New recommendations to make oral contraceptives (OCs) available over-the-counter (OTC) from the American College of Obstetricians and Gynecologists (ACOG), recently made headlines. The organization contends that access and cost are the most common reasons women do not use contraception.
Making OCs easily available could potentially decrease the rate of unintended pregnancy, the ACOG argued, pointing out that the health risks of pregnancy are greater than the risks associated with oral contraception. With these new recommendations, concerns have arisen that women will not be screened for cervical cancer or STDs if they do not need to see a prescribing practitioner for their birth control.
There is no evidence to back up the validity of such concerns, nor is there a need for a Pap smear or STD testing prior to starting OCs. Despite this, providers have long required patients to schedule an annual visit to receive contraception.
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This raises an interesting question. If oral contraception becomes available OTC and providers follow the most recent cervical screening guidelines to perform less frequent Pap smears, will the routine annual gynecologic or “well-woman” exam become obsolete?
In a practice bulletin published this summer, ACOG recommended that women aged older than 21 still receive annual comprehensive pelvic exams, but admitted that there is no evidence to support this practice in asymptomatic, low-risk patients. In fact, the only necessary annual exam the organization identified is a clinical breast exam for women aged 40 years and older.
If these recommendations are implemented gynecology practice could change radically in the next decade or so. I would love to see us move away from unnecessary pelvic exams and excessive screening and move toward a purely preventative care annual visit for the healthy woman.
I envision spending the time allotted for the annual focusing on education, discussion and health promotion for all aspects of women’s and sexual health. If women didn’t have to take their clothes off, put their feet in stirrups or dread the speculum exam every single year, perhaps there would be less anxiety and more compliance.
Robyn Carlisle, MSN, CNM, WHNP, works as a full-scope midwife at University Doctors and Kennedy University Hospital in Sewell, N.J.
