‘That’s when I passed out’: Painful IUD insertion was a terrible pain treatment

My most vivid memory of my appointment to have an IUD inserted four years ago is sitting up in bed and seeing the room spinning. I still remember looking down and seeing a fist-sized stain of my own blood, dark red, on the floor.

“Be careful,” I said, dizzily, to the doctor and nurse. “Don’t step on that.”

But they ignored me and left the room. That’s when I fainted from the pain.

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I wish I could say it’s a rare phenomenon, but as the popularity of intrauterine devices (commonly known as IUDs) has grown, so have reports of doctors downplaying or outright lying about the amount of pain the procedure can cause.

Women are used to having their pain ignored: documented gender bias in medicine often leads to women’s medical care taking a backseat to that of men. Women’s complaints of pain are often ignored and they typically wait longer to be treated for the same conditions as men.

The Washington Post reported in 2022 that an analysis of 981 emergency room visits showed that women with acute abdominal pain were 25% less likely than men to receive painkillers, and another study showed that women with symptoms of heart disease were twice as likely to be diagnosed with a mental illness, compared with men with the same symptoms.

Women are simply not believed about their own bodies, or their own pain.

More than eight years ago, the American College of Obstetricians and Gynecologists stated in an article that IUD insertion “is painful for many women.” The organization reaffirmed that view earlier this year in a new article noting that new research since then has not shown “an effective strategy to mitigate this discomfort.”

“It’s really heartbreaking to me when patients feel like they’ve gone through a traumatic experience getting a really great method of birth control,” Jenny Wu, an obstetrics and gynecology resident and researcher at Duke University, told The Washington Post.

Women are given minor painkillers.

It often seems that women’s pain simply doesn’t matter to medical professionals. Meanwhile, men undergoing a vasectomy are regularly offered numerous options for pain management.

“There are a wide range of strategies for managing pain after vasectomy, including over-the-counter pain medications, scrotal support, ice, and prescription opioids,” the American Urological Association reports in its Journal of Urology. “Urologists have an ethical obligation to manage postprocedural pain while minimizing the adverse effects of pain treatment.”

Gynecologists haven’t had that obligation to women with uteruses for far too long. In fact, a 2013 study of 200 women found that on a scale of 1 to 100, with 100 being the worst pain imaginable, women rated the average pain of IUD insertion at about 64, while the average doctor rated it at about 33.

But finally — finally! — after years of pressure from the public, spurred by the prevalence of video-based apps like TikTok, where women have shared their pain as it happens, the U.S. Centers for Disease Control and Prevention has issued some guidelines for doctors. Most importantly, the CDC has urged doctors to fully counsel patients about pain management before the procedure and to listen to their needs.

“We are so grateful to the Biden-Harris administration for providing long-overdue guidance that recognizes pain management for IUD insertion and removal as the preferred standard of care,” Jodi Hicks, CEO and president of Planned Parenthood Affiliates of California, told me. “Unnecessary physical suffering should never restrict anyone’s access to reproductive health care, and all people seeking contraception should feel empowered to choose the contraceptive method that is best for them.”

“Since many Planned Parenthood health centers already subscribe to this practice, we know firsthand how truly life-changing this option is and will be for patients seeking contraceptive care in our state.”

The new guidelines also indicate that there should be more options for pain relief during the procedure. In addition to lidocaine injections, people undergoing IUD insertion can now also request numbing gel, cream or spray.

But it seems some providers needed the message. During my last Pap test at UC Davis Medical Center here in Sacramento, the nurse had barely left the room when she started gossiping and complaining loudly about my request for numbing gel. But that story pales in comparison to what happened to me at a women’s clinic at Fort Bragg nearly four years ago.

My worst possible experience

I have suffered from endometriosis and debilitating dysmenorrhea since I was 11. Endometriosis is a condition that causes uterine-like tissue to grow outside the uterus; in my case, it is particularly common in the muscles surrounding the uterus, also known as adenomyosis. It causes truly unbearable cramps for days at a time, every month.

About a decade ago, my doctors put me on hormonal birth control to completely stop my period and allow me to live a normal life. Since then, I’ve tried almost every type of hormonal birth control, but nothing works as well for me as an IUD.

So there I was, in late 2020, legs spread wide in stirrups, receiving my second IUD implant at a rural hospital in Mendocino County. The OB-GYN was old enough to be my grandfather, and in what should have been a clear red flag, he started lecturing me about my weight until I had to threaten to walk out of the appointment.

I wish I had.

This doctor didn’t believe me when I told him I was in excruciating pain as he poked and scraped my cervix with a metal rod, and then did the same to my uterus with what looked like a wire brush. He also didn’t cut the wire strings of the IUD like I had asked him to do (they sometimes don’t wrap around the cervix, causing painful pokes inside the vagina. I had to go back a few weeks later and pay again to have them properly cut).

The doctor also didn’t believe me when I told him I needed the smallest speculum they had. For the uninitiated, this is a jointed tool that looks like a duck’s bill and is used to open the vaginal canal as wide as possible while the doctor pokes and feels around inside the body.

And apparently he didn’t believe me when I told him towards the end of the appointment that I felt like I was going to pass out from the blood loss and pain.

After sitting up and seeing clumps of my own blood on the floor around the clinic bed, I tried to point them out to the medical staff, but they didn’t bother to clean them up. They quickly left the room without checking on me and left me alone to fight the pain and nausea, passing out several times. A nurse poked her head in about 10 minutes later and asked when I planned to vacate the room. They needed it for the next patient.

I finally found the strength to sit up and stayed in the car crying until I could drive home with one hand wrapped tightly around my lower abdomen. I spent the rest of the day crying on the couch with a heating pad, as the bleeding slowly stopped and the waves of cramping persisted.

CDC guidance was long awaited

I tried to complain about the experience to the clinic administrators. Although the woman I spoke to was clearly horrified by my story, I was told that the doctor was close to retirement and there was little they could do to reprimand him. As far as I can tell, he continues to terrorize women with his draconian medical practices.

It’s a difficult story for me to tell, not only because it’s traumatic, but because it still makes me very angry. I’m also angry at the prevalence of these kinds of experiences among the women I know.

Mine is just one of many stories people with uteruses have about the pain of IUD insertion, a procedure I personally have to undergo every few years to prevent even worse pain from debilitating my life. I really don’t feel like I have any choice but to do so. It’s inexcusable for doctors and medical professionals to minimize the pain we experience, which actually makes women feel bad and dismisses our concerns.

I can only hope that by speaking publicly about our experiences, people like me can finally convince the medical system that our pain is real and deserves respect.