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Survey: Ob-Gyns Wrongly Think Pelvic Exams are Needed Before Prescribing Hormonal Contraception

Survey: Ob-Gyns Wrongly Think Pelvic Exams are Needed Before Prescribing Hormonal Contraception

July 31, 2014 — Summary of "Obstetrician-Gynecologists' Beliefs on the Importance of Pelvic Examinations in Assessing Hormonal Contraception Eligibility," Yu et al., Contraception, June 30, 2014.

Past surveys have found that many clinicians require pelvic examinations before prescribing hormonal contraception to women, even though the American Congress of Obstetricians and Gynecologists, CDC and the World Health Organization all advise that it is sufficient to assess a patient's medical history and blood pressure before writing such a prescription for asymptomatic women, according to a study led by Jean Yu of the University of California-San Francisco's Department of Obstetrics, Gynecology and Reproductive Sciences.

Yu and colleagues devised a study to examine ob-gyns' beliefs regarding the importance of pelvic exams for determining women's eligibility for hormonal contraception and whether ob-gyns find a particular component of the exam to be especially critical.

Methods

The researchers mailed a questionnaire to a national sample of 1,020 U.S. ob-gyns listed in the American Medical Association's Physician Masterfile, which includes information on AMA and non-AMA members. They collected data from May 2010 to January 2011.

The survey asked about routine gynecologic care, with a focus on pelvic examinations in conjunction with the provision of hormonal contraception.

Ob-gyns were asked to assess the importance of three components of pelvic examinations -- bimanual examination, external genitalia inspection and speculum examination -- in determining whether asymptomatic women are eligible for hormonal contraception. The respondents could rank each component as "very important," "moderately important," "a little important" or "not important."

Results

The response rate was 62%, with a final sample of 521 respondents. Respondents saw an average of 85 gynecologic patients per week, and 70% performed 30 or more gynecologic examinations a week.

Among the respondents, 79% considered at least one of the three components of the pelvic examination to be "very," "moderately" or "a little" important. Among all respondents, 29.7% thought the bimanual examination was unimportant for assessing eligibility for hormonal contraception, 35.1% thought the same about the speculum examination, and 46.8% did not consider the external genital examination to be important.

Meanwhile, 21% of respondents believed all three components of the pelvic examination were "not important," in line with professional recommendations. These ob-gyns, compared with the other respondents, tended to be younger, were more likely to be female and often practiced in "settings other than solo or group private practice."

Discussion

"Despite long-standing guidelines stating pelvic examinations are unnecessary prior to hormonal contraception provision, most [respondents] believed they are of some importance," the researchers wrote.

The findings "raise concern that these beliefs may continue to pose a barrier to contraception provision," the researchers continued. They noted, "Demonstration projects have shown that providing hormonal contraceptives without requiring a pelvic examination increases access to contraception and reproductive health services" and that most women "feel it is important to be able to begin contraception quickly and ... associate pelvic examinations with fear and embarrassment."

The Affordable Care Act's (PL 111-148) expansion of contraceptive coverage creates an "opportunity for obstetrician-gynecologists to provide more women with information [about] and access to reproductive health services," according to the researchers.

They recommended more-widespread "dissemination and visibility of current guidelines," which "can help inform providers as well as patients."