Editorial examines the need for routine pelvic exams

In new guidelines, the American College of Physicians recommends that doctors stop performing routine pelvic exams for most women. There is no evidence that pelvic exams are effective at detecting diseases like cervical cancer and plenty to suggest that the procedure provokes fear, anxiety and pain in many women, according to the new practice guideline. In an editorial accompanying the new guidelines, UCSF researchers discuss the efficacy of routine pelvic exams and possible reaction among women's health care providers to the new guidelines. The guidelines build on the Bixby Center's longstanding and rigorous research on pelvic exams, cervical cancer and birth control.

The pelvic exam has “held a prominent place in women’s health for many decades and has come to be more of a ritual than an evidence-based practice.” The new recommendations may be “controversial” since the exam has “long been considered a fundamental component” of women’s health visits. For instance, 2012 guidelines from the American College of Obstetricians and Gynecologists continued to recommend annual pelvic exams for all women ages 21 and older, and a recent survey revealed that US Ob-Gyns conduct the exam for the vast majority of patients. “Ending such a prevalent practice with widespread support among women’s health providers will be met with formidable challenges,” according to the authors.

Even if the new recommendations do not change why and how often doctors perform pelvic exams, they should “prompt champions of this examination to clarify its goals and quantify its benefits and harms.” Given current evidence, providers who continue to offer the exam should at least be aware of the “uncertainty of its benefits and its potential to cause harm through false-positive testing and the cascade of events it prompts.


Improving birth control access for women living with HIV

Although contraception is an important preventive health care tool for all women, many women face barriers when trying to access birth control. In particular, HIV-positive women face unique challenges, such as misconceptions among health care providers about what methods are safe. In fact, there are no medical reasons to restrict contraceptive access to women at risk of HIV, and only one class of HIV medications—known as protease inhibitors—may interfere with hormonal contraception.

In order to better understand this issue, researchers with the UCSF Bixby Center surveyed doctors and nurses working in HIV-prevalent areas of South Africa and Zimbabwe. They found that most providers (85%) offered women oral contraceptive pills, but only about a quarter considered the pill appropriate for women with HIV or at risk of HIV. A higher proportion of providers considered injectable contraceptives appropriate for HIV-positive women (46%) or women at risk of HIV (42%). Few providers considered emergency contraception appropriate for women with HIV (13%) or at risk of HIV (16%).

These findings emphasize the urgent need to improve health care providers' knowledge about contraceptive safety, especially among providers caring for HIV-positive women. Integrating family planning and HIV care has already been shown to improve the quality of contraceptive care. Having access to a wide range of birth control options can help women protect their health and wellbeing, and make important decisions about their lives and families.


Bixby program joins global effort to develop HIV/AIDS vaccine

The UCSF Bixby Center's partnership with the University of Zimbabwe (UZ) recently joined a global research effort to develop a safe and effective vaccine to prevent HIV. The program's research site in Chitungwiza, Zimbabwe, is joining the HIV Vaccine Trials Network (HVTN), the world's largest publicly funded international collaboration facilitating the development of HIV vaccines. The U.S. National Institute of Allergy and Infectious Diseases is the network's main sponsor.

The UZ-UCSF site in Chitungwiza will expand to support its growth in HIV vaccine research. This infrastructure development will be complete by 2015, with the first study expected to start in spring 2015. These will be the first ever HIV-related vaccine clinical trials conducted in Zimbabwe.

The UZ-UCSF team is excited to join HVTN's network of clinical research sites at leading research institutions on five continents.

Photo credit: Beth Novey


Women’s social networks influence IUD use

Unintended pregnancy remains a persistent public health issue in the United States. Increased use of effective contraceptives, like intrauterine devices (IUDs), has the potential to reduce unintended pregnancies. Although IUDs are highly effective and rapidly reversible, less than 4% of U.S. women ages 15-44 used this method between 2006 and 2010. Although popular media has described "IUD evangelism" among women using this method, little is known about how women's social networks may influence contraceptive attitudes.

To fill this gap, researchers with the UCSF Bixby Center investigated how information about contraceptives, particularly IUDs, is spread through social networks and how this information influences women's attitudes. They found that: 

  • Women reported communication with female friends and family members was a valued means of obtaining information about contraceptives. 
  • Negative information—which was often factually incorrect—was more common and more memorable than positive information in communication with friends and family. 
  • Social contacts and TV commercials were the main sources of negative information about IUDs; clinicians were the main source of positive information. 
  • Most current or former IUD users had recommended the method to friends or family. Their most common messages were the method's high efficacy and the advantage of not having to remember to take a pill every day.

Women frequently discuss contraception in social settings, and these conversations may influence decisions regarding IUDs. Interventions supporting and encouraging positive and accurate social communication about IUDs may be a promising approach to increase interest in this highly effective method.


Improving post-abortion contraceptive services in Nepal

Since Nepal legalized abortion in 2002, safe abortion services have helped reduce high pregnancy-related complications and deaths. This policy change also created new opportunities to offer women contraception, as women presenting for abortion may also have an unmet need for contraception. Despite these new opportunities, contraceptive use in Nepal has plateaued since 2006, with 43% of married women using modern methods of contraception. On average, women have nearly one child more than desired.

Researchers with the UCSF Bixby Center recently examined the contraceptive information and services Nepalese women receive at an abortion visit. They found that: 

  • Two-thirds of women reported receiving information on at least one effective method at their abortion visit, most commonly injectables (52%) or pills (45%). 
  • Women not currently living with their husband or partner were less likely to receive contraceptive information than women living with husbands (57% vs. 68%). 
  • Women who had never given birth were less likely to receive information than women who had (53% vs. 68%). 
  • Patients at nongovernmental clinics were more likely to receive contraceptive information than women at public hospitals. 
  • Forty-four percent of women received effective contraceptive supplies at their abortion visit, most commonly the injectable (28%) or pills (12%). 
  • However, 48% of women choosing long-acting reversible contraception (LARC) and 83% of those selecting sterilization left the abortion visit without an effective method.

Although considerable progress has been made to provide comprehensive family planning services after abortion, challenges remain. Expanding the range of contraceptive methods discussed would allow more women to obtain an acceptable method. Addressing barriers to immediate post-abortion LARC provision would prevent gaps in protection. Legalization of abortion in Nepal presented an unprecedented opportunity to expand contraceptive access—ongoing efforts to improve contraceptive services will continue to reduce the number of women at risk of unintended pregnancy.