Providing OCs without exam may be better for some teens
Contraceptive Technology Update 11(11): 161-164
1990
ISSN/ISBN: 0274-726X PMID: 12283377 Document Number: 371563
Experience with a demonstration project at 3 clinics affiliated with the Family Planning Council of Southeastern Pennsylvania suggests that elimination of the pelvic examination as a prerequisite for oral contraceptive (OC) provision may increase teenagers' use of birth control. The experiment was based on the finding that fear of pelvic examinations is a major reason teenagers delay seeking contraceptive supplies for an average of 1 year after beginning sexual intercourse. A 1986 Harris Poll found that 69% of 12-17-year-old females indicated they postpone visiting family planning clinics because of this fear. 30% of the participants in the Pennsylvania project admitted they were afraid of being examined by a physician. The Smart Start project permits teenagers to postpone the pelvic examination and blood work for up to 6 months after the initial clinic visit. OCs are provided at the 1st visit (foam and condoms are also offered) if there are no contraindications, but OC acceptors are contacted by phone 5-10 days after initiation of OC use and must return for 3 and 6-month follow-up visits. At present, 33% of girls in the Smart Start project are choosing to delay their pelvic examination. There are no data available yet as to whether this option leads adolescents to seek contraception earlier. No significant differences have been noted, however, between those who undergo pelvic examination at the 1st visit and those who elect to postpone it in terms of OC continuation and attendance at the 6-month follow-up. To address possible medical implications of this approach, teens who are at risk of a sexually transmitted disease or have missed a menstrual period are not permitted to delay the pelvic examination.