DEKYAS NEWS World Breaking News and Trusted Source
Related Articles
Federal officials confirmed this month that the pain people can feel when getting an IUD may be more than doctors’ promises of “just a prick.”
The local anesthetic lidocaine “may be useful in reducing patient pain” during IUD insertion, according to new guidelines from the U.S. Centers for Disease Control and Prevention. Doctors are also being encouraged to talk to patients about pain management.
Women have taken to social media to call for more pain management options, even sharing videos of themselves grimacing, screaming and crying as IUDs were inserted.
But complaints about pain are not limited to the small, durable contraceptive.
Many relatively quick outpatient procedures can be painful, including biopsies and exams of the uterus and cervix. Gynecologists and patients say there needs to be more conversations about local anesthetic options, as well as other pain-relieving options for these procedures.
What are the options for pain management?
Lidocaine spray or gel used as a local anesthetic and other pain treatments (think ibuprofen or an injection of anesthetic) are safe for most patients and can be effective, gynecologists say.
The CDC’s new guidance is just that — not a hard and fast rule. And American College of Obstetricians and Gynecologists spokeswoman Rachel Kingery said in an emailed statement that there is no timeline for the group to issue clearer guidelines on pain management for in-office procedures.
All of Dr. Cheruba Prabakar’s patients who receive an IUD also receive, at a minimum, a local anesthetic spray.
The owner of Lamorinda Gynecology and Surgery in Lafayette, California, near Oakland, also books patients for 45-minute appointments, where she can answer their questions and discuss their concerns in depth.
Some practices offer even stronger options. In March, after requests from their patients, Planned Parenthood League of Massachusetts added sedation options for IUD placements and certain procedures where doctors are ruling out possible cancers. Patients aren’t fully asleep, but they are drowsy.
Receive weekly health news
Receive the latest medical news and health information every Sunday.
Dr. Luu Ireland, an obstetrician-gynecologist at the Planned Parenthood League of Massachusetts and UMass Memorial Hospital, said there are milder pain medications available, including anti-anxiety pills and local anesthetics.
“I can’t tell you how many patients I’ve seen who chose less effective methods of birth control or stopped using birth control altogether because they were afraid of having the procedure,” she said of IUDs.
Prabakar believes the biggest barrier to more patients getting their pain taken seriously isn’t cost or equipment. It’s time and trust.
“There are a lot of patients who have a history of trauma, a history of embarrassment,” said Prabakar, who is an adviser to the Alliance for Women’s Health and Prevention. “They can barely tolerate a speculum, let alone some of these other procedures.”
Gynecology students should be taught from day one about how trauma affects patients, said Dr. Deborah Bartz, an obstetrician-gynecologist at Brigham and Women’s Hospital who also teaches at Harvard Medical School.
She said that this could include looking at the extent to which fear and trauma can influence the pain a patient experiences at the gynecologist’s office. It could also be that people who have never given birth are at greater risk of experiencing pain during these types of visits.
Research shows that health care providers frequently underestimate the pain of inserting an IUD. Women of color are less likely to have their pain taken seriously by health care providers; extensive research shows that Black people are treated for pain less often than white patients.
“If women have been pain-free since childhood, they may be more vulnerable to trauma in the health care setting,” said Kate Nicholson, executive director of the National Pain Advocacy Center, a nonprofit that focuses on policy change.
When guidelines – or gynecologists – fall short, it may be up to the patient to speak up.
“(In obstetrics and gynecology) there’s this culture of, ‘Women are strong. We can do this without painkillers.’ But why? How come?” said Sarah Friedberg, a Massachusetts mother of three who experienced pain at the gynecologist’s office for the first time since getting an IUD 20 years ago — despite taking an over-the-counter painkiller.
Friedberg’s periods had always been exceptionally heavy, and after giving birth to three children, her doctors recommended that she have her uterus removed. In August 2022, she went to the hospital to have blood work and other tests done in preparation for a hysterectomy. A doctor said they needed to take some tissue samples from her uterus.
This was the first time she had heard that a biopsy was needed, and she had not taken anything for the pain beforehand. Friedberg said no and that she had to reschedule.
“I’m someone who, if I don’t like the nail polish they’re wearing, I would never say, ‘Let’s not do that,’ or ‘This is wrong,’ or ‘I want something different,'” Friedberg said. “I don’t want to make a splash in general.”
She read about what the biopsy generally entailed. She read about an option online — lidocaine spray — and asked her doctor about it. It took some searching, but her doctor found a few.
Her plea paid off. She was not in extreme pain.
Friedberg hopes the updated CDC guidelines will ensure that women — and their daughters, when the time comes — have a different experience at the gynecologist.
“But it’s very, very late,” she said. “It’s 2024. Come on, guys.”
What questions can you ask the gynecologist?
— What are my options for pain management? They will likely tell you one of three levels: oral (ibuprofen), local anesthesia (lidocaine spray or gel), and injection (paracervical blocker). Sedation may be an option, but you will likely need to book that in advance and arrange a ride home.
— How do I know how much pain I can feel? Everyone’s pain threshold is different, and your level of anxiety and stress can also play a role. Talk to your doctor about your past experiences and concerns, even if you’re just nervous.
— What if my doctor doesn’t listen to me or prescribe the medication I ask for? Continue to advocate for yourself and come armed with knowledge. Experts agree that patients are often confused about their options, and new CDC guidelines encourage gynecologists to talk to patients first. You can always seek a second opinion if needed and time permits.
It’s not rocket science, says Cheryl Hamlin, a gynecologist in Cambridge, Massachusetts, and chief of reproductive services for the American Medical Women’s Association.
Doctors simply need to tell patients what options they have, answer their questions and let them decide for themselves.
