Routine pelvic examinations in women prescribed oral contraceptive pills (OCPs) for acne management are scrutinized to assess their impact on dermatological outcomes versus gynecological health. A synthesis of clinical trials, patient surveys, and medical guidelines reveals that these routine exams do not significantly enhance the effectiveness of acne treatment with OCPs but are linked to increased patient discomfort and false-positive results. Evidence suggests that routine pelvic examinations do not significantly impact the effectiveness of acne management with OCPs but are associated with increased patient discomfort and higher rates of false-positive results. The analysis indicates that a more personalized approach, focusing on selective pelvic examinations based on individual risk factors and clinical symptoms, may offer a more practical and patient-centered alternative. The review advocates for a reexamination of existing guidelines to better align with a model of individualized care, emphasizing the need for further research to optimize best practices at the intersection of dermatological and gynecological care. Adopting a personalized approach to pelvic examinations could substantially improve patient care by minimizing unnecessary interventions and discomfort while maintaining the efficacy of acne treatment with oral contraceptive pills.
References
[1]
Del Rosso, J.Q. and Kircik, L. (2024) The Cutaneous Effects of Androgens and Androgen-Mediated Sebum Production and Their Pathophysiologic and Therapeutic Importance in Acne Vulgaris. Journal of Dermatological Treatment, 35, Article ID: 2298878. https://doi.org/10.1080/09546634.2023.2298878
[2]
Muinovna, K.F. and Kizi, K.F.A. (2024) The Role of Genetic Mutations in the Development of Acne. American Journal of Biomedical Science & Pharmaceutical Innovation, 4, 33-48. https://doi.org/10.37547/ajbspi/volume04issue07-05
[3]
Sun, L., Yu, Q., Peng, F., Sun, C., Wang, D., Pu, L., et al. (2024) The Antibacterial Activity of Berberine against Cutibacterium Acnes: Its Therapeutic Potential in Inflammatory Acne. Frontiers in Microbiology, 14, Article 1276383. https://doi.org/10.3389/fmicb.2023.1276383
[4]
Ryguła, I., Pikiewicz, W. and Kaminiów, K. (2024) Impact of Diet and Nutrition in Patients with Acne Vulgaris. Nutrients, 16, Article 1476. https://doi.org/10.3390/nu16101476
[5]
Grandi, G., Guariglia, G. and Facchinetti, F. (2023) The Role of Combined Oral Contraceptives Containing Norgestimate for Acne Vulgaris Treatment: A Review. The European Journal of Contraception & Reproductive Health Care, 28, 184-191. https://doi.org/10.1080/13625187.2023.2197539
[6]
Jaisamrarn, U., Chaovisitsaree, S., Angsuwathana, S. and Nerapusee, O. (2014) A Comparison of Multiphasic Oral Contraceptives Containing Norgestimate or Desogestrel in Acne Treatment: A Randomized Trial. Contraception, 90, 535-541. https://doi.org/10.1016/j.contraception.2014.06.002
[7]
Zhang, G.Y., Lin, T. and Sun, Q.N. (2015) An Oral Contraceptive Containing Ethinyl Estradiol and Drospirenone for the Treatment of Women with Moderate Acne Vulgaris: A Randomized, Multicenter, Placebo-Controlled Clinical Trial. Chinese Journal of Dermatology, 48, 85-89.
