Written by Amanda Pisciotta
Edited by Samantha Cavusoglu
Listening to Women's Pain
Have you or anyone you know undergone an IUD (intrauterine device) insertion? Reflect on the experience. If pain was a significant aspect, you're not alone. Lately, there's been a crucial dialogue in the media about women's pain, particularly concerning IUD insertions. While doctors and medical professionals are the experts, only you truly understand your pain threshold. With numerous individuals reporting intense pain during this procedure, it is time we start listening.
What is an IUD and How is it Inserted?
An intrauterine device, or IUD, is a small T-shaped form of birth control that is inserted through the vagina and cervix into the uterus, usually in your healthcare provider's office[1]. The purpose is to prevent pregnancy or alleviate menstrual symptoms like heavy bleeding or pain. The insertion process typically takes about 5 to 10 minutes, similar to a gynecological exam[2]. You'll lie on your back with feet on footrests and a drape covering your body[2]. The provider uses a speculum to hold the vagina open and cleans the area with an antiseptic solution[2]. Then, a pelvic exam is done to assess the size, shape, and position of the uterus and ovaries, using a tool called a "medical sound" to ensure the IUDs safe placement. The IUD, around 1 ¼ inches long, is inserted into the uterus through a tube, guided by the sound. Once in place, the arms of the IUD open into a "T" shape, and the tools are removed[2]. Some may experience cramping, pinching sensations, or dizziness during insertion, but serious reactions are said to be rare and do not affect the IUDs performance[1].
How Common Are IUDs?
IUDs rank as the second most popular reversible birth control method worldwide, following birth control pills. Globally, approximately 23% of individuals using contraception opt for IUDs[3]. In the United States, IUD usage surged from 2% to 14% between 2002 and 2014[3]. They offer a convenient and highly effective option for long-term birth control, ideal for those seeking alternatives to daily pills or requiring non-hormonal choices with a 99% efficacy in preventing pregnancy[3,4].
Moreover, beyond contraception, IUDs serve as effective treatments for reducing cramps and lightening periods, with some individuals experiencing cessation of menstruation altogether[5]. Hormonal IUDs prove beneficial in alleviating severe cramps, heavy periods, and anemia, offering relief for those with endometriosis—a condition characterized by uterine tissue growth outside the uterus, leading to pelvic pain and fertility challenges. These devices can reduce endometriosis lesions, alleviate pelvic pain, and inflammation[5,6,7].
Despite the evident advantages of IUD usage, why do fewer young women opt for them? Fear of insertion pain stands as a significant deterrent, compounded by the wide variability in pain tolerance among patients, making it challenging for doctors to reassure potential recipients—especially if patients feel their concerns aren't adequately addressed by medical professionals.
Common Insertion Experiences
While physicians often describe IUD insertion as causing "some cramping or pain," typically deemed as bearable, the reality reported by patients starkly contrasts this depiction[8]. Many women recount the experience as "one of the most traumatic physical experiences" they've endured, with some even fainting during insertion without receiving anesthesia[9]. A 2022 study scanning TikTok for the top 100 videos with the hashtag #IUD revealed that nearly all—97 percent—highlighted the pain and negative side effects experienced during the procedure[10].
Despite physicians downplaying the pain, patient accounts suggest otherwise. Why, then, do medical professionals and we as a society, accept the notion that women should endure such pain? Why is it more common for physicians to dismiss or gaslight patients' pain rather than taking proactive steps to prevent it?
Why Do Women Experience Pain
While many insurance plans cover the cost of the IUD itself, anesthesia or sedation during the insertion procedure is often not covered. Even if a physician deems it necessary, insurance may still deny coverage, with only 4% of women being offered or informed about this option[11]. Instead, patients are typically advised to take over-the-counter medications like Tylenol or ibuprofen to manage pain during the procedure[11]. However, numerous studies have found these medications to be ineffective in alleviating pain during IUD insertion[11].
