It is a very scary time in America to risk pregnancy. Between the costs of giving birth and raising a child, the fall of Roe v. Wade and the increasing restrictions on even medically necessary abortions in states like Texas, it makes sense for women to seek out their best options for contraception. Among these options is the intrauterine device, or IUD – one of the longest-lasting and most effective forms. Unfortunately, this is where a longstanding pattern of poor communication and disregard for women’s pain comes into play.
In 2012, I spent the ride home from a Portland clinic in the back seat of my high-school sweetheart’s car, shaking and screaming in pain. I was 17 years old, and thirty minutes before, I had experienced my first IUD insertion. Like many young women who have not given birth (“nulliparous,” in medical terminology), I was neither prepared mentally nor physically for the excruciating cramps that lasted for two hours post-procedure.
I had taken to the internet in the days leading up to my appointment. The results of my Googled “Is the IUD painful?” led me to WebMD. According to WebMD’s page on birth control and intrauterine devices, IUD insertion “shouldn’t hurt too much,” but “it’s a good idea to plan for pain relief before you get an IUD.” Sounds great!
I took two ibuprofen an hour before my appointment and hopped onto the clinic’s paper-lined table feeling prepared. What followed did not align with the expected “mild discomfort” or “slight cramping” the internet and my provider told me may occur.
Not only were my cramps post-fitting the most intense I have ever felt, they continued for hours. I was one of the unlucky women whose IUD insertion experience was more than “uncomfortable,” it was severe and traumatic. But my experience is not an anomaly or even rare.
Adverse IUD experiences are frequent, and there are documented risk factors that increase the chances of severe pain during and after insertion. Having never given birth and being under 35, I had both of these risk factors. But neither WebMD nor my practitioner warned me ahead of time, and that’s a problem.
Despite an impressive failure rate of less than 1%, the United States boasts the lowest rate of IUD use of any industrialized nation. Which I believe is a contributing consequence of the unaddressed gap between how our health care system talks about insertional pain and what women report experiencing.
This is a medical trauma issue at its core. The breakdown in communication regarding patient pain preparation and experienced pain doesn’t only have temporary effects, it impacts women’s willingness to get another IUD in the future.
In a Harvard Medical School study that compared women’s insertion experiences of either the IUD or birth control implant (two of the most popular long-term options), the future implications of painful IUDs are clear. While only 8% of women in the implant group reported that the pain from insertion would stop them from getting the same device in the future, a whopping 43% of the IUD group reported the same.
By tying these numbers into a larger conversation about informed patient consent, it becomes clear that there is a need for medical professionals to rethink how they talk about IUD pain expectations and management with patients. Until then, health care providers are inadvertently robbing patients of choice in the future. American women have already been robbed of enough reproductive choice.
The tragedy of the matter is that intrauterine devices are a genuinely revolutionary birth control option: they are convenient, highly effective and come in both hormonal and nonhormonal options. But what good are these benefits if many women are too traumatized from previous insertion experiences to continue using the IUD? While pain may be an unavoidable part of the fitting process — at least for over 70% of nulliparous women — providers need to start being candid about it upfront. I know I would have felt less terrified and confused as I writhed for hours if I’d been given a proper heads-up.
Lowering the number of traumatic IUD experiences begins with knowledgeable communication and ends with fully informed patient consent. Tell us to prepare for the worst, even if it never comes. Tell young women who have never given birth that they’ll likely experience pain, maybe even severe, from insertion. Being upfront is the starting point to redeem the IUD’s reputation.
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