In late July, after months of calling doctors’ offices and suffering through pain, 23-year-old Erika of Wakefield posted a question in a Boston Reddit thread: “How do I find a doctor willing to remove an IUD under sedation or anesthesia?”
Erika, who asked that we not share her last name to protect her privacy, received over 140 responses — ranging from advice to personal stories of pain and medical trauma related to women and reproductive health procedures.
Several experts told GBH News that, despite major advances in modern medicine, the unique pain endured within this sliver of health care is often viewed differently.
Awareness appears to be increasing in recent years of just how painful procedures like getting an IUD can be, with TikToks on the topic garnering millions of views. But Boston-area doctors told GBH News that, while more advanced pain-control methods are available, many patients may not know about these options.
“There’s this cultural expectation that people who inhabit female bodies should expect to feel pain that comes with it,” said Dr. Nancy Stanwood, chief medical officer of Planned Parenthood of Southern New England. She said it starts with periods, traditionally referred to as “Eve’s Curse.”
“And I just want to call B.S. on that,” Stanwood said.
“We do have modern medical options to make discomfort less, be that with a pelvic exam, be that with an IUD insertion, be that with an abortion procedure, be that with a delivery,” Stanwood said. She said people deserve to have those options available to them.
Erika was 20 years old when she went to the gynecologist for the first time.
She didn’t receive a sex talk as a teenager, and only decided to go after a friend told her “it was time.” She first went to the gynecologist and, after talking through her trauma history and medications, her doctor suggested the copper IUD as a birth control method.
She asked the doctor about what the IUD insertion procedure might feel like.
“He told me it would be a little pinch,” she recalled.
She said she took the suggested 800 milligrams of ibuprofen before her appointment. The procedure started, but she asked to stop due to a panic attack.
“I was so worked up and fearful because of just my history of trauma,” she said. “And prior I had never even had an [pelvic] exam of any kind.”
The doctor suggested she come back to try it again when she was menstruating, she said. So a few weeks later, she did — this time, taking her own anti-anxiety medication and the ibuprofen.
She said the doctor was good about telling her what was going on, and that it was going smoothly — until he used an instrument to help straighten out her uterus.
“I ripped into my thighs with my fingernails and I honestly sounded like a dog, like a yelping dog,” she said. “And I was shaking, I was hyperventilating. I was like in shock at how much pain. That was like my 10.”
In the last three years, she said, the pain has persisted, first with intense cramping and heavy periods.
She then discovered, when she went in for an unrelated medical emergency, that her IUD had moved out of place.
“It causes me pain regularly. Like if I hit a bump in the road too hard, I feel it like almost jabbing me — and you're not supposed to feel it at all,” she said.
And since it had been so traumatic when the doctor had inserted the IUD, Erika asked her doctor’s office if they could remove it under sedation.
“It was just, ‘Nope, we don't offer that,’” she said.
That's when, in her desperation, she turned to Reddit looking for answers.
We all experience pain differently
There are a lot of pain control options for reproductive health procedures — especially around IUD insertion and removals. But Erika said she learned more about those options from a Reddit thread than from her provider.
After speaking with local medical professionals, one thing was clear: everyone experiences pain differently.
Multiple doctors told GBH News they have treated some patients who are comfortable enough to text on their phones during an IUD insertion or removal. But others nearly faint, or they vomit or they even say it was the worst pain they’ve experienced — like Erika.
“It is not so much that women are expected to deal with the pain,” said Dr. Kate White, vice chair of academics in Boston Medical Center’s Department of OB/GYN. “It’s that the amount of pain they're experiencing is not believed.”
Many reproductive health procedures are considered routine.
“‘Routine’ means it’s routine for the person who's doing it. Not for the person who’s having it,” said White. “Root canals are really routine.”
Knowing your options
If you’re going in for a reproductive health procedure soon, there are a few basic pain control options to ask your doctor about. For a procedure like an IUD insertion, these options can range from ibuprofen to deep sedation. Doctors say that people should ask ahead of time, as some of these options may require arrangements before the procedure appointment.
Many providers encourage taking ibuprofen ahead of time, but for some, that may not be enough.
“It is not so much that women are expected to deal with the pain. It's that the amount of pain they're experiencing is not believed.”Dr. Kate White, Boston Medical Center
One option is a paracervical block, an injection of lidocaine to the cervix.
“I sort of liken this to getting Novocain at the dentist before you get a cavity filled,” White said. “It is one of the evidence-proven techniques to reducing pain and discomfort during an IUD insertion. And you can go just to a regular appointment and have this done.”
Moderate sedation is often a cocktail of two different medications — one for pain and the other for anxiety. It will likely make a patient feel sleepy, but still conscious for the procedure.
With deep sedation, a patient will be fully unconscious for the procedure. Depending on the facility it may be done in an operating room or procedural unit.
Patients will need to weigh the logistics of each option — like finding a ride home from an appointment, or whether insurance covers the sedation costs. Some types of pain control require a referral or longer wait times for an appointment.
“I would like to get to the point where the patient gets to make that choice,” White said.
Acknowledging trauma and identity
Many providers have shifted to operating through a trauma-informed lens.
“We sort of assume that everybody has had some form of trauma and so that we are kind of using the same practices for every patient in terms of how we approach a pelvic exam,” said Dr. Rachel Cannon, the medical director of the GYN Procedure Unit at Boston Medical Center.
Cannon explained this approach can take many forms, including talking through a procedure while the patient is still fully clothed, verbalizing what they will feel and when, limiting the number of people in the room and making sure patients know they can stop at any time.
“I always tell the patient, like, 'You are the boss,'” she said.
White said she’s started laying out these options to people who come in.
“Patients get so much relief out of just being offered it that sometimes they say, ‘Well, it’s nice to know I can get it,’” she said.
Cannon also emphasized that pain control options, specifically sedation, can impact gender nonbinary or transgender patients differently.
“Having a pelvic exam can be very dysphoric for them,” Cannon said. “So having the option to be completely sedated ... I think is incredible because it honors their wishes to live in the body that they want to be in, but also allows them to get the health care that they need.”
What next for Erika?
Erika, the young patient from Wakefield, recently learned her doctor is going to make accommodations for her to be sedated when he removes her IUD.
“I started sobbing from just like how relieved I was to have the doctor who knows my history, who also did the procedure, and just a doctor in general be like, ‘Yes, I can make accommodations for you if you're able to wait a little longer,’” she said.
She doesn’t know whether the sedation will be covered by insurance. But even if it’s not, she said she’s at the point where she’d rather pay it off over time than go through another painful experience.