Pelvic Exams, Pap Tests and Oral Contraceptives

When you need tests to get birth control pills—and when you don’t

Before you get birth control pills, your doctor may want you to have a pelvic exam with a Pap test. Your doctor should get a complete medical history before giving you a prescription for birth control pills. But you usually don’t need a Pap test and pelvic exam, especially if you are a teen. The tests can even be harmful. Here’s why:

Teens usually don’t need the Pap test.

A Pap test looks at cells in the cervix for signs of cancer. The cervix is where the vagina connects to the uterus. Many doctors do a Pap test at the same time as a pelvic exam, which checks for infections and other problems.

Teenagers generally don’t need a Pap test. They rarely have cervical cancer.

Also, Pap tests in teens have unclear results. Something might seem abnormal, but usually it gets better on its own. Your doctor may want to do tests for sexually transmitted diseases (STDs), but these tests can be done using blood or urine samples. They do not require a pelvic exam.

The pelvic exam can be a barrier to getting birth control.

Many young women are anxious about having their first pelvic exam. So they put off getting birth control. This is bad for their health because it can lead to unplanned pregnancies.

Preventing unwanted pregnancies is important for emotional, physical, and financial health. Studies show that teen girls have more risks from pregnancy, compared to adults.

Avoid unnecessary costs.

A complete physical exam that includes a pelvic exam costs about $125. A Pap test adds another $40, or more if you get tests for sexually transmitted diseases. If the Pap test result isn’t normal, follow-up can cost over $350. Some women, especially teens, don’t need all these tests.

But if you see your regular doctor for an office visit without a pelvic exam, the cost is less than $100.

Do I need any exam before getting birth control pills?

You should have pelvic exams and Pap tests based on your age and health history. But you don’t need an exam or Pap test just to get a prescription for birth control pills.

Before you get birth control pills, your doctor should always do a basic medical exam and:

  • Check your blood pressure.
  • Ask if you’ve ever had blood clots.
  • Ask if you smoke.

High blood pressure, blood clots, and smoking are risk factors. If you have a risk factor, you should consider other forms of birth control. Birth control pills may not be a good choice.

Should I get a pelvic exam if I don’t need a Pap test?

You can have a pelvic exam without a Pap test. But you rarely need to. You might need a pelvic exam if you have pelvic or abdominal pain, abnormal bleeding or discharge, or severe menstrual pain.

This report is for you to use when talking with your healthcare provider. It is not a substitute for medical advice and treatment. Use of this report is at your own risk.

© 2017 Consumer Reports. Developed in cooperation with the American Academy of Family Physicians.