Challenges Women with History of IPV Face: Mandatory Pelvic Exams
Written by Miriam Bermejo
Edited by Kelly Chau
March 21, 2022
Edited by Kelly Chau
March 21, 2022
Before 1994 healthcare providers were once required to perform pelvic exams in order for women to receive hormonal birth control. However, the World Health Organization has stated that women can now acquire such contraceptives without these exams. Although health organizations continue to reiterate this statement, many healthcare providers still make pelvic exams mandatory for women to receive prescribed birth control. Serving as another barrier to birth control access, this nonessential requirement negatively impacts women who have experienced intimate partner violence (IPV).
Intimate partner violence is any form of abuse (physical, sexual, or verbal) or aggression that happens in close relationships. At least 43 million women in the U.S. experience some form of IPV, and around 22 million U.S. women report some form of sexual violence from an intimate partner in their lifetime. Past research says women who experienced IPV feel more pain and discomfort during their pelvic exams which can further retraumatize them. These women are also more likely to use less effective birth control methods, be inconsistent with birth control use, and not use birth control overall compared to those who have not experienced intimate partner violence.
To study perspectives towards pelvic examinations among women with a history of IPV, researchers selected women based on set criteria and surveyed their feelings and preferences towards pelvic exams, birth control, clinic visits, and their history of intimate partner violence. They found that 196 of the 1490 women reported that they delayed clinic visits to avoid a pelvic exam. The relationship between women who experience pressured sex and delayed clinic visits to avoid pelvic exams was more apparent than that of those who experienced other forms of abuse. In fact, there was no relationship found between women who experienced other forms of abuse (e.g., verbal, physical, etc.) and delayed clinic visits.
Although a statistically significant relationship was present between women who’ve experienced pressured sex and delayed clinic visits to avoid pelvic exams, the study had some limitations. For instance, there may have been a statistical error when calculating and analyzing the results. Furthermore, pelvic exams were not defined in the surveys so it is unclear whether the participants' attitudes were towards a specific part of the exam or the exam overall. Additionally, since only women who were present at family planning and abortion clinics were included in the study, these results do not generalize to women who have not gone to such clinics due to differing attitudes towards pelvic exams.
While intimate partner violence, unfortunately, is common in the United States, requiring a pelvic exam in order to be prescribed birth control creates a barrier for women who experienced IPV in preventing pregnancy and also increases possible health risks. Instead of making these sorts of exams a requirement, it should be a joint decision between the provider and patient based on the patient's feelings and medical needs.