Whenever anybody asks me how I like my Mirena IUD, I tell them that I love it, as earnestly and vigorously as someone actually earning commission from Big Estrogen. I say that the ease of not taking a pill, the peace of mind that comes with using the most effective form of birth control, and the infrequent periods were all worth the pain. And I mean it! But I wouldn’t exactly call getting an intrauterine device inserted breezy; in fact, I would call it a downright bad time. It’s an experience that’s left me wondering: Why are women expected to pay for reproductive freedom with a procedure that is invasive, vulnerable, and so painful that it’s known to make patients vomit and faint?
While I am glad to have my Mirena IUD, I’m not certain that I would’ve gotten it if it weren’t a necessity. I began taking the combination estrogen and progestin pill in high school after suffering through years of debilitating cramps, aided by nothing more than Advil and some light sympathy. But it took until I graduated from college for a doctor to tell me that because of my chronic migraines with aura, taking the pill greatly increased my stroke risk, and that continuing to prescribe me the pill would violate the American College of Obstetricians and Gynecologists’s guidelines.
I’m slightly embarrassed to admit that I put off getting my IUD for so long because I was terrified by the horror stories. But I’m also not alone in that fear. Every so often, I’ll see young people on TikTok recounting their inaugural gynecological nightmares—many of them Pap smears or IUD insertions. Check the comments on these videos, and you’ll see responses like, “I’m never getting a Pap smear as long as I live,” or, “Getting an IUD was the worst experience of my life and I would sooner die than get another.” A lot of those comments come from a place of naïveté, but that doesn’t diminish their validity: It is completely natural to balk at the idea of making yourself physically and emotionally vulnerable to a stranger, and trusting them to treat you with humanity. And it’s even more reasonable to wonder why we have to physically suffer during a common, should-be-routine procedure.
The “tough it out” mentality seems to particularly plague obstetric and gynecological procedures, a sad fact that is especially true for Black women, who are least likely to have their self-reported pain taken seriously by a medical establishment still rife with implicit bias. Before my own IUD appointment, my doctor advised I take four Motrin, which is basically a dose fit for a hangnail. (I may or may not have also helped myself to one of my dog’s Fourth of July Xanax to help calm my nerves…there are no awards for suffering, as they say.) And, anecdotally, of all my friends and acquaintances with IUDs, I’d never heard of anybody being offered any kind of substantial pain relief at all; nothing beyond 800 mg of ibuprofen, in fact.
So, imagine my surprise when I learned there’s a perfectly effective pain mitigation option that no doctor had thought to mention to me or any of my friends. “For people who’ve never given birth, doing what’s called paracervical block significantly decreases the pain associated with IUD insertion,” says Aileen Gariepy, director of Complex Family Planning at Weill Cornell Medicine. The paracervical block is lidocaine delivered to the cervix via injection, which doesn’t exactly sound pain-free, but Gariepy notes that most patients consider it far preferable to an insertion aided solely by aspirin. She offers it in her own practice, including to medical residents who have admitted to her their own fears about the painful procedure. “I share the evidence with them and almost everybody takes me up on it,” she says. “Then they’re like, Oh my God, that was night-and-day different.” Also relatively unknown, Dr. Gariepy says, is the inefficiency of misoprostol, which some gynecologists use to soften the cervix before insertion. “When that was actually studied in a randomized trial, misoprostol actually increased the risk of pain due to cramping and diarrhea and some other side effects, and it didn’t change pain scores,” she says.
So why are paracervical blocks still so under-the-radar, and why are so many people taking misoprostol if it doesn’t mitigate any pain? “With any medical research data that gets published, it takes 20 years before most people know about it,” Dr. Gariepy says. So, in the years we have left before paracervical blocks become widely used, Dr. Gariepy suggests researching where to get the procedure done—such as at a research hospital or university-affiliated clinic—as well as practicing self-advocacy.
Self-advocacy is a worthy goal (in a doctor’s office, as well as anywhere else in the world), but for many patients, speaking up can be extremely difficult. Before my own procedure, I told my doctor that I was concerned about the pain and suffered from bad cramps. “I just put one of these in a 17-year-old and she didn’t even flinch,” she said gruffly. While possibly an attempt to assuage my fears (albeit with less-than-ideal bedside manner), I felt as though my worries and my pain were an inconvenience to her, making me feel more like a sentient vagina than a person.
I wish I could say that my experience with IUD insertion was an unfortunate outlier, but a recent study found that physicians assess IUD insertion to be half as painful as patients report it to be. This issue isn’t fading away, either; Google Trends recorded record-high searches for “IUD” the week Roe v. Wade was overturned, and one year later, OBGYNs are seeing an increased interest in IUDs now that abortion safety and access has been gutted across the country. But while the popularity of IUDs grows, the use of meaningful pain mitigation stays stagnant. We shouldn’t have to wait another 20 years for our pain to be taken seriously.