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Plan B Needs a Doctor
Over-the-counter sale of the morning-after pill puts teens and preteens at risk.


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Marc Siegel

How many parents think it’s okay for a twelve-year-old girl to have unprotected sex and then decide on her own to follow it up with the morning-after pill? If you find any parents like this, please contact social services right away — until recently, their daughter’s doctor could at least have stopped a twelve-year-old from using the morning-after pill regularly, as a form of birth control, because a prescription was required.

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Ignoring the essential role of a physician in treating teenagers and dispensing active chemicals is the major problem with unrestricted over-the-counter use of the morning-after pill for all ages, a policy that a federal judge in Brooklyn, Edward R. Korman, has now approved. (The pill was first made nonprescription for those 18 and older, until a ruling by the same judge lowered the limit to 17.) Most doctors believe all females who are sexually active should visit a gynecologist regularly to screen them for HPV and other sexually transmitted diseases. It is especially important to begin screening the youngest females. It is during these visits that a gynecologist can openly discuss the reasons the preteen is sexually active, who the partners are, and the need for condom use. If necessary, the doctor can also authorize a supply of morning-after pills while explaining more effective ways of birth control.

Since the morning-after pill, Plan B One-Step and its generic counterparts, disrupts the menstrual cycle, it increases the likelihood that a young teen will become pregnant and not know it. It can cause significant bleeding if the drug is used to excess. This is particularly problematic in a young woman who is likely to have irregular menstrual periods to begin with. A good doctor can monitor these side effects and advise the patient on how to treat them.

A gynecologist is considered a primary-care provider, which means that he or she may be the only doctor that a woman sees. At a time when doctors are being replaced more and more by pharmacists and physicians’ assistants, it is important to remember what the main role of a physician really is. The doctor-patient relationship involves knowing your patient and offering her treatments to fit her specific needs. A good doctor knows how responsible her patient is, what the risks of taking a drug are, and whether a medication such as the morning-after pill is being used appropriately for an unexpected emergency or is actually encouraging more reckless sex and promiscuity.

The idea that obtaining a prescription slows down the process unnecessarily for a young woman in trouble is not sufficient justification for cutting doctors out of the loop. The same specious argument could be used for making antibiotics available over the counter, as they are in Europe. How many wounds or sore throats go untreated in the U.S. because of the wait to see your doctor? But how many cases of C. difficile diarrhea or anaphylactic shock would be caused if antibiotics were too easy to come by and no one was monitoring their effects?

Even though recent studies have shown that most young teens use Plan B only when medically appropriate, for those who don’t, or for those who develop vomiting or cramping or excess bleeding from its use, a doctor needs to be there. A young teen is even more likely to have difficulties handling these side effects than is an older woman.

Depersonalizing medicine and sex is the problem, not the solution.

— Marc Siegel is an associate professor of medicine at New York University and medical director of Doctor Radio at NYU Langone Medical Center. He is a Fox News medical contributor and author of The Inner Pulse: Unlocking the Secret Code of Sickness and Health.



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