical breast exam and >71% for STI screening), while the prevalence ratios for screening were higher for clinic users, even after multivariable adjustment. Conclusions Results suggest that most women would obtain reproductive health preventive screening if oral contraceptives were available OTC, and also highlight the need to improve access to preventive screening for all low-income women.

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“…Prior studies on cervical cancer screening preferences suggest that some women place importance on the examination even if it is not effective for cancer screening, 10,11 but others may prefer not to undergo the examination, especially if it could lead to unnecessary intervention or interfere with access to contraception. 8,12–14 …”

Section: Commentmentioning

confidence: 99%

Routine bimanual pelvic examinations: practices and beliefs of US obstetrician-gynecologists

Henderson

Harper

Gutin

et al. 2013

American Journal of Obstetrics and Gynecology

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Objective Less-than-annual cervical cancer screening is now recommended for most US women, raising questions about the need for routine annual bimanual pelvic examinations. Little is known about clinicians’ bimanual pelvic examination practices, their beliefs about its importance or the reasoning underlying its performance in asymptomatic women. Study Design We conducted a nationwide survey of US obstetrician-gynecologists. Respondents (n=521) reported their examination practices and beliefs based on vignettes for asymptomatic women across the lifespan. Results Nearly all obstetrician-gynecologists perform bimanual pelvic examinations in asymptomatic women across the lifespan, although it is viewed as less important for a newly sexually active 18-year-old. Reasons cited as very important included adherence to standard medical practices (45%), patient reassurance (49%), detection of ovarian cancer (47%) and identification of benign uterine (59%) and ovarian conditions (54%). Conclusions Obstetrician-gynecologists perform bimanual pelvic examinations in the vast majority of asymptomatic women, but the importance placed on the examinations and reasons for conducting them vary.

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Provision of Hormonal Contraceptives without a Mandatory Pelvic Examination: The First Stop Demonstration Project

Abstract: Programs that provide hormonal contraceptives without requiring a pelvic examination can expand low-income women's access to these methods and improve the chances that they will obtain other reproductive health services.

Cited by 47 publications

References 4 publications

Obstetrician-gynecologists’ beliefs on the importance of pelvic examinations in assessing hormonal contraception eligibility

Obstetrician-gynecologists’ beliefs on the importance of pelvic examinations in assessing hormonal contraception eligibility

Reproductive health preventive screening among clinic vs. over-the-counter oral contraceptive users

Routine bimanual pelvic examinations: practices and beliefs of US obstetrician-gynecologists

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