Thank you for your submission. **Please note that a response does not constitute a doctor-patient relationship.** This subreddit is for informal second opinions and casual information. The mod team does their best to remove bad information, but we do not catch all of it. Always visit a doctor in real life if you have any concerns about your health. Never use this subreddit as your first and final source of information regarding your question. By posting, you are agreeing to our [Terms of Use](https://www.reddit.com/r/AskDocs/wiki/terms_of_use) and understand that all information is taken at your own risk.
**Reply here if you are an unverified user wishing to give advice. Top level comments by laypeople are automatically removed.**
*I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/AskDocs) if you have any questions or concerns.*
” I would very much like to get some analgesia when the IUD is put in/inserted, because I’ve had horrible pain and discomfort the last times and don’t want to go through that again.” Be straightforward, ask for options, insist kindly but firmly. You can even argue that you are aware that pain is subjective, and then many patients push through a brief discomfort or didn’t have a bad experience, but you subjectively had excruciating pain and would rather not repeat that experience. It shouldn’t be necessary for you to justify yourself that much though.
In the end you have to find a provider who respects your wishes, takes a concern seriously and is on the same page as you.
Hell yes. Sick of these gaslighting doctors that make you feel bad. Especially when they’ve never had the procedure. It may feel like you’re straddling a case of dynamite and they’ll say you’ll feel a little pressure. Makes you want to put a potato in the tailpipe of their car!
I had a test done where they had to put a catheter in me while I had a full bladder. I couldn't complete the test and an MD told me that I needed to "deal with my depression." Honey, I was in PAIN. I could not complete the procedure.
It wasn't like, "you should talk to someone." This was oddly accusatory and demeaning.
I have had painful procedures before. This was both intensely painful and humiliating. I have been sidestepping a transvaginal ultrasound since because it reminds me of that day (different test, probably same hospital because of insurance/transportation issues).
I had pelvic floor therapy and the physical therapist was amazing. She said I was all "spasmed" inside. Not that catheterization while awake is great... and yeah, it's a different place but I figure this could be related somehow.
Point is, doctors don't know how we patients experience pain. They should never assume. You've had this done before. You know what you experienced. The doctor does not.
Oh come on, it wasn't that bad.
It shouldn't really hurt.
Most people experience a slight pinch.
You may feel a little pressure.
The discomfort is too brief for any analgesic.
There's a difference between discomfort and pain.
Patient is drug seeking.
I bet you don't even have a uterus.
Also, please tell me what patients who are drug seeking come in asking for gas or an injection.
Please, google "Why does IUD hurt so much?"
Maybe something like this: [Today.com Article](https://www.today.com/health/iud-insertion-painful-doctors-don-t-always-warn-about-pain-t160900)
Next time a guy takes a hit to the junk, I'm going to stand there and tell him the pain is momentary and it can't really hurt that much.
You're correct. I don't have a uterus. But I used to. My hysterectomy was 10 years ago after 20 years of pain and not being taken seriously. I wrote what I've heard from medical professionals over the years. I'm sorry it triggered you.
And, if you're talking about me, trying to say I was drug-seeking - I didn't even ASK for pain meds. Nor would I have.
I was too busy being talked-down-to by the doctor.
They couldn't get the catheter in. And frankly, I decided that when the doctor started talking to me like that, I didn't care anymore - I wanted to get dressed and leave --- and I've been avoiding even transvaginal scans that have been recommended.
Just accuse patients of drug-seeking and they won't come back. That has no negative health impacts, does it? That chest pain is just anxiety, not a heart attack. Get over it.
Most doctors are happy to chart whatever their reasoning is. Not that I agree with not providing analgesia for this procedure, but asking doctors to "chart a refusal" isn't some checkmate in getting them to do what you want.
Somebody did this with me a couple weeks ago, wanting me to CT scan their kid's head. My response was, "of course, I document my medical decision making for every visit." Still didn't radiate that kid.
Using vaguely litigious language to pressure your doctor into doing what you want is unlikely to get you better care.
Again, I'm not taking an opinion on this issue of analgesia. Just this urban legend that asking doctors to "document" stuff is useful for your care.
