New Guidelines Address I.U.D. Insertion Pain and Offer Management Options

Live|New Guidelines Call on Doctors to Take IUD Insertion Pain Seriously

A national organization that sets practice standards for physicians has for the first time outlined how doctors can give patients pain-relief options during the insertion of intrauterine devices and other common gynecological procedures.

The new guidelines, published today by The American College of Obstetricians and Gynecologists, urge doctors to “not underestimate the pain experienced by patients,” marking a significant change for the organization. In years past, ACOG acknowledged that common gynecological procedures can be painful, but stopped short of recommendations because of mixed evidence on the efficacy of pain management options. These new guidelines echo those issued for I.U.D. insertion pain by the Centers for Disease Control and Prevention in the fall, but are more expansive in that they cover pain management for a range of other procedures, including cervical biopsy, endometrial biopsy and intrauterine imaging.

To decrease the pain associated with these procedures, ACOG now recommends either an anesthetic cream, a spray or an injected local anesthetic known as a paracervical block.

The change is in part a response to a groundswell of complaints from patients on social media, in the news and directly with physicians. “There’s really a push from our patients to understand what the options are — what’s available to them,” said Dr. Kristin Riley, an obstetrician-gynecologist and co-author of the new guidelines. “I mean, we’re all on social media, and we all see it,” she said. That feedback was “certainly on our minds.”

After assessing available data on pain management, the group acknowledged that evidence on effectiveness during common gynecological procedures is still conflicting and limited, but noted that doctors should advise patients on what to expect and discuss the options. The organization also noted that particularly vulnerable populations, including those with a history of chronic pelvic pain, sexual violence or abuse, or substance use disorder, should be given special consideration as they may have a different pain tolerance than other patients, or a resistance to pain medications.

The update represents a positive shift for an industry that has in the past been accused of dismissing female pain, said Dr. Ashley Jeanlus, a private practice gynecologist and complex family planning specialist in Washington, D.C. “ACOG is making it very clear that we should be treating our patients with equity, dignity and trust and ensuring that they’re not expected to kind of tough it out anymore.”