Woman holding a pill.

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Women and Pain: A Case for Compassion in Medicine

Tuesday, January 23, 2024

“Take 1000mg of Tylenol or Motrin one hour before your procedure.” This line is heard by countless women who are often told the pain will be “just a pinch,” by their doctors on the day of their Inter-Uterine Device (IUD) procedure. Yet during the procedure, the cervix is pierced and held in place by a steel instrument, and the IUD is speared through the cervical opening into the uterus. Rarely is it ever “just a pinch.” 

One of the greatest marvels in human medicine was the invention of birth control. The ability for women to control their first pregnancy (and subsequent pregnancy spacing) has opened new paths for them and how they wish to control their lives. Per the United Kingdom National Health Services (U.K NHS), aside from abstinence, an IUD is the most reliable form of birth control, which works long-term, and has fewer systemic side effects compared to other contraceptive methods.

However, it can be a painful procedure and is often given without any form of analgesics. The lack of drugs can rightfully be a significant deterrent for women considering the best birth-control option for themselves and, consequently, reduces their reproductive choice. Healthcare providers must be more proactive in explaining the procedure, pain control options (including offering analgesics), and post-procedure care. Healthcare providers must also listen with an empathetic ear when patients express pain.

This misconception that women have greater pain tolerance stems from colonial medicine and structural competencies that include incomplete healthcare access for women and biases in gender-based medicine. Groundbreaking research in OBGYN was founded on inhumane and unethical surgeries on Black female slaves who were perceived to have greater pain tolerance than white women.

Over time, this practice continued, and women’s reproductive-related procedures as a whole are still lagging in terms of pain control. This is tied with the health structural competencies that prioritized men’s healthcare, and research for medication geared towards men rather than women.

One study reported how healthcare providers perceived women’s pain as less than men's, and women were more often suggested psychotherapy instead of medication for pain compared to men.

A separate literature review confirmed gender bias in patient-provider encounters and that women’s pain is taken less seriously and treated less often than men's.

One proactive measure providers can do is increase health education around the procedure: they should relay exactly how the procedure is conducted, talk through which parts can be painful, and disclose how different the pain severity can be for individuals. 

Even the U.K NHS downplays the pain by stating on their website: “It can be uncomfortable when the IUD is put in, but you can take painkillers after, if you need to.” 

This nonchalant approach to such a medical procedure is one frustration women have, as noted by Heidi Martinez from Huffpost.

When receiving her IUD, Martinez was under the impression that it was a similar pain level to a flu shot but instead was bedridden for a week. Similarly, some women report less physical pain but indicate other indirect responses, such as nausea, vomiting, or dizziness. This was true for Jamie Driscoll from the HuffPost as well.

“I ended up almost passing out from the pain,” said Driscoll. “They had to give me several rounds of those smelling salts they crack open. It was just an excruciating experience.” 

If doctors clearly informed the patient of the potential pain, it would allow women to be mentally ready for the procedure, have clear expectations, and be able to plan for the day and the days ahead. It also gives them the opportunity to bring a supportive advocate/chaperone for emotional support. 

Secondly, all forms of pain control must be on the table. Local anesthesia is offered for everyday outpatient procedures, such as vasectomies — yet a special request is often needed for IUD insertions.

A cervical block is a form of local anesthesia that can be given to reduce the pain of the tenaculum (which pierces into the cervix to stabilize and angle it for IUD insertion), and the entry through the cervix. Meanwhile, Misoprostol has also been found to be an effective option that helps loosen the cervix for IUD entry. 

However, these are not industry standards, and patients may not even be aware it was an option. Typically, non-steroidal anti-inflammatory drugs (NSAIDs) are recommended before the procedure, yet one study found they did not provide relief

Anxiety medications are also prescribed, yet that does not address the root of the issue: the physical pain directly related to the insertion. Some of this is due, in part, to opposing viewpoints from physicians. One such physician is Dr. Jennifer Chin, who told Rewire Newsgroup “for most people [IUD insertion] does not cause significant pain.” 

Dr. Chin reported that she only gives cervical blocks to patients she “predicts” will have high pain. She has given medication twice in 5 years for IUD insertions. However, this viewpoint undermines the individual’s experience and as noted by another study, doctors often underestimate patients' pain levels experienced specifically during IUD procedures

This continues to align with the historical bias against women’s pain levels. Moreover, providers downplaying patients' physical pain overlook the emotional distress caused by the procedure and make the patient's literal cries during the procedure feel unheard and belittled. 

The healthcare community must continue to develop evidence-based strategies in combating patient’s need for pain management during IUD procedures. This starts by acknowledging the historical bias against women in their perception of pain.

Women should have full disclosure regarding the procedure and their options, be offered all available forms of pain relief, and allowed to determine what method they feel is best for their bodies to tolerate. 

Since the choice of birth control and level of pain is extremely subjective for each individual, these proactive measures empower women by giving them full choice in birth control (by removing the fear of pain from IUDS) and the right to make autonomous decisions based on respect for their bodies and the highest level of ethical care.