Study finds medical exams unnecessary before prescribing 'the Pill'

Wilson School professor James Trussell co-authored a research paper published on May 2 about the necessity of examinations on women who seek hormonal contraception.

Trussell worked with professors from the University of California and scientists from The Population Council and Family Health International to produce this research paper, which asserts that pelvic and breast examinations are superfluous requirements for women to receive "birth control" medication.

The paper, which summarizes and evaluates pertinent medical literature, according to the JAMA website, maintains that while these examinations are important to women's health, they "do not provide information necessary" for doctors to determine their patients' ability to safely use hormonal contraceptives.

Though this research paper was published quite recently, Trussell said he has been investigating this issue for almost 20 years. "It's not something we just dreamt up this afternoon," he said. "I've been working for almost all of my professional career [on this]."

Trussell and his colleagues also published a textbook on contraceptives, titled "Contraceptive Technology."

"Birth control ought to go over-the-counter," he said. "These examinations are not necessary."

Trussell stands by his and his coauthors' findings. Yet he did predict that several groups will probably object to his team's findings, citing the effects as having potentially negative consequences.

One such group, he said, believes this would be detrimental to women's health because women will be less inclined to be examined by a gynecologist. Trussell called this way of thinking "paternalistic" and said that to require such examinations for the provision of birth control "perpetuates the notion that [hormonal contraceptives] are dangerous."

At the Sexuality Education Counseling and Health center in McCosh Health Center, annual gynecological exams are not required for students to receive birth control pills, said Carolyn Torre, a nurse practitioner and administrative director at SECH.

"It is important for me to have a [medical] history [of the patient] . . . doing an annual exam and a PAP test may not be medically necessary," she said.

However, Torre also noted that female students who receive oral contraceptives from SECH often choose to have an examination at the same time "for efficiency's sake."

"I think the thing you have to realize," Torre explained, "is that Trussell is an economist and a demographer, but not a clinician . . . so he doesn't really know what happens here."

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While Torre said she agrees with Trussell's assertions, she said she does not want women students to be misled.

"I don't want women to think they don't need a [gynecological exam] when they are sexually active," she said.

"My concern is that there are women who will take the pill . . . and have a false sense of security." Since birth control pills do not protect against sexually transmitted diseases, Torre explained, gynecological exams are necessary to detect STDs in sexually active women.

According to Torre, Trussell's research paper will not have an overwhelming effect on the amount of patients SECH will examine. "I don't think we are going to have an influx of phone calls," she said.

Yet Torre also said that Trussell's research could potentially prevent some unwanted pregnancies. "I think people might get here a little bit sooner when they realize they don't have to get an annual exam [in order to receive hormonal contraceptives]," she said. "It isn't imperative . . . this is a process."

Trussell said that his work was published only a week ago and it is too soon to tell what the reaction of the medical community will be. "We haven't had a reaction [yet]," he said.

Trussell said he believes the timing of this publication was ideal. "We thought the time was right," he said. "It's definitely an idea whose time has come."