In the last couple of years, there have been a lot of stories on social media about IUD insertion. The main concern is whether doctors are downplaying the pain involved with the procedure. Some stories feature people who were told by their provider that IUD insertion wouldn’t hurt—but who describe the procedure as very painful. They also say that their provider dismissed their pain. Several patients said that the only pain management offered was over-the-counter ibuprofen. By drawing attention to this issue, these patients have helped usher in change in the guidelines that health care providers follow.
Last year, the Centers for Disease Control and Prevention (CDC) issued updated recommendations for providers. CDC acknowledged that lidocaine (a topical anesthetic) “might be useful” in IUD placement. While this stopped short of recommending the use of pain management, the guidance did recommend that providers counsel IUD patients on pain management options before the procedure. This represented a big shift in care as many providers never thought to have these discussions.
An Acknowledgement that Providers Underestimate the Pain of IUD Insertion
Now, the American College of Obstetricians and Gynecologists (ACOG) is building on this progress. ACOG has issued new guidance on pain management for procedures such as IUD insertion and biopsies. ACOG acknowledges that providers often underestimate the pain patients feel during their procedures. The organization says there is “an urgent need for health care professionals to have a better understanding of pain-management options.”
The guidance document discussed a number of pain management strategies. These include lidocaine sprays, creams, and injections. They also discuss the use of anti-inflammatory drugs such as ibuprofen before the procedure. Which strategy works best varies by procedure (LEEPs and hysterotomies are more painful than IUD insertion). They also vary by person, since everyone experiences pain differently. Again, the most important change to the guidance is the suggestion that all patients receive counseling about pain-management options.