People are screaming, crying, throwing up – literally – during their contraceptive IUD insertions. Why? Because pain relief for this procedure is not required and, often, not even an option. We dive into the nitty gritty of why this is a problem and what doctors might be able to do about it.
Katie-Rebecca Whittam was just 19 when she threw up all over her nurse who was inserting the copper coil into her womb. As the procedure went on, she felt faint and the room was spinning. Suddenly, the pain was so overwhelming, her knee was jerking upwards, kicking the poor vom-covered nurse right in the face.
“She had a sore nose, I was feeling faint and sick, and it was just the worst. It was a horrendous experience.” the now 25-year-old said.
With all this nausea and accidental violence toward our GPs, we come to beg the question.
What is an IUD?
An intrauterine device, also known as an IUD or “the coil”, is a form of birth control, that is inserted as a copper device into the uterus to stop pregnancies.
The copper coil kills the sperm in the womb and stops it from fertilising the egg without needing any hormones. This is different from the IUS, a hormonal coil that releases progesterone into the uterus.
Although they have different names, the insertion process is the same and is 99% effective. There are several different shapes for the coil.
“The T shape is one of the most common.” said family planning nurse, Carol Lord.
“To insert it, the wings at the top fold down so it’s just one slightly thicker strip.
“You’ve got to pop that through the cervix far enough for the wings of the side to spring up to make the T shape again within the womb.”
Why are IUD insertions still so painful?
Currently, there is no required option to be offered to patients for pain relief, and patients are now speaking out about their stories.
Lucy Cohen, 40, a CEO of a money company also experienced excruciating pain during her coil insertion in 2021. The entrepreneur went on to create her own survey for people who underwent IUD insertions.
95% of respondents said that they believe better pain relief should be offered for IUD procedures.
Dr Louise Massey, Sexual Health consultant for Aneurin Bevan University, is one of eight medical professionals working with Lucy to perform a formal study on IUD insertion pain for the medical scientific press.
“I’ve had to try and provide people with a decent amount of pain relief for coil fits,” explained Dr Louise. “During that, I realised that many GPs are not giving the pain relief area as much thought as they might.
“We want to understand how it affects people who do experience pain. We could gather medical evidence which could modify training requirements so that everybody has to provide the full range of pain relief and the patient can choose whether they want it or not. That would be what we hope to find.
“You wouldn’t do a vasectomy without using anaesthetic in every single case. Why don’t we do the same for coil fits?”
The study going is in the application stages with the research group, RfPPB Wales, for funding but is hoping to go begin in October 2023.
“There’s also a disconnect between the clinician and the patient when they are in pain.” Dr Louise said. “We need to work out how to inform women that not everything will be available in each setting and avoid unnecessary discomfort”.
“Relationship between the fitter and the oil there needs to be a sort of ongoing dialogue. It’s important that it’s got to be an equal power base, particularly if you’re dealing with somebody who has had an unwanted sexual experience.”
How painful is it?
In Lucy’s survey, 75% of people rated their pain a seven or higher on a scale from one to 10. Reasons for such high pain included not having given birth vaginally, a history of painful smear tests or sexual abuse, or the procedure being carried out by an inexperienced fitter.
“I actually think if we look back 20 years’ time, we’ll look back at the way that we treated people with uteruses in the medical profession and classify it as barbaric,” Lucy said. “It’s smacks of a historically patriarchal medical system. And that is fundamentally why we are where we are now.”
From this research, Lucy began a campaign for better pain relief, working closely with medical professionals and creating a petition which received over 35,000 signatures.
Carol Lord has been performing insertions for 20 years and explained why the procedure can cause so much pain.
“We’ve put a foreign body into you and your body all of a sudden you get like pain because it’s trying to kick it out on to kick it out.”
“When we put it in, the cervix is a very sensitive part of the body, and you can get various problems.”
