The American College of Obstetricians and Gynecologists and the World Health Organization both say pap smears aren’t a necessity to prescribe contraception, but do recommend they be a routine procedure in standard health care. According to the ACOG pap smears should be done every 3 years for women over 30 if they have no history of abnormal exams and every 2 years for women 21-30 with no abnormal results. Women under 21 are not recommended to get pap smears. This is because many cervical abnormalities will heal themselves if left alone so medical intervention can increase costs and invasive procedures to fix something that will likely fix itself; yet according to a study done by Katherine B. Roland, 76.4% of office based doctors and 85.2% of hospital based doctors recommend re-testing in 12 months even for patients with two consecutive normal pap tests.
If so many women are uncomfortable with the testing and guidelines indicate they aren’t an annual necessity, why are so many doctors still requiring them annually for birth control prescriptions? It seems the answer to that is multi-faceted. One is pretty much why I never had a problem with it, the earlier you catch cancer the less likely it is to be fatal so some doctors may test yearly in spite of the fact that interference isn’t always needed. Simply put sometimes interference is needed and a little discomfort in the present outweighs serious issues in the future.
For other doctors it may be motivated by billing. Medicaid and most private insurance plans have predetermined charges for a pap smear, but that have unclear designations for birth control consultations so in order to simplify billing they combine the two services. Doing both at once can also make things more convenient for the patient; requiring only one appointment for various issues instead of individual appointments for each thing.
With the newly released requirements for health insurance coverage this issue could become more relevant than it is now. Since both pap smears and all FDA approved methods of birth control will now be covered without a co-pay, access to these services will be available to more women. For the women who are uncomfortable with the prospect of a pap smear, to the point of skipping prescription birth control or not, it seems doctors really need to uncouple these services. No one should deny themselves their preferred method of contraception because they wish to avoid invasive testing.
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