Planned Parenthood offers birth control without pelvic exam

One thing that comes between many females and birth control pills is the dreaded pelvic exam, but as of the beginning of August, women can go to Tri-Rivers Planned Parenthood, Inc. in Kirksville and obtain a prescription for birth control pills without undergoing a pelvic exam.

Women can delay the pelvic exam for up to six months while taking the oral contraceptive. In the past, women wanting to begin the pill were required to undergo the pelvic exam before the prescription was written.

Students have expressed skepticism about this new policy. Many female students said they are confused about the logic behind the new policy and do not see any advantage in delaying the inevitable.

"Aren't they supposed to do the pelvic exam?" freshman Lauren Filla said. "I think that they should just go ahead and do it because obviously you're going to have to have it done anyway."

Another student saw the policy as an incentive for woman to become sexually active.

"I think that it's bad because it's like saying, 'Hey, go out there and have some sex,'" freshman Valerie Moyers said.

The deferral policy was actually implemented by the National Planned Parenthood Federation several years ago. Kirksville's Tri-Rivers office is a part of a Missouri Planned Parenthood affiliate. The affiliate, which is headquartered in Rolla, waited until this summer to adopt the policy.

Along with the new deferral policy, the National Planned Parenthood Federation conducted a study on the results of the physical examination exemption with a monitoring and surveillance system built into the new program. Planned Parenthood hypothesized an increase in the utilization of the hormonal methods of contraception and that deferrals would not adversely affect the overall health of women in their policy guidelines.

"We wanted to wait until the national office completed their study on the effects of deferring the physical exam before we joined them," said Robin Corderman, director of health center operations at the Rolla office.

The Student Health Center also provides students with birth control pills without first requiring a pelvic exam. Students are allowed to make an appointment for the exam up to three months later.

Brenda Higgins, director of the health center, said she is not critical of Planned Parenthood's policy and shares the same rationale for deferring the exam.

"You shouldn't attach contraception and health issues," Higgins said. "Pregnancy is a higher medical risk than birth control. Getting started on the pill is an extra incentive for people to go [to the gynecologist]."

Planned Parenthood's policy change statement that was issued several years ago states, "De-linking hormonal contraception from a physical exam may increase access to contraception for women who cannot get an examination at the same time due to time or financial constraints."

Higgins said some action is taken to help prevent the harmful side affects the pill can cause, such as breast cancer, strokes and other vascular problems.

"Planned Parenthood does the appropriate screening to assess high-risk patients, which prevents some women from getting the deferral," Higgins said.

As outlined in Planned Parenthood's new policy, patients must complete the informed consent process, have a targeted medical history and a blood pressure measurement and be educated about the importance of physical exams before they are allowed to delay the pelvic exam.

"The screening is enough to prevent the serious side-effects of birth control from occurring," said Corderman. "Only good candidates [for oral contraception] who have a clean medical history are given prescriptions."

Regardless of the evidence that delaying the exam is medically safe, many doctors and nurses think doing the exam at the time the prescription is given is still the best policy.

"Maybe I'm old-fashioned, but oral contraceptives are a prescribable medication and I think you should at least have physician contact before [you prescribe it]," said Dr. Gary Early, a D.O. in Kirksville.

Early admits that his belief that birth control should not be so freely given out was partially a moral disagreement.

"To me, just saying OK, we'll give you six months of birth control, is like inviting you to go out and have sexual relations," Early said.

Aside from moral issues, Early also stressed that "performing the physical exam gives doctors a good chance to go over with the patient the risks and benefits of oral contraceptives, inform them of the side-effects such as migraine headaches that [it] can worsen, and gives them time to counsel patients on the proper way to use oral contraceptives."

Higgins agrees that students should have pelvic exam done sooner rather than later.

"Birth control services should be evidence-based, and the pelvic exam is a good opportunity to provide patients with education on prevention," Higgins said.

"[Planned Parenthood] provides a wonderful service in our community," Higgins said. "And I support that someone is out there on the cutting edge."