Putting numbing gel on the cervix for pain relief is a practice that only some nurses use during the procedure.
“I would say putting a bit of anaesthetic gel should be used in all cases. “I would instruct doctors to do that, because you are saving trauma all around,” she said.
Are there any pain reliefs that could help?
This was not something that was taught as an essential practice in training.
However, Lucy Cohen argues that research has shown numbing gel is not a good enough pain relief.
“There’s no empirical evidence, there’s no study to prove it works. They just use it because it’s cheap,” she said. “The application is poorly done. It’s not left enough time. I’ve heard stories of people reporting being in pain and then the fitter puts it on halfway through the procedure. That’s ridiculous.”
A study published in 2015 proved that Lidocaine 10% spray, another cheap form of local anaesthetic, “significantly lowered the overall procedural pain” but is not something that is commonly used.
Results from the campaign
After Lucy’s campaign, the NHS and the Royal College of Oxford updated their guidelines to reflect that it’s not just ‘mild discomfort’ and to advise it proper anaesthetic should be used at every insertion.
However, it is yet to be established whether that’s happening in practice or not.
“I have spoken I’ve had women watch me since this ruling has come out that they weren’t offered any pain relief at all,” Lucy explained. “So it really is a postcode lottery as to where you get your fitting done and whether you’ll be offered appropriate pain relief.”
Alison Bodill-Maher, 27, went twice to her appointment and had completely different experiences.
“The first time I was unable to get it fitted due to a personal reason. It was a shame because that doctor was lovely and gave me numbing gel.” Alice said. “Then the second time I was feeling nervous and wasn’t given any numbing gel and had a nurse who was not empathetic – which didn’t help to put me at ease.
“I couldn’t go through with it and begged the nurse to take it out as the pain was too much.
“The process was the most painful thing I have ever experienced. I was in absolute hysterics, borderline inconsolable and if I think about it now it still makes me feel a bit sad.”
For a lot of people, the IUD is the only option for effective birth control due to varying health issues.
After winning her battle with cancer, writer Gina Tron, 40, was not able to use hormonal birth control.
She spoke about her painful insertion experience in 2021.
“I don’t usually like scream or cry or anything like that,” she said. “But I couldn’t even control it. It was probably the worst physical pain ever.
“I felt like my whole body was under attack like it was a different kind of pain than I’ve ever really experienced.
“I just remember shaking and sweating. When I got off of the table like my back was just like covered in sweat.”
So, why don’t we just use a different form of contraception if it’s so painful?
Why do we still use the IUD?
“The non-hormonal IUD is the most effective form of contraception that doesn’t have hormones attached to it,” Lucy explained.
“It’s in place for 10 years. If you’re traveling, or if you struggle to take pills every day, it’s a fantastic form of contraception. The barrier to entry for it, though, shouldn’t be horrendous pain”.
“Culturally, we bear the responsibility for contraception. And that’s why we do it because what realistically what other choices do we have?”
With all the advanced science of today, we need to be question whether this is a sexist issue.
“There’s a lot of misogyny around birth control because the implications of what it means,” said Gina. “Whether conscious or not, there’s an attitude that people think if you want to be out there having sex, then you have to go through a bit of pain.”
“Let’s look at unisex procedures,” Lucy said. “A colonoscopy. Everybody is offered sedatives because we all know that it’s a potentially painful and unpleasant procedure.
“But yet the minute there is a, what they call, minor gynaecological procedures, we’re not offered the same respect whatsoever.
“That’s what I want to see that fundamental shift and first of all, the way that it’s viewed and second of all, standardising the process.”
With the hope of a new scientific study and discussion in the medical community, there is hope to look forward to pain-free IUD insertions.
“It might be mild discomfort, but as far as I’m concerned, you cannot give proper informed consent for the procedure,” said Lucy. “If you don’t know that there is a potential for it to be incredibly painful, you are being misled.”
Edited by Ramona Gabriela Toderascu