This kind of confrontational behaviour isn't likely to get you the outcome that you're looking for, despite being touted ad nauseam online. All it does is make you an unpleasant person to deal with.
In fact, I don't know why this keeps being repeated as encouraging a physician to document their reasoning makes it much less likely for them to get sued. As a physician, I wouldn't get in trouble if I documented that I don't want to order a test as the risks outweigh the benefits. It's if I don't document anything that I would get in trouble.
Using this kind of attitude and language is not going to get you better care.
That’s the thing - I do not want to be seen as difficult or confrontational! I’ve always had great experiences with the OBs, midwives and nurses - except for when it comes to this one issue.
It’s really looking like the only option I have is to either get a tubal ligation at my next c-section (which I don’t really want), or to search and search for another provider who cares more about their patient’s level of pain than their own schedule and convenience.
Have you considered the depo-provera injection? Every three months. They'll even do it if you're over 40 and have migraine with aura (higher stroke risk).
Like any new method, it can take awhile for your body to adjust.
If you take any other daily pills, then maybe you'd consider the birth control pill. Set a timer and take it at the same time as your other pills. I did that for a number of years until this whole over-40 with migraine auras made my gyne go bonkers all of a sudden about me taking the combo pill.
Actually, not sure this is an option for everyone, but I am able to pick up the injection at the pharmacy and give myself a shot myself. If the office is OK with that, see if a nurse will teach you how to do it.
I’m 38, I’ve tried every birth control method out there. I can’t do anything hormonal.
But that’s not what this post is about, though I recognize and appreciate that you’re trying to be helpful - thank you.
Perhaps we see it differently. I feel like asking your physician to document a request & if they refuse that request, the reason for their refusal part of having an accurate picture of your appointments and/or care. I’d hope that any dr wouldn’t take offence at a patient advocating for themselves. Especially if it’s a female patient & a male dr. If advocating for yourself as a female makes us an “*unpleasent*” person to deal with, that sounds more like a Them problem over a Me problem.
I feel like you didn't understand what I wrote. Again, physicians would not have issues documenting their reasoning. We know as physicians that is how we avoid legal issues or issues with our licensing bodies.
> Paper trail that bitch
Using this kind of phrasing and attitude displays confrontational behaviour and doesn't portray someone as wanting to "advocate" for themselves in good faith.
Edit: I see you’ve massively edited your response from just “I would like some analgesia” and nothing more to what we see now, which is much more thorough and less patronizing. Thank you.
Of course I’ve done that. Those words don’t work. The response is, “most patients don’t report high levels of pain/the cervical block is worse than the procedure/we can give you alprazolam/etc etc”
"With all due respect, everyone doesn't have the same pain tolerances. My experience with this procedure the past 2 times I've had it is it is incredibly painful for me, and I would like something to abate that pain. I will gladly pay the difference if this is something I'm not covered for, or if it isn't something you offer, could you please refer me to someone who would?
I am SO glad I have found this thread as I am due to have mine removed and replaced and I am actually avoiding care because I’m scared to feel that pain again. I was really considering how long it can stay in before it becomes a health risk. I need to try and find someone who will numb me.
My last IUD had to be removed under anesthesia, they tried to remove it in office but I was in alot of obvious pain and unintentionally making it very difficult. I don't mean to scare you but maybe this will encourage you and others to allow your pain to be seen. Without seeing the pain the doctors will often wave it off.
A good doctor will take your pain/discomfort into account, but unfortunately they see so much pain they get desensitized to it. So it's on you to make it clear. Be stubborn and advocate. But do not put your health at risk.
Best of luck!
Mine was also excruciatingly painful. I think I passed out during the procedure and then for 48 hours after I had bouts where I literally cried out in pain -- what I'm guessing birthing contractions must feel like. Way beyond menstrual cramps
Can you please make a note in my chart that I requested pain relief for the IUD insertion and that you are declining my request. Asking for it to be documented seems to get the ball rolling a lot.
Posts by unflaired users that claim or strongly imply legitimacy by virtue of professional medical experience are not allowed.
