Facilitating gynecological examination and long acting reversible contraception for women with substance use disorder: a prospective cohort study.

Background: Women with substance use disorder (SUD) face a higher risk of sexual assault, abuse, cervical premalignant lesions, and unplanned pregnancy compared to the general female population. To meet the specific needs of this vulnerable group, we established a comprehensive gynecological service. The study aimed to describe the characteristics of women with SUD who accessed these services. Furthermore, we evaluated their cervical cytology and sexually transmitted infections (STIs) test results, preferred contraceptive methods, and the overall acceptability of the service.

Methods: We enrolled 48 women undergoing outpatient or inpatient treatment for SUD in the South-Trøndelag region of Norway in the study. Each women received a comprehensive gynecological anamnesis, including a history of sexual assault, followed by a gynecological examination at the outpatient clinic of the Department of Obstetrics and Gynecology. The examination included ThinPrep Tests and microbiological swabs. They were also offered contraception options, with an emphasis on Long Acting Reversible Contraceptives (LARC), at no cost. Participants provided feedback on the service immediately after their consultation and again six months later.

Results: Nearly two-thirds (63%) of the women with a mean age 31.8, reported a history of sexual assault. One in three (33%) had cervical cytology or human pappilomavirus (HPV) test results necessitating treatment or follow-up, though no cases of sexually transmitted infections were found. Two thirds (66%) of eligible women chose LARC as their contraceptive method. Among the 23 women reached for a follow-up phone call six months later, all expressed high level of satisfaction with the service and indicated they would recommend it to other women in similar situations.

Conclusions: An integrated, specialized gynecological service that provides cervical testing and contraceptive counselling can effectively reach women receiving outpatient or inpatient treatment for SUD, who typically fail to follow-up routine women's health screening programmes. If implemented, this approach has the potential to reduce unplanned pregnancies and improve early detection of cervical pathology in this vulnerable population.