By the time patients express surprise at the pain they experience during in-office gynecological procedures, we’re too late to the pain management conversation. Exclamations of, “Whoa, this is uncomfortable,” and the struggle to be still indicate patients in need and in pain.
I had a stark reminder of that this summer when videos of women writhing and grimacing during IUD insertions and removals, or colposcopies, started making the social media rounds. They are far from isolated incidents, and bring to light the long-quieted truth that women routinely endure unnecessary pain during gynecology procedures.
“Just deal with it” is not a legitimate pain relief solution. Communication, comfort, and control are. To meaningfully implement that, we physicians must start at the beginning, fully preparing our patients and ourselves for clear explanations and a wide range of pain management options, from over-the-counter anti-inflammatories to local anesthesia. We cannot fast-track that work, and we need to look beyond the CDC’s new guidelines, which are vague and long overdue suggestions.
My gynecology practice goes further, starting by acknowledging that these procedures, while common, are not routine for our patients. The idea that we perform these procedures regularly doesn’t mean our patients experience them that way. They are having contraceptive or biopsy devices inserted into their bodies; rushing through explanations of that, or minimizing the potential discomfort or pain, doesn’t help patients. We need to help set reasonable expectations for the experience to improve the outcome. That needs to happen well before the patient undresses for the procedure.
A patient with a complex medical history and multiple serious health conditions recently came to me needing an endometrial biopsy, the removal of a small piece of tissue from the lining of the uterus (endometrium) for examination. Her health was too fragile for surgery and anesthesia, so I prepared her differently. In addition to making clear to her the procedure and its potential risks, I offered her two rounds of cervical ripening medication, a sonogram to guide the procedure, local anesthesia, and anti-inflammatories. After thoroughly preparing our patient, her pain was minimal.
That outcome was possible, in part, because I treated her like the unique patient she is, not just “a case.”
When we explain the mechanics of the procedure to our patients, we can make that clear. We can explain the many factors that affect pain experiences: every woman’s anatomy, cervical positioning, and nerve pattern is unique. Whether the patient has given birth before and experienced and managed pain in the past can matter a great deal. We can agree on a clear signal so the patient can pause a procedure and remain in control.
In my practice of more than 15 years, I’ve witnessed some patients — including teenagers new to these procedures — breeze through them with minimal discomfort. Others, including those who have navigated childbirth and other gynecological interventions, have experienced significant pain. But all of my patients have better outcomes when I hone communication and tailor options to their history, preferences, and pain tolerance.
In a workshop about relationship-centered communication, I learned about the power of asking open-ended questions in these situations. It has become key in making patients feel part of their own care and addressing pre-procedure anxiety. When the conversation is, “Do you have any questions? No? Let’s start,” the interaction is rushed. On the other hand, asking, “What questions do you have for me?” offers patients the chance to inquire and advocate for themselves.
That foundation is everything. The CDC’s guidelines are merely a starting point; they fall short of addressing what each individual patient needs, and what each patient needs their gynecologist to hear. Eliminating surprises, offering pain relief options, and tailoring our communication demonstrates respect for our patients’ autonomy and ensures we offer opportunities for patients to voice their concerns. It’s time to leave behind the practice of silent endurance in favor of consistently proactive communication and compassionate care.
Stephanie McNally, MD, is vice president of Northwell Health’s Ob/gyn Service Line, and the director of Ob/gyn Services at the Katz Institute for Women’s Health in New York.
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