Clinical breast and pelvic examinations are commonly accepted practices
prior to provision of hormonal contraception. Such examinations, however,
may reduce access to highly effective contraceptive methods, and may therefore
increase women's overall health risks. These unnecessary requirements also
involve ethical considerations and unwittingly reinforce the widely held but
incorrect perception that hormonal contraceptive methods are dangerous.
This article reviews and summarizes the relevant medical literature
and policy statements from major organizations active in the field of contraception.
Consensus developed during the last decade supports a change in practice:
hormonal contraception can safely be provided based on careful review of medical
history and blood pressure measurement. For most women, no further evaluation
is necessary. Pelvic and breast examinations and screening for cervical neoplasia
and sexually transmitted infection, while important in their own right, do
not provide information necessary for identifying women who should avoid hormonal
contraceptives or who need further evaluation before making a decision about
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The Rational Clinical Examination
Table 42-3 Probability of Pregnancy if Patient Reports Not Using Birth Control
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