Ella Howell is a fourth-year journalism major and writes a column for the Daily News. Her views do not necessarily reflect those of the newspaper.
When getting a vaccination or blood drawn, healthcare professionals warn you of a “little pinch.” The slight discomfort is what you would anticipate when a needle pierces the skin; a quick, sharp pain that’s gone before you know it.
Many people who are scared of needles when they’re young outgrow that fear as shots and blood work become expected routines. When you’re told you’ll feel a pinch, you know exactly what you’re about to experience.
When I decided to switch from the pill to an intrauterine device (IUD) at 19, I received the same warning of a slight pinch. But it was entirely different from the feeling I was conditioned to tolerate.
An IUD is one of the most effective contraceptives with a success rate above 99 percent, according to Planned Parenthood.
With such a high percentage, it has become a common form of birth control since its introduction in the early 1900s.
With a high volume of insertions and different practices and training among medical professionals, experiences and studies vary regarding pain levels.
According to Dr. Jennifer Kaiser, it can be very painful, but patients receiving an IUD rarely need anything stronger than over-the-counter anti-inflammatories 30 minutes prior to the procedure.
While many patients spend more time filling out paperwork than actually receiving their IUD, this is not the experience for a significant number of people. Too many healthcare professionals assume those experiencing pain are outliers and, therefore, don’t address the alternative.
I was told during my consultation appointment that the whole thing would be really quick, and there was nothing to be scared of. They said the worst part would be mild discomfort during the placement.
The only direction for pain management I got was to take 800 mg of ibuprofen 30 minutes before the appointment, the same solution as when I used to get my braces tightened in middle school.
I have always had a relatively high pain tolerance and was repeatedly assured it would be quick and virtually painless, so I took the ibuprofen and went to my appointment alone.
I wasn’t informed that other factors play into the anticipated pain level for an IUD insertion.
People who have never given birth reported significantly higher pain compared to those who had a previous vaginal delivery, according to the National Library of Medicine.
No one explained each step of the placement or even addressed the possibility of extreme pain. I was completely blind to what I was about to endure.
According to the European Journal of Contraception and Reproductive Healthcare, only 9 percent of those who hadn’t given birth considered the insertion process to be “painless,” 72 percent reported feeling moderate pain, and 17 percent said the procedure caused severe pain.
Multiple steps can cause pain when getting an IUD, which can vary depending on the provider.
After a speculum is inserted, a tenaculum slightly pierces both sides of the cervix to stabilize it.
This step can cause pain due to both the manipulation of the cervix and uterus, as well as the sharp points of the tenaculum. A tenaculum is a pair of forceps with two sharp, hooked ends to hold tissue. Some doctors are exploring alternative options to reduce pain and bleeding, but the device has been used in reproductive healthcare for over a century.
Once the cervix is gripped using the tenaculum, a sounding device measures the depth of the uterus for proper placement. Finally, the IUD is inserted using a tube and deployed to form its T-shape.
Each step of the insertion and placement can cause the feeling of “pressure” and cramping that ranges in severity.
Unfortunately, I fell on the severe end of that spectrum. With the tenaculum, I was told to brace for slight discomfort. At first, it felt like a strong cramp, but it didn’t go away. Instead, it continued to build into waves of sharp, indescribable pain.
By the time she started to measure, I could feel my eyes begin to water. Moving wouldn’t help, so I fought to stay still through the duration. She kept telling me to take deep breaths and that it would be over soon, but nothing helped.
Before moving on to each step, she explained what she was doing, but her constant repetition that I would only feel slight discomfort or pressure was invalidating.
Being in the most intense pain I had ever felt while it was actively being minimized put me in a position where I didn’t feel comfortable communicating the agony I was in.
When she was finished, she asked me if I was OK, and I just nodded — I thought the pain would stop and I could leave. She told me I did a great job on her way out and never came back.
As I laid on the table with my feet still in the stirrups, unable to move because I was scared it would make the pain worse, my body didn't feel like my own.
I stared at the fluorescent lights alone in the exam room, waiting until I could walk to my car. But I began to feel extremely nauseous from the severity of the cramping.
I became nervous as my discomfort and queasiness worsened. Having no prior warning that this was a potential outcome, I felt like something was wrong, but I was alone.
I must have been there for a while because the nurse came in to ensure I was OK. By then, I was very lightheaded and nauseous, and my skin was so clammy my paper gown was sticking to me.
The nurse brought me a bucket as I started throwing up, and she had to call my mom to come pick me up.
My whole body began to shake uncontrollably as the nurse waited with me. She told me it was probably my body adjusting to the influx of hormones. I was confused as to why none of this was discussed before.
When I left the exam room, I was unable to stand up straight as I walked through the closed clinic.
The situation could have been entirely different if I had been given an accurate description of the process rather than just the ideal.
I began to see a lot of IUD horror stories on social media similar to my own. My experience was validated, but the commonality of that level of pain is inhumane.
Some medical professionals do offer alternative pain plans, but it is not the normal routine. According to the American Medical Association, there’s no standard of care for pain management with IUD placement in adults who haven’t given birth, as “effective interventions for pain relief are lacking.”
As awareness and conversations around the problem continue to grow, doctors must stop underestimating the pain associated with predominantly female reproductive procedures.
Many procedures can be safely and painlessly performed on a conscious patient with local anesthesia, according to the American Society of Anesthesiologists.
It’s a one-time injection used in medical practices like skin or breast biopsies, repairing broken bones or stitching deep cuts. It should be routinely offered to people receiving IUDs as well.
According to family planning specialist Dr.Sheila Mody, many clinicians seem to be hesitant to offer it because they feel like it will interrupt the flow of the clinic. But in her experience, her patients can leave much sooner when they aren’t “lying on the exam table in pain.”
The lack of recognition in the medical community regarding the extent of pain from IUD insertions isn’t talked about enough. Patients should be informed of all options and potential outcomes to fully consent to any medical procedure.
Contact Ella Howell via email at ella.howell@bsu.edu.
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