Published
OK everyone, my two cents in this old debate.
One of the major reasons to require an annual exam for the Rx of OPCs is that, for many women, this is the ONLY well women care they receive. The exam consists of more than just a pap smear, it includes a full physical.
I disagree that an annual exam is a particular barrier to contraceptive use (one hour, once a year!) - bigger barirres are the myths surrounding OCPs, the lack of OCP coverage by many health insurance policies, and the misuse of OCPs.
Persons on medicare/aid/welfare and various other programs get the exam and OCPs at no cost.
I think the "morning after pill" should be readilly avalible over the counter, as there is little to no risk - even for the smoker.
Yes, the PDR lists the absolute contradictions; however, there are relative contradictions - especially for smokers over 35. that is not included in the PDR, nor does it include evidence or references. The PDR is printed by the pharm companies, and is basically "politically correct".
Two better resourses for information on OCPs are Hatcher's "Contraceptive Technology" or Dickey's "Managing Contraceptive Pill Patients." These are the definitive "bibles" on the subject.
ANYWAY - like i said - my two cents
PAC, RNC CNM, presently in an innercity Chicago women's health clinic
PS sorry about my spelling..........
I think you'd be surprised at how many younger women don't want the pap smear and to avoid it either use condoms or nothing at all. I don't think this is a requirement here anymore. I know that women can get Rxs for injectable contraception like Depo, so I am not certain as to why they have to get an exam for oral contraceptives.
Even depo users have a yearly exam usually
As for the younger women who do not want a pap - unfortunetly, if they are sexually active, the chances are they have already picked up the HPV virus, some 5 strains of which have been proven to cause cervical cancer.
We are finding more and more relativly young women with the early cervical changes which can eventually lead to cervical cancer - most of which we pick up during pregnancy exam - of which the PAP is a part of.
Many times this is their first PAP
I never knew that there were so many things out there and so frequently until I started working the OB side. I think with teens there are some delicate issues out there that would influence Contraception methods. Depo- great because they won't forget it but sometimes if they gain a lot of weight they may not return for their next dose. Orals- may forget. If they do think they are pregnant I have seen a few take a whole box at once. But either way it promotes unprotected sex and annul exams really do need to be done. Many patients may not feel it is important because they do not know the reasoning. I usually find patient chatting instead of patient teaching to work better. Let them know why and make them a part of the exam. The younger generation seems to want to be in control so let them.
Jared
jamistlc
244 Posts
Greetings All Nurses,
I have asked several questions and now I have an other one. These excerpts are from an article originally http://www.arhp.org/clinical/greatdebate.htm
Titled:
This Doctor is advocating a reduction in a standard of care that he even missed the piont. One that the clients he is serving do not get the care they so much need like a yearly Pap for preventive health. And two that the PDR specifically containdicates oral contraceptives for women with a
Correct me if I am wrong but Breast Cancer is a estrogen-dependant neoplasia and a clinical breast exam is one method of finging a sign of the pathology? In addition a cervical Pap smear will find a wndometrium pathologiacl process that would contrindicate the use of the pill, also?
Now I am totally confused he is advocating an abolishment of the Pelvic exam prior to prescribing the pill. Why that will set women's health back decades and indanger women who have this standard of care applied to their care, right? Maybe I am missing something but I think his agenda is to left wing?
Looking for responses!
All POV please!
Peace,
Have a Blessed Day,
Jami :)