Contraceptive initiation and pap smears: what are your thoughts?

[kmspac611]

My new position has me seeing lots of female adolescents and young adults wanting to start on birth control. Most are under 21, thus not meeting ACOG guidelines of starting pelvic exams with pap smears. In cases where I see a patient who wants to start on birth control, but is not yet 21, I always offer the option of letting them decide if they want a pap smear or STD screening. Of course, if they are not using protection or are having any symptoms, I try and push to perform a pelvic exam with STD screening at the least.

I am looking for anyone's input and opinions regarding the above information and this question: should we be "forcing" annual pelvic exams with paps on patients in order for them to start or continue to receive birth control? My answer is no, because I think the ACOG guidelines are appropriate and what should be followed, but would like to hear other's thoughts, particularly if you think yes and why we should.

Thanks!
 

[LT_Oneal_PAC]

Doing paps prior to 21 can actually be harmful by increasing testing and unnecessary procedures due to clinically insignificant HPV that patients under 21 will likely clear.

I ask that they submit a urine to test for GC/C yearly between ages 16 and 26 as EBM has shown this decreases community infections. 

I’m not sure of the point of a pelvic just for pelvic sake without symptoms.

i always provide BC and a year supply to increase regular compliance. Adding barriers just increases unwanted pregnancies

[ALC0313]

A pelvic exam is not required for an asymptomatic patient in order to prescribe contraception... But while the patient is in your office discussing contraception you want to recommend the appropriate routine screening, which would be Ct/Ng screening for all sexually active women and Pap smears > age 21 according to ASCCP guidelines (there's a great app you can download which gives you the appropriate screening/intervention based on Pap or colpo results, patient's age, pregnant or not, HPV +/-). I often see adolescent patients who are newly sexually active and reluctant to have a pelvic exam. For these patients I send their urine for Ct/Ng and then educate them that I will recommend a pelvic exam at the next visit for the purpose of cervical Ct/Ng culture (because it's more accurate than urine). For patients who are not sexually active I often defer a pelvic exam, unless they are having symptoms that would require it. For adolescents that deny being sexually active I send their urine for Ct/Ng anyway, because surprise! they're often lying because their mom is in the exam room. Anyway I hope that answers your question. It sounds like you're on the right track, why are you second guessing yourself? Is your SP doing something different?

[kmspac611]

Thanks for the input! I'm definitely not second guessing, mainly just wanted to know other thoughts and if there were some that were different than the way I have been practicing. It's good to know that everyone so far seems to be on the same line of thinking!

[Avalon]

I'm an OB/GYN PA and agree with the above.  If there are no reported GYN concerns, pelvic exam is unnecessary in the sexually active teen.  CDC does recommend annual STI screening in sexually active, unmarried women below the age of 26, and another great option for this is to have patients self collect a vaginal wall sample.  Studies have shown self collection to be as reliable as clinician screening.   In addition to GC and CT, our swab detects trichomonas and mycoplasma genitalum.