Holding Birth Control Hostage
Recently, my doctor gave me an ultimatum: Come in for a pelvic exam, or I won’t refill your birth control pills. The problem arose after I tried to get my prescription refilled before going on vacation in March, only to be told that the doctor’s office wouldn’t sign off on the refill because it had been a year and one month since I’d had an annual exam and a Pap smear. A nurse grudgingly gave me a monthlong reprieve if I promised to come in for an exam when I returned from my trip.
I really, really didn’t want to go in for an exam. I’ve had two kids, a false positive Pap test and all the ensuing misery that comes with it, and spent enough time in the stirrups to last a lifetime. All I really wanted were my pills; I was pretty sure the exam could wait another year or more.
The science was on my side.
Just a few weeks earlier, the US Preventative Services Task Force, an independent group of national experts that makes evidence-based health care recommendations, released new guidelines declaring definitively that women over 30 don’t need a Pap smear more than once every three years unless they have a couple of risk factors, which I don’t have. The American Congress of Obstetricians and Gynecologists has said that birth control pills can safely be prescribed without a full-on exam.
Doctors, though, don’t seem to be in any hurry to give up old habits. After I got back from vacation, I emailed my doctor, citing the new guidelines, and asked if he could give me a new one-year prescription for birth control pills without a pelvic exam. He wrote back, “Yes, one can argue about whether or not you need a pap, but current recommendations are still for an annual exam, blood pressure readings, updating family history, (‘torturous pelvic exam,’ I’m afraid), etc. So I would still like you to come in. See you soon?”
The doctor had me over a barrel. As it turns out, my experience isn’t unique. Doctors regularly hold women’s birth control prescriptions hostage like this, forcing them to come in for exams that research is increasingly showing are too frequent and often unnecessary and ineffective.