I can't believe no one would publish this. What you are saying is so necessary and so true. Btw, all the ob-gyns I know still "require" annual pelvic exams if you want to get a birth control prescription.
Thank you for this. I'm so glad a friend shared it with me. As a freshly-minted doctor, I have not yet given this issue enough consideration. You have encouraged me to do in a new light, and it will likely change the way I discuss this with my patients. So maybe it's okay that it wound up on your blog instead of in some journal.
When I first heard about the discussions regarding the necessity of annual pelvic exams I wondered out how pelvic exams impact birth control and access to medical care. Specifically, when I was teenager (I'm 35 now - not sure if things are still done this way), I could not get any treatment for severe endometriosis nor get oral contraceptives where I lived without submitting to a pelvic exam. For me, this was a huge issue. I lived in a small town with only male OBGYNs and nothing like Planned Parenthood. I delayed getting treatment and going on oral contraceptives because I was scared of and embaressed by the idea of a pelvic exam. None of the OBGYNs would so much as prescribe me a painkiller without a pelvic exam and their attitudes toward it kept me away from needed treatment for a long time. (I was 13 when I started to try to get treatment).
What are your thoughts on the necessity of a pelvic exam for the purpose of prescribing oral contraceptives?
Thank you. It is extremely well written, and I love reading your thoughts on this (or on anything, really).
Here in France, the whole discussion around women's bodies and health care decisions is very different (there are large billboards for the local equivalent of Planned Parenthood -- publicly funded -- in the Metro and most of the French I've talked to were rather shocked by the recent US Supreme Court decision). But they've changed the recommendations on annual pelvic exams here, too.
I am coming to this discussion late, I just found this post but It’s really an interesting issue. I have wondered about the issue of annual exams, knowing that Pap recommendations changed years ago. I have trouble with the idea that doctors should continue to perform uncomfortable exams that are not clearly indicated because of patient expectation or even because of larger socio-cultural trends. There are also questions of unstated or even unrecognized ulterior motives. That is not to single out your specialty at all. Radiology community became quite upset at the suggestion that yearly mammograms after 40 are not clearly indicated. As individual physicians, most of us try to act in the best interests of our patients but we are human and our professional societies exist for the purpose of promoting our interests, including interests not loudly articulated. I think it would be interesting to ask the question of whether OB-GYNs and other physicians actually have annual pelvic exams. We like to talk about how we make the worst patients but that is not really accurate. We are actually among the most informed patients and we recognize medicine’s limitations. Our personal choices maybe as informative as professional society recommendations. I like to make jokes about the fact that I haven’t had a physical in over a decade (I have had obstetrical and gynecologic care during this time but not the annual exam in question) but it is really not rebellion or even laziness, it’s actually an informed choice. Anybody want to do a poll/study?
I can't believe no one would publish this. What you are saying is so necessary and so true. Btw, all the ob-gyns I know still "require" annual pelvic exams if you want to get a birth control prescription.
ReplyDeleteThank you for this. I'm so glad a friend shared it with me. As a freshly-minted doctor, I have not yet given this issue enough consideration. You have encouraged me to do in a new light, and it will likely change the way I discuss this with my patients. So maybe it's okay that it wound up on your blog instead of in some journal.
ReplyDeleteVery informative.
ReplyDeleteWhen I first heard about the discussions regarding the necessity of annual pelvic exams I wondered out how pelvic exams impact birth control and access to medical care. Specifically, when I was teenager (I'm 35 now - not sure if things are still done this way), I could not get any treatment for severe endometriosis nor get oral contraceptives where I lived without submitting to a pelvic exam. For me, this was a huge issue. I lived in a small town with only male OBGYNs and nothing like Planned Parenthood. I delayed getting treatment and going on oral contraceptives because I was scared of and embaressed by the idea of a pelvic exam. None of the OBGYNs would so much as prescribe me a painkiller without a pelvic exam and their attitudes toward it kept me away from needed treatment for a long time. (I was 13 when I started to try to get treatment).
What are your thoughts on the necessity of a pelvic exam for the purpose of prescribing oral contraceptives?
Thank you. It is extremely well written, and I love reading your thoughts on this (or on anything, really).
ReplyDeleteHere in France, the whole discussion around women's bodies and health care decisions is very different (there are large billboards for the local equivalent of Planned Parenthood -- publicly funded -- in the Metro and most of the French I've talked to were rather shocked by the recent US Supreme Court decision). But they've changed the recommendations on annual pelvic exams here, too.
I am coming to this discussion late, I just found this post but It’s really an interesting issue. I have wondered about the issue of annual exams, knowing that Pap recommendations changed years ago. I have trouble with the idea that doctors should continue to perform uncomfortable exams that are not clearly indicated because of patient expectation or even because of larger socio-cultural trends. There are also questions of unstated or even unrecognized ulterior motives. That is not to single out your specialty at all. Radiology community became quite upset at the suggestion that yearly mammograms after 40 are not clearly indicated. As individual physicians, most of us try to act in the best interests of our patients but we are human and our professional societies exist for the purpose of promoting our interests, including interests not loudly articulated. I think it would be interesting to ask the question of whether OB-GYNs and other physicians actually have annual pelvic exams. We like to talk about how we make the worst patients but that is not really accurate. We are actually among the most informed patients and we recognize medicine’s limitations. Our personal choices maybe as informative as professional society recommendations. I like to make jokes about the fact that I haven’t had a physical in over a decade (I have had obstetrical and gynecologic care during this time but not the annual exam in question) but it is really not rebellion or even laziness, it’s actually an informed choice. Anybody want to do a poll/study?
ReplyDelete