[8]
Fitzpatrick, L., Mauer, E. AND Chen, C.L. (2017) Oral Contraceptives for Acne Treatment: US Dermatologists’ Knowledge, Comfort, and Prescribing Practices. Cutis, 99, 195-201. https://pubmed.ncbi.nlm.nih.gov/28398414/
[9]
Lutfi Rahmawati, D., Rahayu, D.E. and Hardjito, K. (2023) Correlation between Oral Contraceptive Use and the Incidence of Cervical Cancer. Poltekita: JurnalIlmu Kesehatan, 16, 497-504. https://doi.org/10.33860/jik.v16i4.1285
[10]
Guo, C., Zhan, B., Li, M., Yue, L. and Zhang, C. (2024) Association between Oral Contraceptives and Cervical Cancer: A Retrospective Case-Control Study Based on the National Health and Nutrition Examination Survey. Frontiers in Pharmacology, 15, Article 1400667. https://doi.org/10.3389/fphar.2024.1400667
[11]
La Vecchia, C. and Boccia, S. (2014) Oral Contraceptives, Human Papillomavirus and Cervical Cancer. European Journal of Cancer Prevention, 23, 110-112. https://doi.org/10.1097/cej.0000000000000000
[12]
Sharma, K., Venkadalakshmi, V., Dhandapani, M., Gainder, S. and Singh, T. (2024) Assessment of Anxiety and Stress among Women Undergoing Hysterosalpingography in a Nehru Hospital, PGIMER, Chandigarh. Nursing & Midwifery Research Journal, 20, 124-128. https://doi.org/10.1177/0974150x241249253
[13]
Lee, J.M.-., Tan, T.Y., Chua, C.S.L., Cheong, X., Goy, R.W.L., Ang, S.B., et al. (2022) A Qualitative Study of Patients’ Experience during Vaginal Examination & Transvaginal Ultrasound in a Tertiary Hospital in Singapore. The Journal of Sexual Medicine, 19, S98-S98. https://doi.org/10.1016/j.jsxm.2022.10.134
[14]
Lin, M., Narkcham, S., Jones, A., Armylagos, D., DiPietro, B., Okafor, O., et al. (2022) False-Negative Papanicolaou Tests in Women with Biopsy-Proven Invasive Endocervical Adenocarcinoma/Adenocarcinoma in Situ: A Retrospective Analysis with Assessment of Interobserver Agreement. Journal of the American Society of Cytopathology, 11, 3-12. https://doi.org/10.1016/j.jasc.2021.08.001
[15]
Shafer, M.-. (2001) How Good Is the Pelvic Examination, and Is It Being Upstaged by Newer Technologies? Western Journal of Medicine, 175, 244-245. https://doi.org/10.1136/ewjm.175.4.244
[16]
Millstein, S.G., Adler, N.E. and Irwin, C.E. (1984) Sources of Anxiety about Pelvic Examinations among Adolescent Females. Journal of Adolescent Health Care, 5, 105-111. https://doi.org/10.1016/s0197-0070(84)80008-x
[17]
Reynolds, R.V., Yeung, H., Cheng, C.E., Cook-Bolden, F., Desai, S.R., Druby, K.M., et al. (2024) Guidelines of Care for the Management of Acne Vulgaris. Journal of the American Academy of Dermatology, 90, 1006.e1-1006.e30. https://doi.org/10.1016/j.jaad.2023.12.017
[18]
Santer, M., Burden-Teh, E. and Ravenscroft, J. (2023) Managing Acne Vulgaris: An Update. Drug and Therapeutics Bulletin, 62, 6-10. https://doi.org/10.1136/dtb.2023.000051
[19]
Skiba, M.A., Bell, R.J., Islam, R.M., Handelsman, D.J., Desai, R. and Davis, S.R. (2019) Androgens during the Reproductive Years: What Is Normal for Women? The Journal of Clinical Endocrinology & Metabolism, 104, 5382-5392. https://doi.org/10.1210/jc.2019-01357
[20]
Darney, P.D. (1995) The Androgenicity of Progestins. The American Journal of Medicine, 98, S104-S110. https://doi.org/10.1016/s0002-9343(99)80067-9
[21]