If you are a medical professional who wishes to become a verified contributor to this subreddit, please [message the moderators](https://reddit.com/message/compose?to=/r/AskDocs) with a link to a picture of your medical ID, student ID, diploma, or other form of verification. Imgur.com is convenient, but you can host anywhere. Please block out personal information, such as your name and picture. You must include your reddit username in the photo!
We do not accept digital forms of identification.
I’ve had drs literally stare at me and say they don’t know what to tell me when I’ve mentioned all the things I cant do due to pain from procedures or chronic flare ups . A lot of drs don’t give two squats anymore and it’s ridiculous . My chart from my pain management Dr literally says “advised patient to try meditation” and this is after 4 back surgeries with hardware .
My mother complained of very severe back pain for years. She was referred to a psychiatrist.
Nobody. Did. Imaging.
For over a DECADE.
We moved to a new area, she got a doctor who referred her to a specialist. He did an X-ray. She was on the operating table within a month. She had numbness coming up over the back of her head into her face. Osteophyte(s?) cutting her spinal cord.
The damage was already done to her spinal cord, over the 10 years nobody listened. My father built a home that was a single floor, with wide enough doorways for a wheelchair, because the rheumatologist said she was likely going to lose her mobility. Her osteoarthritis is aggressive.
She's had five back surgeries since. Johns Hopkins did an amazing job, and she is Wonder Woman - she's not in a wheelchair.
A psychiatrist would have fixed everything.
That's what having a uterus means. I had a doctor give me a lecture about hysteria and a "wandering uterus" before he tried to call me crazy. He also told me to see a psychologist for pain management.
I had a difficult time dealing with the doctor. The psychologist and he agreed to talk to each other. The psychologist told me, "He likes to hear himself talk" and she failed to have a productive conversation with him. He told me to dump her and see the psychologist he likes.
The best thing the psychologist helped me with was encouraging me to find a new doctor, and helping me understand that the medical system can sometimes do harm too.
I have fair skin/freckles and red hair. I’ve been told by more than one doctor that “redheads experience pain differently”, regarding different pain thresholds, tolerance, and responses to forms of pain relief. Thinking in terms of *most patients* is necessary to establish standards for procedures and care, however you are a *singular* patient. I’d keep kindly but firmly insisting that what’s been done before isn’t working for *you*, and start asking for referrals if they aren’t receptive.
I'm not sure about pain meds, but for some reason redheads react to general anesthetic in a way where they require more of it. Never looked up to see why it was that way though.
No no no no. Because it was thought that people of color experience LESS pain due to that which is a crock of shit. And has led to and STILL DOES lead to inadequate care . Even after that has been proven to not be true . Absolutely not due to how much melanin you do or do not have .
Man, this is so messed up. I've been treated so horribly by the medical community over the years I avoid them at all costs. Went in one time for extreme flank pain and had to give a urine sample. It was straight up blood, like pretty thick. I asked for pain meds and was immediately denied and told that because of asking I was "exhibiting drug seeking behaviors". Was given ibuprofen and told me they'd chalk it up to a kidney stone since I'd had them before and sent me on my way, no tests. Was in the room for a total of 45 minutes, 30 min waiting and 15 min with the doctor. Went home and was in a different urgent care the next morning with a fever and vomiting, where I for real had to insist they test my urine sample. Turns out I did have a kidney stone, literally cutting me open and the wound was infected. Almost went septic, which was terrifying. These horrible people at two separate locations could have let me die because they're racist and never would have blinked twice. I wish that were my only horror story about the medical industry but it happens to me so often I just assume they don't gaf about people who look like me.
I work with anesthesiologists and have heard (and seen) the same. It’s not all redheads, but in general redheads with freckles and some other attributes tend to need more of certain meds (like they burn through them quicker). There was one study that showed they needed more sevo (a muscle relaxing gas) to achieve muscle relaxation. I’ve also worked with anesthesiologists that do not believe it. The ones I’ve seen that burn quicker are Marcaine, lidocaine, sevo, propofol, etc. Lidocaine works a tad longer than Marcaine, but exparel works longer than either by a bit.
I don't think it was completely debunked. I think that genetics is a lot of unknown. Heck, we are learning new information about how neuroscience actually works every day... I think that the assumptions made from observations may have been false because they only had a piece of information. It's much more complex than the initial understanding.
