Bimanual Pelvic Examinations: Temporal Patterns and Imposed Barriers to Contraception Use

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PROJECT ABSTRACT/SUMMARY Preventive pelvic examinations, or those performed in asymptomatic, non-pregnant women, have been a standard component of preventive gynecologic care for decades. Today, more rigorous and less invasive screening mechanisms have surpassed the preventive pelvic examinations in effectively detecting diseases such as sexually transmitted infections and cervical cancer, for which preventive pelvic exams were previously used. Furthermore, preventive pelvic examinations frequently induce fear or embarrassment in young women and contribute to unnecessary, harmful, and resource-intensive subsequent diagnostic procedures. In light of this, recent reviews and position statements question the widespread or routine use of preventive pelvic examinations. More importantly, preventive pelvic exams have been an unnecessary barrier to self- administered hormonal contraception access. Preventive pelvic exams as a prerequisite to self-administered hormonal contraception use have been removed from drug labeling and practice recommendations because these exams are not necessary to facility safe, effective use of these contraceptives. However, against these requirements and recommendations, most physicians still require a preventive pelvic examination before they prescribe oral contraceptives. The overall goals of this proposed project are to evaluate the de- implementation of the use of preventive pelvic exams routinely and as a prerequisite to self- administered hormonal contraception access, a clinical practice that is ineffective and harmful. This objective aligns with the AHRQ Research Priority Area to harness data and technology to improve health care quality and patient outcomes. In Aim 1, we will use a database of medical and prescription claims data of employer-sponsored commercially insured women to examine the changes in rates of preventive pelvic exams following the first societal guideline changes recommending the use of routine preventive pelvic exams, from the American College of Physicians in 2014. In Aim 2, we will use a survey to understand women’s experiences with and perceptions of pelvic exams as a barrier to contraception use. In Aim 3, we will use the same database from Aim 1 to evaluate whether women who fill a prescription for a self- administered hormonal contraceptive method (contraceptive pills, patch, or ring) experience a higher prevalence of preventive pelvic exams at a recent preventive care visit compared to women who are not using those methods. Our work will provide evidence to inform interventions that will support and empower providers and patients for evidence-based gynecologic care related to preventive pelvic exams and access to self- administered hormonal contraception.