Stalas, J., Morris, R., Bu, K., von Bargen, K., Largmann, R., Sanford, K., et al. (2024) Comparing the Risk of Deep Vein Thrombosis of Two Combined Oral Contraceptives: Norethindrone/ethinyl Estradiol and Drospirenone/Ethinyl Estradiol. Heliyon, 10, e26462. https://doi.org/10.1016/j.heliyon.2024.e26462
[22]
Lortscher, D., Admani, S., Satur, N. and Eichenfield, L.F. (2016) Hormonal Contraceptives and Acne: A Retrospective Analysis of 2147 Patients. Journal of Drugs in Dermatology: JDD, 15, 670-674. https://pubmed.ncbi.nlm.nih.gov/27272072/
[23]
de Gooyer, M.E., Deckers, G.H., Schoonen, W.G.E.J., Verheul, H.A.M. and Kloosterboer, H.J. (2003) Receptor Profiling and Endocrine Interactions of Tibolone. Steroids, 68, 21-30. https://doi.org/10.1016/s0039-128x(02)00112-5
[24]
Arowojolu, A.O., Gallo, M.F., Lopez, L.M. and Grimes, D.A. (2012) Combined Oral Contraceptive Pills for Treatment of Acne. The Cochrane Database of Systematic Reviews, No. 7, CD004425. https://doi.org/10.1002/14651858.CD004425.pub6
[25]
Thiboutot, D., Archer, D.F., Lemay, A., Washenik, K., Roberts, J. and Harrison, D.D. (2001) A Randomized, Controlled Trial of a Low-Dose Contraceptive Containing 20 μg of Ethinyl Estradiol and 100 μg of Levonorgestrel for Acne Treatment. Fertility and Sterility, 76, 461-468. https://doi.org/10.1016/s0015-0282(01)01938-0
[26]
Koo, E.B., Petersen, T.D. and Kimball, A.B. (2014) Meta-analysis Comparing Efficacy of Antibiotics versus Oral Contraceptives in Acne Vulgaris. Journal of the American Academy of Dermatology, 71, 450-459. https://doi.org/10.1016/j.jaad.2014.03.051
[27]
Alderton, I., Palmer, B.R., Heinemann, J.A., Pattis, I., Weaver, L., Gutiérrez-Ginés, M.J., et al. (2021) The Role of Emerging Organic Contaminants in the Development of Antimicrobial Resistance. Emerging Contaminants, 7, 160-171. https://doi.org/10.1016/j.emcon.2021.07.001
[28]
Stewart, F.H., Harper, C.C., Ellertson, C.E., Grimes, D.A., Sawaya, G.F. and Trussell, J. (2001) Clinical Breast and Pelvic Examination Requirements for Hormonal Contraception. JAMA, 285, 2232-2239. https://doi.org/10.1001/jama.285.17.2232
[29]
American College of Obstetricians and Gynecologists (2019) Over-the-Counter Access to Hormonal Contraception (Committee Opinion No. 788). Obstetrics & Gynecology, 134, e96-e105. https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2019/10/over-the-counter-access-to-hormonal-contraception
[30]
Qin, J., Saraiya, M., Martinez, G. and Sawaya, G.F. (2020) Prevalence of Potentially Unnecessary Bimanual Pelvic Examinations and Papanicolaou Tests among Adolescent Girls and Young Women Aged 15-20 Years in the United States. JAMA Internal Medicine, 180, 274-280. https://doi.org/10.1001/jamainternmed.2019.5727
[31]
Bloomfield, H.E., Olson, A., Cantor, A., et al. (2013) Screening Pelvic Examinations in Asymptomatic Average Risk Adult Women. Department of Veterans Affairs (US). https://www.ncbi.nlm.nih.gov/books/NBK224896/
[32]
George, R., Clarke, S. and Thiboutot, D. (2008) Hormonal Therapy for Acne. Seminars in Cutaneous Medicine and Surgery, 27, 188-196. https://doi.org/10.1016/j.sder.2008.06.002
[33]
Weitlauf, J.C., Finney, J.W., Ruzek, J.I., Lee, T.T., Thrailkill, A., Jones, S., et al. (2008) Distress and Pain during Pelvic Examinations. Obstetrics & Gynecology, 112, 1343-1350. https://doi.org/10.1097/aog.0b013e31818e4678
