title: Pelvic examinations and access to oral hormonal contraception.
abstract: OBJECTIVE
  Requiring a pelvic examination before prescribing oral contraception poses an unnecessary barrier to contraceptive access. Medical guidelines have outlined the safety of oral contraception provision without a pelvic examination, yet little is known about the practices of clinicians providing reproductive health care. Our purpose was to investigate clinicians' requirements for pelvic examination and what may account for practice differences.
  
  
  METHODS
  We administered a mailed survey to a national probability sample of obstetrician-gynecologists (ob-gyns), family medicine physicians, and advanced practice nurses specializing in obstetrics and gynecology and women's health or family medicine in 2008-2009 (N=1,196), with a response rate of 65.3%.
  
  
  RESULTS
  Nearly one third of ob-gyns and family medicine physicians reported always requiring a pelvic examination when prescribing oral contraception (ob-gyns 29%; family medicine 33%). A higher proportion of advanced practice nurses in primary care (45%) and a markedly lower percentage of advanced practice nurses in reproductive health (17%) reported always requiring the examination. In adjusted analyses, older clinicians were more likely to require the pelvic examination (odds ratio [OR] 1.03, P<.01) and clinicians serving a higher proportion of Medicaid patients more likely (OR 1.62, P<.05). Providers in private practice were more than twice as likely as those working in family-planning or community clinics to require pelvic examinations (OR 2.30, P<.01).
  
  
  CONCLUSIONS
  One third of clinicians we surveyed require pelvic examinations before provision of oral contraceptives, despite guidelines indicating they are unnecessary and research suggesting they can pose a barrier to contraceptive access.
authors.affiliation: From the Department of Obstetrics, Gynecology and Reproductive Sciences, Bixby Center for Global Reproductive Health, University of California, San Francisco, San Francisco, California.
authors.forename: Jillian T
authors.initials: JT
authors.lastname: Henderson
authors.forename: George F
authors.initials: GF
authors.lastname: Sawaya
authors.forename: Maya
authors.initials: M
authors.lastname: Blum
authors.forename: Laura
authors.initials: L
authors.lastname: Stratton
authors.forename: Cynthia C
authors.initials: CC
authors.lastname: Harper
mesh_terms: D057179:Advanced Practice Nursing; D003278:Contraceptives, Oral, Hormonal; D003625:Data Collection; D005194:Family Practice; D005260:Female; D058869:Gynecological Examination; D006176:Gynecology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009774:Obstetrics; D010818:Practice Patterns, Physicians'
chemical_list: D003278:Contraceptives, Oral, Hormonal