IUD Insertion Can Be Excruciating. Why Aren’t Patients Given Help?

When Dani, 39, made an appointment to have an intrauterine device inserted, her gynecologist – whom she trusted and had seen for years – said it wouldn’t be a big deal.

“He makes it sound like you just lie down and he puts it in, no pain medication needed,” said Dani, who asked that only her first name be used while discussing her birth control method.

Instead, “I can’t describe to you the pain I felt,” he said. Dani screamed, surely the people in the waiting room could hear. “I felt like a hot knife was being slowly stabbed inside me.” Then, he said, he was in “severe” pain for two days.

“I just hope I was warned. Look, I know things hurt ― it’s OK. I can handle that as long as I can handle myself and prepare for it,” she said.

Birth control is highly personal, and options that work for one person may not necessarily work for another. However, health care providers tend to introduce IUDs as the gold standard of reversible contraception. This is for good reason: IUDs are more than 99% effective in preventing pregnancy, as opposed to the birth control pill, which in the real world is more similar 91% effective because people often forget the pills. IUDs can be left in place for years, and they can dramatically improve the quality of life for anyone struggling with heavy, painful periods.

HuffPost heard from more than 100 people about their experience with IUD insertion, many of whom said the process was more painful than anyone had warned them to be. And even a lot of Research on women’s experiences during IUD insertion suggests that their pain levels are generally quite low, that is not what the anecdotal evidence suggests. Doctors, nurses, midwives and other health care providers trained to insert an IUD also know a wide range of what patients experience.

What Dani and others wonder is why no one prepared them for the possibility that the procedure might not, in fact, be quick and easy. They also wonder why ― when there are pain relief and sedatives available to them ― they are not offered any options to help manage their significant discomfort.

Currently, there are five brands of IUDs available in the United States. They fall into two categories: hormonal options and the copper IUD. Although those alternatives rely on different mechanisms, they all work by preventing sperm from becoming an egg, preventing pregnancy. And the admission process for each is similar. A health care provider – usually a doctor, nurse or midwife – inserts a speculum into the vagina, then places the IUD (a small T-shaped device) into a tube that passes through the opening of the cervix and into the uterus.

During that process, there are certain points when patients are more likely to feel discomfort or more significant pain, explains Maureen Baldwin, an OB-GYN at Oregon Health & Science University whose clinical research has -exploration of IUD placement after childbirth and improvement of women’s pain.

“There is an instrument placed in the cervix. An instrument is passed through the cervix. Then there is the passage of the IUD where it touches the inside of the uterus. Those three time points are the most painful,” says Baldwin, adding that patients whose cervix is ​​tight often experience more pain.

Baldwin also noted that some patients experience less direct (but less intense) autonomic response which leaves them feeling nauseous or dizzy. There can also be a strong emotional component to all of this. Research suggestsfor example, that people who expected a lot of pain during their procedure were more likely to report that it was painful.

“What I can tell you is that there is a lot of variation, not only from research but from my own clinical experience. I know there are people who are just better at it. And there are some people – they may be motivated and may not be anxious — they’re just feeling more pain,” Baldwin said.

Many of the women who spoke to HuffPost said they were simply not adequately warned that the procedure could be painful. When they put the IUD in and they were obviously struggling, they were ignored.

That was the case for Jamie Driscoll, 26, who had an IUD inserted in 2016 and was told it was a “quick” and easy procedure.

“I almost passed out from the pain. They had to give me several rounds of smelling salts that they were opening. It was just an excruciating experience,” she recalled.

Driscoll remembers hearing herself moan in pain on the exam table — not outright screaming but obvious “sounds of distress.” At least his health care provider stopped by and talked to him. When he got home, Driscoll threw up all night.

What’s troubling about these stories is that there are pain relief options available, and health care providers like Baldwin encourage patients who are concerned about pain during the procedure to ask about their options.

“Patients should ask their clinic or provider what possible options are available. They can ask them if there is an option for sedation in any form. Some clinics may offer it and some may not,” Baldwin said, noting that sedation may be offered through an IV, for one example. He said “Most clinics” can put an anesthetic into the cervix as an injection or a numbing block.

Some providers may also offer anti-anxiety medication, he said. Baldwin noted that patients are sometimes told to take over-the-counter pain medication beforehand, but there is no evidence that it actually helps with pain during the procedure.

“I think patients should be proactive in asking if the clinic can offer those services. I also think we should have some kind of clinic designation for higher level clinics. for referrals for more challenging cases,” he said. In an ideal world, patients would be presented with their pain relief options without having to ask.

Patients should also be told they may want someone with them, and several respondents told HuffPost they felt unsafe driving home alone afterward.

Heidi Martinez, 27, said she assumed getting an IUD would be like getting a flu shot — uncomfortable, sure, but no big deal. So she was lucky that she happened to go to her appointment with her boyfriend, who is now married.

Afterwards, “I sat in the car with him and just cried,” she said. He was in bed for a week. Later, he wondered for a moment if he was just being too sensitive. Finding stories like hers online at least proved she wasn’t dramatic or weak, Martinez said.

Of course, there are cases where the IUD is not appropriate. Kim, a 41-year-old from Virginia (who also asked that only her first name be used), got her first IUD a decade ago, with no real issues. When she went in for another IUD this month, the insertion itself was painful, but she felt worse afterward.

“I spent the rest of the day on the couch, then I went to bed early and I woke up at 1 a.m. with a horrible, horrible constant, excruciating pain,” she said.

The next day, he had an appointment to have it removed. “I was like, ‘Get this thing out of my body. I don’t want it,'” Kim said.

But, for the most part, the women interviewed for this article had glowing things to say about their IUDs and said they would get one again.

“I think I still chose the right birth control for me, but if I could have made the situation less painful – or if I had been warned and prepared myself with more support, with more pain medicine, which someone took. care of me afterwards — I think I would have fared a lot better,” said Driscoll, who explained that he is a sex educator and didn’t want anyone reading this story to hear her experience and determine that getting an IUD is not worth the cost.

What the women we heard from wanted was for their pain to be taken seriously, for patients to be given more education beforehand and practical pain relief options in the moment — the same way that the people are offered options for, for example, a colonoscopy or wisdom tooth removal.

The medical world as a whole is gradually getting better at recognizing and responding to women’s pain, but as these experiences show, many providers are still lacking. They face a difficult balance between ensuring that IUD insertion remains a relatively quick in-office procedure ― accessible to patients in a wide range of health care settings ― while also ensuring that they are equipped to address the real difficulties of some experience.

“For my provider who I’ve had for more than 10 years to be so blasé about it feels like a betrayal,” says Dani, who tried the birth control pill, the implant and the birth control ring before settling down. with an IUD. “Look, even through this traumatic experience, I really like it … I just want girls to be more prepared than I was.”