Why Is Pain Relief Not Offered For IUD Insertion?
When it comes to matters of not getting pregnant, that most birth control options are accompanied by at least one negative side effect is almost a given; choosing contraceptives can feel like a case of picking the best of a bad bunch. Such as IUD (intrauterine device). Lasting for five to 10 years with an over 99% protection rate, the appeal is obvious, hence it is one of the most popular options for birth control that comes highly recommended by doctors. However, while medical professionals have long sung the praises of the little T-shaped device, the silence around the physical pain women suffer during – and after – the IUD insertion process has been deafening. Now, after years of quietly enduring the pain, it has recently become a point of contention in online spaces such as TikTok. Users are sharing their – often quite distressing – experiences. The key question is, why is pain relief not offered for IUD insertion?
IUDs are available in two main formats: hormonal and copper. Most insertions roughly follow the same sequence: insertion of the speculum (a metal or steel contraption in the shape of a duckbill, used by gynaecologists to widen the vagina walls, making it easier to examine), cervical clamping, measuring of the womb, insertion of device and trimming of the strings. Gynaecologist Dr Staci Tanouye explains that the process “usually only takes about two minutes”. Simple right? In theory, yes. It is a relatively quick procedure but not a pain-free one; the so-called ‘quick pinch’ of the cervical clamping is essentially two needles piercing the flesh of the cervix, and having the womb measured by a plastic rod and the foreign device subsequently inserted is, for many women, followed by intense period-pain-like cramps.
As someone who has had the pleasure of two insertions, I can attest to the pain. While I managed to walk home from both of my procedures, it was quite the endurance. My first insertion came with an audience. The room consisted of a nurse, a student doctor, a doctor and my boyfriend at the time. Interestingly, everyone seemed more concerned about my boyfriend’s wellbeing, debating whether he should stay in the room or whether he would faint, as I lay there anxious and with my legs akimbo. (Perhaps the concern for his tolerance is unsurprising when you consider that most pain relief treatments are trialled on men and thus cater to men.) This insertion itself was very uncomfortable – it felt like severe period cramps – but not unbearable. The second insertion followed a removal and was much more painful. As the doctor clamped my cervix I tensed up and the pain was excruciating. My breathing quickened, I felt dizzy, and tears quickly formed in my eyes. My doctor was extremely sympathetic and gave me some time to gather myself. Still, it was not going to happen – my cervix said ‘no’. So, she signalled to the nurse to get the local anaesthetic. I got an injection into my cervix (always fun) and the searing pain I felt vanished. Then, off I hobbled home, somewhat dazed and sore.
Sadly, my experience was not unique. Registered nurse Alex Waters described her IUD insertion as “the most painful experience ever,” which was followed by three days relegated to the sofa for recovery. My experience differed in that I was given a local anaesthetic. Pain relief was not offered to Waters. “I wish I’d known to take some painkillers beforehand or gone to someone who could have helped me,” she says. Dr Tanouye agrees that some degree of pain relief should be standard. “Pain control should definitely be a discussion prior to every insertion. What [medical professionals] need to do is have this discussion [with the patient] ahead of time so they can make an informed and individualised decision.”
So, why isn’t pain relief guaranteed for IUD insertion? The difficulty, explains Dr Tanouye, is that pain is subjective, hence it is impossible to offer one standardised form of pain relief. “The pain of the cervix and uterus is very complex; there is a huge range of pain that is experienced – from none to severe. Studies have shown that most report the pain to be no worse than a period cramp, but there will always be people with less or more pain than the average. There are multiple nerves that innervate the cervix and uterus and even here there is a variation from person to person. So while many different pain-control options have been studied, none have consistently shown improvement.” While the argument around the subjectivity of pain is valid (my own experiences of IUD fittings differing in pain levels attests to this), making it difficult to decide on an appropriate level of pain relief, if the conversations with women around IUDs are anything to go by, there still isn’t an adequate amount of communication taking place around tailoring pain relief to a woman’s needs.
Hence activists and healthcare providers championing women’s health are stepping in. One example of change is the US-based service Tia, which is creating ‘a new standard of care for women’. Providing treatments for everything from mental health to hormone disorders, Tia also offers insertion and removal of IUDs and is pioneering acupuncture as an option for pain relief as part of the treatment. In the UK, in 2021, Lucy Cohen created a petition on Change.org to advocate for better pain relief for IUD insertions and removals after her own excruciating insertion; the petition has since amassed over 35,000 signatures. This rise of women taking to online spaces to share their stories, campaign and spread awareness has finally brought the issue of women’s pain to the forefront; the growing number of first-hand accounts has finally led the medical sector to openly acknowledge the issue. The Faculty of Sexual and Reproductive Healthcare (FSRH) and the Royal College of Obstetricians and Gynaecologists (RCOG) released a statement in 2021 with the president of the RCOG Dr Edward Morris stating, “It is very distressing to hear about the experiences of pain some women have suffered having the contraceptive coil fitted. We believe that unbearable pain during any gynaecological procedure is unacceptable and all specialists working in women’s health; specialist nurses, GPs and gynaecologists need to listen and take account of what is being said.” A welcome step but is it enough to obliterate the issue of women’s pain being ignored? Not so fast says Dr Tanouye. “Historically, this has been a problem in all [areas] of medicine [this issue is particularly acute when it comes to women of colour]. And while we are getting better at recognising and understanding women’s pain, we still have a long way to go.”
Georgia Moot is a model and writer, based between London and New York. Georgia has written for British Vogue, Refinery29, Browns fashion and Dazed