• Hunter K Holt, George F Sawaya, Alison M El Ayadi, Jillian T Henderson, Corinne H Rocca, Carolyn L Westhoff, and Cynthia C Harper.
• Department of Family and Community Medicine, University of California, San Francisco, CA, USA. Hunter.Holt@ucsf.edu.
• J Gen Intern Med. 2021 Jul 1; 36 (7): 188318891883-1889.

BackgroundConcern regarding pelvic examinations may be more common among women experiencing intimate partner violence.ObjectiveWe examined women's attitudes towards pelvic examination with history of intimate partner violence (pressured to have sex, or verbal, or physical abuse).DesignSecondary analysis of data from a cluster randomized trial on contraceptive access.ParticipantsWomen aged 18-25 were recruited at 40 reproductive health centers across the USA (2011-2013).Main MeasuresDelays in clinic visits for contraception and preference to avoid pelvic examinations, by history of ever experiencing pressured sex, verbal, or physical abuse from a sexual partner, reported by frequency (never, rarely, sometimes, often). We used multivariable logistic regression with generalized estimating equations for clustered data.Key ResultsA total of 1490 women were included. Ever experiencing pressured sex was reported by 32.4% of participants, with 16.5% reporting it rarely, 12.1% reporting it sometimes, and 3.8% reporting it often. Ever experiencing verbal abuse was reported by 19.4% and physical abuse by 10.2% of participants. Overall, 13.2% of participants reported ever having delayed going to the clinic for contraception to avoid having a pelvic examination, and 38.2% reported a preference to avoid pelvic examinations. In multivariable analysis, women reporting that they experienced pressured sex often had significantly higher odds of delaying a clinic visit for birth control (aOR 3.10 95% CI 1.39-6.84) and for reporting a preference to avoid pelvic examinations (aOR 2.91 95% CI 1.57-5.40). We found no associations between delay of clinic visits or preferences to avoid a pelvic examination and verbal or physical abuse.ConclusionsHistory of pressured sex from an intimate partner is common. Among women who have experienced pressured sex, concern regarding pelvic examinations is a potential barrier to contraception. Communicating that routine pelvic examinations are no longer recommended by professional societies could potentially reduce barriers and increase preventive healthcare visits.© 2020. Society of General Internal Medicine.

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