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A pelvic exam is an examination of the vagina, uterus, ovaries, and pelvic floor in which a patient lies on their back with their legs spread, usually with their feet in stirrups, while a healthcare provider inserts two fingers into the vagina and presses down on the abdomen at the same time. Also sometimes called a "bimanual exam" the pelvic exam also usually includes a speculum exam, and sometimes includes a rectal exam. 

The pelvic exam was once believed to be an effective screening method and diagnostic test for a wide variety of reproductive health conditions, including STDs, STIs, ovarian cancer, and fibroids. It was also commonly believed that a pelvic exam was necessary to safely and effectively use hormonal contraception like the pill. However, in the last two decades research has shown that pelvic exams are not a reliable screening method for ovarian cancer, do not reliably detect fibroids, and are not necessary to screen for or treat STDs or STIs. 

Despite once being believed by OB/GYNs to be a gold standard test, and frequently peddled as such, over the past two decades, significant evidence has come out showing that pelvic exams don't actually show any proven benefits. 

The first was an expert panel appointed by the American College of Physicians in 2014, which found that routine pelvic exams did not show any proven benefits and actually were likely causing more harm than good.  

On the heels of the ACP's recommendation in 2016, the US Preventive Services Task Force concluded the same thing and also no longer recommends routine pelvic exams. 

Both organizations cite a lack of any credible evidence showing that pelvic exams benefit patients, effectively screen for diseases, prevent the progression of diseases, or accurately diagnose reproductive health conditions. And mention pain, fear, and anxiety. embarrassment, and unnecessary treatment as potential harms.  

None of this information should have been surprising or taken the US this many years to discover, as many countries inculding the UK had already known for decades that pelvic exams showed no proven benefits and have never performed them as a regular health screening. 

It's complicated, and to be perfectly honest with you, we will probably never fully understand the reasons why medical professionals have been so against following the recommendations to stop performing pelvic exams; other than that there seems to be a myriad of them, and none of them are because they actually disagree with the recommendation based on evidence.  

With some doctors not bothering to beat around the bush and just coming right out and admitting it's about money, one even asking the question, "Are you trying to bankrupt us (gynecologists)?" of the ACP when they made the recommendation to stop the exams. 

Others cite pure resistance to change as their reasoning.

 Some use personal anecdotes to claim that they have "saved lives" with the exam yet cannot or won't provide any actual evidence to support those claims. A few have even gone as far as to claim that when other doctors perform pelvic exams they might be useless but when they perform them they are not, an argument so absurd and laced with self -importance its bordering on downright megalomania it's hard to believe anybody would actually make it.

Then we have the strange and unusual case of Barbra Levy, the former vice president of health policy for American College of OB/GYNs who made an incredibly disturbing and creepy statement in defense of pelvic exams in which she describes the invasive exam as  a "bonding experience" and a "time of intimacy" between patients and providers. 

insert 74 vomit emojis here!    

No, you do not need a pelvic exam to safely and effectively use most birth control methods.

The only possible exceptions to this rule are IUDs and other vaginal birth control methods. 

You do not need a pelvic exam to use the pill, the patch, the shot, or the implant that goes in your arm. 

No reputable health organization recommends a pelvic exam in order to safely and effectively use most forms of birth control, as per the ACOG.

Despite it being readily available common knowledge that a pelvic exam is not necessary to safely and effectively use most forms of birth control, some healthcare providers and clinics still choose to violate their patients' rights and hold prescriptions hostage in exchange for medically necessary pelvic exams. 

This is an incredibly outdated, harmful, and abusive practice and should under no circumstances be tolerated. 

If you find yourself in a situation where your doctor is telling you "no pelvic exam, no birth control" you absolutely have options and do not have to consent to an unnecessary, violating, and humiliating exam. 

Steps you can take: 

1. Find a different place to get your birth control. You can find a different local clinic, speak to your state health department to see if they require unnecessary exams, go to your local Planned Parenthood, or use an online service like Nurx, the Pill Club, Simple Health, or the myriad of other similar services that ship your prescription right to your door with no hassle and sexual assault. 

2. Once you've secured your prescription from a different source, fire the provider that attempted to force a medically unnecessary pelvic exam on you. 

No reputable provider would behave in this way. 

3. If you're comfortable doing so, we strongly recommend letting the provider holding prescriptions hostage know why you've decided that you no longer want to work with them. As long as providers face no consequences for this behavior it will continue, if every provider who chooses to violate patient rights starts to hemorrhage patients, eventually they'll learn and stop doing this. 

If you don't know what to say or how to start the conversation we have several scripts and templates available on our resources page that may help you. 

4. File a complaint against the provider with your local medical board. 

Filing a formal complaint let's both your local medical board and the provider themsleves know that this is unacceptable. 

We also have instructions on how to file a complaint as the medical boards for all US states linked on our resources page. 

5. You can also choose to have a conversation with your doctor about why they feel requiring a pelvic exam is necessary or appropriate but be warned if you go with this option whatever their answer is, it's wrong and doesn't make the practice remotely acceptable.