The guidelines recently issued by the CDC regarding intrauterine device (IUD) insertion mark a significant, albeit overdue, milestone in recognizing and addressing the pain experienced by women undergoing this procedure. While the guidelines are somewhat vague, their publication is a crucial step forward in the broader movement to legitimize female pain, an issue that has long been overlooked in medical practice.
Historically, the recommended pain management strategies for IUD insertion have varied widely, and depend heavily on the individual provider’s discretion rather than standardized protocols for pain control. This lack of consistency has caused many women to fall through the cracks of adequate pain control and endure severe discomfort with minimal pain relief. The option to receive an IUD under sedative anesthesia is rarely available, and more comprehensive pain control methods, such as paracervical blocks or the application of topical lidocaine on the cervix, are not readily offered by most outpatient healthcare providers.
The CDC’s new guidelines are a first step in addressing gaps in women’s pain control by acknowledging the need for pain management during IUD insertion, and recommending that healthcare providers counsel their patients on pain management strategies and consider more intensive forms of pain control to prioritize patient comfort.
My personal experiences observing IUD insertions have been a testament to the need for improved pain management protocols. Although I’ve seen the procedure being done in outpatient gynecology settings, I was particularly troubled after accompanying a close friend to her appointment. After experiencing severe mood swings from hormonal birth control, my friend opted for the copper IUD (ParaGard), a non-hormonal option. Despite carefully researching the procedure online and readying herself mentally, she told me afterwards that nothing could have fully prepared her for the intensity of the pain she experienced. As the IUD was inserted, she reported feeling three sharp, intense bouts of pain that she could only describe as “a sharp poker piercing her insides.”
In the weeks following, I read countless accounts from other women about their experiences with IUD insertion. While there was a general consensus that the procedure was painful, the degree of pain seemed to vary significantly. Some women described the pain as being as manageable as strong period cramps, with many returning to work the same day; others reported severe cramps, bleeding, and pain lasting for days or even weeks.
At my own routine visit months later, I asked my ob/gyn why there was so little warning about how painful the process could be and why stronger pain relief options were not offered. I questioned why, for example, a wisdom tooth extraction would warrant a weeklong prescription for codeine, while most people have to endure IUD insertions with nothing more than extra-strength ibuprofen.
Her response was simple: “We’re women. Sometimes we have to be tough.”
This response, though well-intentioned, demonstrates a significant part of the problem. In a society where female pain is often downplayed or dismissed, the expectation that women should simply “tough it out” perpetuates a dangerous norm. It raises the question: how much pain is too much? And more importantly, why should any person, regardless of gender, have to endure almost unbearable pain during a medical procedure when there are measures available to prevent it?
Studies have shown that female pain is frequently underestimated or misattributed by health professionals as over-exaggeration. For example, research indicates that women are more likely than men to be prescribed sedatives rather than pain relief medications for conditions that cause severe pain, such as coronary heart disease. This discrepancy is part of a broader issue in which women’s pain is systematically delegitimized, leading to inadequate treatment for a range of conditions.
The CDC’s guidelines are a positive first step toward addressing this issue, but much more needs to be done. The guidelines recommend that healthcare providers discuss pain management options with their patients, including the use of local anesthesia (lidocaine, paracervical blocks), nonsteroidal anti-inflammatory drugs (NSAIDs), and other pain relief methods. However, the guidelines leave much of the specific decision-making to individual providers. This lack of specificity could result in continued variability in the quality of care women receive.
There is a pressing need for more research into effective pain management strategies for IUD insertion and other gynecological procedures. Studies should explore the benefits of using a combination of local anesthetics, oral analgesics, and sedatives to provide comprehensive pain relief. Additionally, more healthcare providers need to be trained in administering these pain management techniques and should be encouraged to offer them routinely as part of the IUD insertion process.
There is also a need for greater awareness and advocacy around the issue of female pain and its treatment in the medical landscape. Women should feel empowered to speak up about their pain and demand appropriate pain management during medical procedures. Healthcare providers, in turn, should listen to their patients’ concerns and take them seriously, rather than dismissing them as mere complaints. The broader societal attitude toward female pain also needs to shift. The idea that women should simply endure pain as a natural part of life is deeply ingrained in many cultures, but it is both outdated and harmful.
Pain, especially severe pain, is the body’s signal that something is wrong, and it deserves to be treated with the same urgency as any other medical issue. Women deserve to have their pain recognized and treated with the care and respect it warrants.
Nidhi Bhaskar is a third-year medical student at the Warren Alpert School of Medicine at Brown University in Providence, Rhode Island, and a member of MedPage Today‘s advisory board, The Lab. An alumnus of Brown University and the University of Oxford, she hopes to bridge her background in medical anthropology with the practice of medicine to shape global health interventions and public policy.
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