The gender pain gap continues with IUD fittings

An intrauterine device (IUD), or what is more commonly known as ‘the coil’, is a contraceptive for women (1). IUDs sit inside the uterus and change the way sperm cells move to prevent pregnancy (1). Given the location of the device, the fitting of the IUD is an invasive procedure, involving the insertion of a T-shaped plastic and copper device through the cervix and into the uterus (1). Although many women only experience slight discomfort during the procedure, others have reported excruciating pain, comparing the agony to childbirth, or to breaking a limb (2). Despite these accounts, pain medication is not usually offered for the fitting (3). Instead, women are merely advised to take ibuprofen and paracetamol before or after the procedure (3). This was the case for the BBC television presenter Naga Munchettty, whose experience is outlined below.

Last year, Naga Munchetty spoke out about her incident with having an IUD fitted in a BBC Radio 5 Live show (2). Munchetty reported that she felt ‘violated’, and the broadcast also featured callers who spoke about their own negative experiences with the procedure (2). In their own descriptions of having IUDs fitted, the callers all stated that there was no offer of pain relief or warning about the possibility of experiencing extreme pain (2).

Although anaesthetic gels or anaesthetic injections can be used on the cervix, these treatments are not usually offered (1). Therefore, since IUD fittings have the potential to induce excruciating pain, the question stands as to why these medications are not used as a standard procedure?

Interestingly, one study emphasises that the forewarning of pain in IUD fittings is crucial in reducing the physical pain of IUD insertion (13). The study which focused on the insertion experience found that there is a high prevalence and severity of preprocedural anxiety among women receiving an IUD (13). Therefore, the authors suggest that because of this severe anxiety, local anaesthetics alone are unlikely to considerably improve the experience of receiving an IUD (13). This is because they found that greater anxiety surrounding the anticipation of the procedure might be associated with increased pain perception (13). They also found that an imbalance between pain expectation and reality was extremely common, suggesting that healthcare providers may not be providing appropriate counselling about the range of pain severity which can be experienced in IUD fittings (13). As follows, they suggest that future IUD studies should investigate preprocedural counselling to improve the experience of the procedure (13).

Due to gender-based stereotypes, women have a reduced status as credible givers of knowledge about their bodies (4). These stereotypes have influenced the treatment of women in healthcare services, due to the tendency to view their accounts of pain as overreactions or exaggerations. The lack of appropriate medication offered in IUD fittings demonstrates the reluctance to acknowledge the severe pain that women can experience during the procedure (2). Consequently, having an IUD fitted can cause severely high levels of preprocedural anxiety and trauma from enduring the pain (13). Thus, it is vital that healthcare services begin to offer more sufficient pain relief for the fitting process.