Pelvic exams can be a barrier to birth control for women with history of intimate partner violence
Pelvic examinations used to be required to obtain hormonal contraception, creating a substantial barrier to accessing Starting in the mid-1990s, professional medical organizations walked back this requirement. However, many providers still require a pelvic examination prior to prescribing or administering contraception.
Women who have experienced intimate partner violence report lower rates of contraceptive use, as well as use of less effective methods and less consistent use, than those without an intimate partner violence history. Intimate partner violence, or physical, verbal, or sexual abuse or aggression that occurs in close relationships is a serious public health problem. Over 43 million U.S. women have experienced some form of intimate partner violence in their lifetime, with approximately 23 million reporting some form of sexual violence. Women who have experienced intimate partner violence may be especially concerned about pelvic examinations done before prescribing contraception. Previous research has shown that pelvic examinations can re-traumatize women and that women with a history of intimate partner violence can experience more pain and discomfort with the examination.
New research examined attitudes towards pelvic examinations of women with a history of intimate partner violence, looking specifically at delays in clinic visits for contraception and preference to avoid pelvic examinations during contraception visits. Overall, 13.2% of women reported ever having delayed going to the clinic for contraception to avoid having a pelvic exam. Only experiencing sexual violence, as opposed to physical or verbal violence, was associated with ever delaying a clinic visit. Almost one-third of surveyed women reported ever experiencing sexual intimate partner violence, specifically pressure from a sexual partner to have sex. Those who reported experiencing pressured sex often had significantly higher odds of delaying a clinic visit and for preferring to avoid pelvic examinations. More than one-third of women reported a preference to avoid pelvic examinations during these clinic visits.
Prior research has shown that fear of pelvic examinations may lead younger women to delay or avoid obtaining oral contraception and this new study indicates that this effect is even more dramatic in women with history of experiencing pressure to have sex., Providers who require a pelvic examination before providing contraception create an unnecessary barrier for vulnerable women who have experienced pressured sex. This research further supports the importance of removing requirements for pelvic examination for contraceptive access in all healthcare settings. Clinics and providers should communicate to patients that routine pelvic examinations are no longer recommended nor required for obtaining contraception.