The Benefits of Anesthesia for Insertion
Although the medical field often deems pain from IUD insertion as bearable and an unnecessary cause for anesthesia, there are proven benefits for both patients and providers with its use. While initial attempts at placing IUDs are typically successful, some placements may cause pain for the patient or present technical challenges for the provider[12]. Implementing effective approaches to reduce patient pain, such as anesthesia, can enhance physicians' ability to successfully place the IUD[12]. Additionally, it can help diminish barriers to IUD access and broaden patient access to comprehensive contraceptive options. This approach aligns with promoting reproductive autonomy and fostering equitable contraceptive care.
Conclusion
While this discussion aims not to dissuade individuals from attending routine checks, undergoing IUD/IUS fittings, or hysteroscopies, it's crucial to acknowledge that many women are not offered sufficient pain relief options if they desire them. As a society, we must advocate for women to be fully informed and engage in conversations about pain relief before any gynecological procedure. Pain relief options may include local anesthetic, naproxen spray, gas and air, sedation, and muscle relaxants. Although physicians are highly skilled, they should revisit their foundational training in patient care and attentively address the concerns and complaints their patients express about gynecological procedure-related pain. The aim should be to alleviate this pain and shift the discourse away from normalizing it for women or assigned women at birth, instead of dismissing their experiences.
References:
Stacey, Dawn. “What to Expect During an IUD? The Steps for Intrauterine Device Placement.” Very Well Health. Last modified, 07 July. 2023, https://www.verywellhealth.com/what-to-expect-during-an-iud-insertion-906772
“Hormonal Intrauterine Device (IUD) Insertion.” Nationwide Children’s. Last Accessed, 12 March. 2024, https://www.nationwidechildrens.org/family-resources-education/health-wellness-and-safety-resources/helping-hands/hormonal-intrauterine-device-insertion#:
“Intrauterine Device (IUD).” Cleveland Clinic. Last modified, 13 November. 2022, https://my.clevelandclinic.org/health/treatments/24441-intrauterine-device-iud
“Contraception - intrauterine devices (IUD).” Better Health Channel. Last Accessed, 12 March. 2024, https://www.betterhealth.vic.gov.au/health/healthyliving/contraception-intrauterine-devices-iud#
“What are the benefits of IUDs?” Planned Parenthood. Last Accessed, 12 March. 2024, https://www.plannedparenthood.org/learn/birth-control/iud/what-are-the-benefits-of-iuds#:~:text=Hormonal%20IUDs%20(Mirena%2C%20Kyleena%2C,really%20heavy%20periods%2C%20and%20anemia.
“Endometriosis.” World Health Organization. Published, 24 March. 2023, https://www.who.int/news-room/fact-sheets/detail/endometriosis#:~:text=Endometriosis%20is%20a%20disease%20in,period%20and%20last%20until%20menopause.
“The IUD for endometriosis.” Health Cert Education. Last Accessed, 12 March. 2024, https://www.healthcert.com/blog/iud-endometriosis#:~:text=Oestrogen%20and%20progesterone%20in%20the,ease%20pelvic%20pain%20and%20inflammation
“What's an IUD insertion like?” Planned Parenthood. Last Accessed, 12 March. 2024, https://www.plannedparenthood.org/learn/birth-control/iud/whats-an-iud-insertion-like#:~:text=How%20does%20it%20feel%20to,IUD%20to%20help%20prevent%20cramps.
Wade, Prudence. “Ask a doctor: Why aren’t women generally offered anesthetic when getting the coil fitted?” Independent. Published 22 June. 2021, https://www.independent.co.uk/life-style/health-and-families/iud-naga-munchetty-bbc-radio-5-live-caitlin-moran-lucozade-b1870499.html
Wu, Jenny. “TikTok, #IUD, and User Experience With Intrauterine Devices Reported on Social Media” NIH: National Library of Medicine. Published 5 December. 2022, https://pubmed.ncbi.nlm.nih.gov/36473194/
Gupta, Alisha H. “Getting an IUD Hurts. Why Aren’t More Women Offered Relief?” The New York Times. Published 14 December. 2023, https://www.nytimes.com/2023/12/14/well/live/iud-insertion-pain-relief.html
Zapata, Lauren. “Local anesthetics for intrauterine device placement.” NIH: National Library of Medicine. Published 24 October. 2022, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9589724/