Some U.S. clinics offer routine sedation for IUD pain, saying it 'shouldn't feel traumatizing'

The pain has been de‐ scribed as agonizing, sear‐ ing and excruciating.

Having a highly effective contraceptive called an in‐ trauterine device (IUD) in‐ serted can cause significant discomfort for some people, and a growing chorus of health-care professionals and patients has been calling for better pain management during the procedure.

Now, a Planned Par‐ enthood location in the U.S. has made headlines for an‐ nouncing it will start offering routine sedation to patients during IUD insertions and re‐ movals, explaining that ac‐ cessing reproductive health care shouldn't invoke fear, and that the procedure "shouldn't feel traumatizing."

But as some people ap‐ plaud the move, the presi‐ dent of the Society of Obste‐ tricians and Gynaecologists of Canada (SOGC) says rou‐ tine sedation has the potenti‐ al to limit access to a highly effective form of contracep‐ tion.

While sedation can be of‐ fered to some patients here who can't tolerate the inser‐ tion in an office setting, it re‐ quires more monitoring, emergency services and an outpatient surgical suite or an operating room, said Dr. Amanda Black.

That can be limiting, she said.

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"We don't do it routinely," Black told CBC News.

She said sedation is not something most providers can do in an office setting, and not all practitioners have easy access to an operating room.

"We can't minimize the fact that people have had un‐ pleasant experiences with IUD insertions. What we need to do is figure out how to improve that experience for them moving forward."

'Way too common' for patients to not get any pain management

About 159 million people worldwide use IUDs, ac‐ cording to 2019 data com‐ piled by the United Nations.

It was the third most com‐ mon form of contraception globally, after female steril‐ ization and male condoms, and just above the pill.

It's also one of the most effective forms of birth con‐ trol, and a "recommended first-line contraceptive method," according to the SOGC.

The SOGC describes IUD insertion as a rapid outpa‐ tient procedure that can be completed in five to 15 min‐ utes.

During the procedure, a small, T-shaped device is in‐ serted through the cervix in‐ to the uterus. In its insertion guide, the SOGC mentions the possibility of "brief mo‐ ments of sharp pain," espe‐ cially when the device passes through the cervix.

Some small studies have found most people describe moderate to severe pain dur‐ ing insertion. Social media platforms like TikTok are full of people describing their negative experiences.

One study of the top 100 videos tagged #IUD on TikTok found that all of the videos conveying patient experi‐ ences had a negative or am‐ biguous tone, and almost 97 per cent highlighted pain and other side effects.

It's "way too common" for patients not to get any pain management while under‐ going the procedure, Dr. Joss Reimer, the Winnipeg Re‐ gional Health Authority's chief medical officer, said in a 2023 interview with CBC Manitoba's Information Radio.

"It's a long-standing prac‐ tice where we just don't value the pain of women the same way we do men, and expect them to go through painful procedures that we wouldn't expect in other circum‐ stances."

LISTEN | Dr. Joss Reimer on IUD pain:

In a statement on April 2, Dr. Colleen McNicholas, the chief medical officer at Plan‐ ned Parenthood of the St. Louis Region and Southwest Missouri, said the organiza‐ tion has been listening to people calling for better pain management solutions and will now offer sedation for "patients who prefer it."

"We're offering sedation to give patients a greater sense of power and control over their bodies and their care," McNicholas said.

Several other Planned Parenthood locations in states in the U.S., such as Massachusetts and Arizona, appear to offer oral and in‐ travenous sedation, as well.

They note that sedation carries increased risk, and patients will not be able to drive themselves home after‐ ward.

Pain management op‐ tions

Every patient is different, and it's important not to dis‐ miss the pain and discomfort someone may experience, said Black, with the SOGC.

"We can definitely do bet‐ ter than we have in the past, and we are making changes to how we do our IUD inser‐ tions because of that," she told CBC News.

Those changes include taking a more individual ap‐ proach, she said, and telling patients ahead of time that they may experience discom‐ fort and cramping - some much more than others. Doc‐ tors should also make sure patients understand that they're in control, and can stop the procedure or take a break at any time.

"In the past, we were somewhat reluctant to use any type of pain medication or anesthetic to try to help with the procedure, because we thought it would actually hurt more to do that, but I don't think that's necessarily the case for all patients," Black said.

But there are options. Patients can take anti-in‐ flammatory medications ahead of time or immediately after the insertion, she said, and doctors can be ready to inject a local anesthetic or use an anesthetic spray.

And just recently, there's the option to use an inhaled pain medication that the pa‐ tient controls themselves during the procedure, Black said.

"At the end of the day, the majority of patients do well."

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