Some Planned Parenthood clinics offer a program called HOPE (Hormonal Option without Pelvic Exam) that allows women to obtain a prescription for birth control pills without submitting to a pelvic exam. The idea is to reduce barriers to contraception as young women in particular are often very uncomfortable with a full gynecological exam. While I commend the program, there is no reason why hormonal birth control should be tied to pelvic exams in the first place. As long as the patient is asymptomatic, taking her blood pressure and medical history is all the information the doctor needs to determine whether she’s a candidate for hormonal birth control. Which is why many other countries don’t require pelvic exams to get birth control pills.
In the US, however, doctors frequently refuse to prescribe the pill unless the patient is willing to strip naked and spread her legs for a gyno exam and Pap smear. It’s an outrageously paternalistic practice that would never fly if the patients were men. Can you imagine doctors withholding a dude’s Viagra unless he submitted to a prostate or rectal exam? Me neither. But it makes about as much sense as requiring a pelvic exam and Pap test to get birth control pills.
Cancer screening should be a choice, not a requirement. And for men, that’s the way it is. Women, however, are coerced into annual cervical cancer screening starting at age 21, often even younger, if they want access to the most reliable forms of birth control. On top of that, there is usually no discussion of the pros and cons of screening all women regardless of risk factors, no information on the test’s reliability, no mention of the percentages of false positives and false negatives, no data on the cancer’s prevalence compared to other cancers that we do or don’t worry about, and nothing about the potential health risks of biopsies performed due to false positives. Nor are American women told that doctors in many other countries warn against screening women under 25-30 because cervical cancer is extremely rare in that age group, while the likelihood of a false positive is extremely high (in Holland, for instance, even high risk women are told to wait until they’re 30 to get their first Pap smear). Hence, no informed consent is possible. But that’s okay; we wouldn’t want women to worry their pretty little heads about these things.