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Bad Women’s Health Blogger!

October 1, 2009

Yesterday I got a call from my pelvic exam provider telling me that they were not going to call in another birth control refill in for me until I scheduled an exam. Apparently I haven’t been in “a really long time” (since 2007). I was all, “But I thought the new guideline was that I didn’t have to have a pap but every 3 years?” Their response was, “That’s right, since you’ve had normal ones, but you still need a bimanual.” So of course, being a medical librarian, I looked it up, and at least the ACOG guideline does still recommend a pelvic exam every year for my age group. Dang. I hate to be both contrary *and* wrong. 😉

[Thoughts on the approach to the birth control refills? MomTFH?]

13 Comments leave one →
  1. October 1, 2009 8:24 am

    Ha, is there anyone who doesn’t avoid those puppies?

    • October 1, 2009 2:38 pm

      You know, in the past I haven’t, but the last time I went, I got a talking to about my weight. I know my provider has good intentions, but it’s not like I’ve lost any weight since then, so I’m less than eager to pay money I’m not sure I can spare to get naked prodded *and* lectured.

  2. October 3, 2009 2:21 pm

    That’s a question I ask myself, Rachel. The office I work in now will give 3 months refill after your yearly prescription has run out. The 3 months is just enough, typically, to hold the women over until their mandatory pelvic exam.

    Do you need a bimanual for OCPs? No, not really. But a pelvic/bimanual exam yearly is a good idea to make sure the uterus, ovaries, tubes, and cervix are all normal. So I think there are a lot of places that will use the birth control thing as motivator to bring women in.

    On the flip side, many women do not know that OCPs can be dangerous in certain medical conditions, and your gyn health care provider won’t know if anything has changed in your health over the last year unless you come in for an exam.

    • October 4, 2009 8:47 am

      True, true. I was just reminding myself that she doesn’t know if my blood pressure is through the roof, if I’m smoking 8 packs a day, etc. unless I come in.

  3. CountryMidwife permalink
    October 3, 2009 6:55 pm

    I think the general BP, depression, sex dysfunction, abuse / wellness counseling is more important than the bimanual (as ovarian cancer is RARELY picked up on bimanual and other disorders that may be found generally require symptoms). But remember, practices need to make money. So, my (midwife) advice: get a Mirena. For lots of reasons 🙂

    • October 4, 2009 8:52 am

      You know, I haven’t considered a Mirena or other non-pill seriously. Not sure why.

    • October 5, 2009 6:34 am

      Yes – there is no evidence that screening bimanual exams in asymptomatic women are of any use at all, and valid concerns that they can lead to high morbidity rates as a result of chasing up chance false positives with invasive procedures.

      There is significant debate here about the utility of routine bimanuals at all, with some providers choosing not to do them even at the time of a Pap smear. Significant numbers of women experience a bimanual exam as more invasive and unpleasant than a speculum exam, and putting women off having Pap smears isn’t a great idea. (cf: fat-shaming!)

      I would have thought the more important thing to check yearly or so would be blood pressure.

  4. MomTFH permalink
    October 3, 2009 9:39 pm

    I think it’s unfair to tie a birth control prescription to such a visit, since it is unrelated. However, I guess I can see why they might be uncomfortable being a prescribing physician to someone they haven’t seen in two years. But, the consequences to not having birth control can be dire, so I wouldn’t refuse to fill the prescription. I would send out a stern warning, however.

    • October 4, 2009 8:51 am

      Thanks. You know, I think I’m kind of spoiled by our electronic medical record system – this provider should be able to see in the system that I saw another primary care type provider in the same system a few months ago for other reasons, and my weight was X, and my blood pressure was Y, and my smoking status was Z, I was otherwise healthy and alert, etc. (I probably should have just had that provider do the exam while I was there, now that I think about it…) I know I probably should go in, I just don’t wanna! That’s why I titled it “bad women’s health blogger” – it’s not exactly a great example to set, is it? 🙂

  5. October 4, 2009 12:30 pm

    Mirena is the one for women who’ve already had at least one baby. What’s that about?

  6. MomTFH permalink
    December 28, 2009 2:14 pm

    Found it! (I was looking for this post.)


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