[34]
Qaseem, A., Humphrey, L.L., Harris, R., Starkey, M. and Denberg, T.D. (2014) Screening Pelvic Examination in Adult Women: A Clinical Practice Guideline from the American College of Physicians. Annals of Internal Medicine, 161, 67-72. https://doi.org/10.7326/m14-0701
[35]
Boyer, S.C. and Pukall, C.F. (2014) Pelvic Examination Experiences in Women with and without Chronic Pain during Intercourse. The Journal of Sexual Medicine, 11, 3035-3050. https://doi.org/10.1111/jsm.12701
[36]
Tancman, S., HaCohen, N., Lazarus, G., Solt, I. and Sagi-Dain, L. (2021) Silent Voices That Must Be Heard—Women’s Perceptions of Gynecologic Examinations. Journal of Psychosomatic Obstetrics & Gynecology, 43, 190-197. https://doi.org/10.1080/0167482x.2020.1864727
[37]
Yanikkerem, E., Özdemir, M., Bingol, H., Tatar, A. and Karadeniz, G. (2009) Women’s Attitudes and Expectations Regarding Gynaecological Examination. Midwifery, 25, 500-508. https://doi.org/10.1016/j.midw.2007.08.006
[38]
Oscarsson, M. and Benzein, E. (2002) Women’s Experiences of Pelvic Examination: An Interview Study. Journal of Psychosomatic Obstetrics & Gynecology, 23, 17-25. https://doi.org/10.3109/01674820209093411
American College of Obstetricians and Gynecologists (2018) ACOG Committee Opinion No. 755: Well-Woman Visit. Obstetrics & Gynecology, 132, e181-e186. https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2018/10/well-woman-visit
[41]
Zari, S. and Turkistani, A. (2017) Acne Vulgaris in Jeddah Medical Students: Prevalence, Severity, Self-Report, and Treatment Practices. Journal of Cosmetics, Dermatological Sciences and Applications, 7, 67-76. https://doi.org/10.4236/jcdsa.2017.71007
[42]
Hellman, J. (2015) Retrospective Study of the Use of a Fractional Radio Frequency Ablative Device in the Treatment of Acne Vulgaris and Related Acne Scars. Journal of Cosmetics, Dermatological Sciences and Applications, 5, 311-316. https://doi.org/10.4236/jcdsa.2015.54038
[43]
American College of Obstetricians and Gynecologists (2018) The Utility of and Indications for Routine Pelvic Examination (Committee Opinion No. 754). https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2018/10/the-utility-of-and-indications-for-routine-pelvic-examination
[44]
Kim, J.Y., Martin, A., Stuparich, M. and Dao, H. (2022) Total Body Skin Exams: The Role of Gynecology and Dermatology—A Cross-Sectional Study. Dermatology Online Journal, 28, Article 3. https://doi.org/10.5070/d328357782
[45]
Henderson, J.T., Sawaya, G.F., Blum, M., Stratton, L. and Harper, C.C. (2010) Pelvic Examinations and Access to Oral Hormonal Contraception. Obstetrics & Gynecology, 116, 1257-1264. https://doi.org/10.1097/aog.0b013e3181fb540f
[46]
Holt, H.K., Sawaya, G.F., El Ayadi, A.M., Henderson, J.T., Rocca, C.H., Westhoff, C.L., et al. (2020) Delayed Visits for Contraception Due to Concerns Regarding Pelvic Examination among Women with History of Intimate Partner Violence. Journal of General Internal Medicine, 36, 1883-1889. https://doi.org/10.1007/s11606-020-06334-8
[47]
Scott, A. and Glasier, A.F. (2004) Are Routine Breast and Pelvic Examinations Necessary for Women Starting Combined Oral Contraception? Human Reproduction Update, 10, 449-452. https://doi.org/10.1093/humupd/dmh031