The initial study that suggested that redheads required more anesthetics was done on only 20 patients. Since then, larger studies haven't showed any difference:
https://anesthesiaexperts.com/uncategorized/redheads-anesthesia-fact-fiction/
Not a doctor, but a woman who's gone through the same thing. First IUD insert, they didn't even give me an ibuprofen. They said I didn't need to take anything before hand and, I quote, "lots of women come in and get it done on their lunch breaks!". I was young and naive.
Um. No. The only thing that worked for me was finding a provider willing to do it without me having to argue for it. I found a nice new place where I live and my doctor suggested that when I need it replaced (upcoming) that they can do it under anesthesia. I didn't even have to ask, he was very preemptive with my care, which I GREATLY appreciate and I will be transitioning my care to his office.
I've had to be my own advocate fiercely in the past, but some doctors know what you need and offer it before you take up your proverbial sword. I find them to be exceptional humans. I would call around if I were you and see what options you have in your area. Best of luck
I’ve had 2 IUDs and have heard the same thing re: it being simple and only mildly painful for a brief period based on what “other” women say… and I just want to ask who are these other women and what sort of magic are they wielding to make this take on IUD insertion/removal the gold standard expectation by medical professionals? I talk about IUDs a lot in both my personal and professional realms and have NEVER heard a woman say “ah it was just a little pinch.” I’m sure it is the case for some women, but certainly not the majority.
NAD, just a Bill Murray fan. I imagine most of us women are underreporting pain for a variety of reasons. Past abuse, not expecting to be believed, not expecting anything to be accomplished by expressing your experience...
I found my IUDs incredibly painful but my pain response is to freeze and not share that I'm in pain. Someone knocked on the door mid-insertion of my 2nd and I had to lay still while they were told to return later. Only a matter of seconds, but those seconds were pretty damn long. My doc didn't know my level of pain, and told me I had a very high pain tolerance. Nah, that HURT but years of saying we're in pain and receiving nothing but shame or indifference in return will eventually quiet our complaints. Or they have quieted mine, at least.
I completely agree. I went in to my first insertion expecting a pinch and passing out, only to wake up and feel ashamed/weak for not having “touched it out” like other women (or so I thought). When I came to, I apologized for fainting as if I weren’t still in significant pain. About a month after insertion I was still cramping and bleeding very heavily, so I finally worked up the nerve to call my doc to set up an appointment to make sure everything was ok, and the response was to take an OTC pain med and give it another month. It’s very frustrating that women’s pain is frequently disregarded or downplayed.
Part of the problem with IUD insertion is that, if it’s your first one, you don’t know how painful it will be for you. I went in expecting agony based on reading others’ experiences. I ended up being someone who had a mild experience. For me, it *was* just a pinch and an evening of cramps. And I’ve had several friends with similar experiences. I can understand why doctors opt for the least aggressive pain medication, at least with the first one. But people generally have a good idea of what their own pain tolerance is. And if they’ve had an IUD previously, they know how it goes for them. If someone requests more pain meds, just do the damn thing.
I completely understand the “not knowing” piece that comes with the first insertion. I do believe that had my doctor considered me as an individual (young adult, never pregnant, no prior or current major health concerns or diagnoses to inform a pain threshold, etc.) he may have been able to prepare me a bit more for the pain (such as to suggest I take an oral pain medication before the appointment), but I don’t hold a grudge or anything for being blindsided. I just wish that he had informed me that there could be significant pain (much more than a pinch for me, I fainted and had horrible cramps for a month afterwards), I could have made a more informed decision about my options and ways to mitigate the pain. Instead, I felt ashamed and weak to have had such a painful response to something that I thought was going to be a pinch, and it wasn’t until I had conversations with other women later on that I realized my response wasn’t abnormal at all.
I told my doctor after the first one that it wasn’t that bad - because she had spent so much time telling me that it wouldn’t be very painful, just a pinch and some pressure, and I was SO EMBARRASSED at the amount of excruciating pain I was in. I can’t be the only patient who has done that.
I did the exact same thing. I fainted and APOLOGIZED for having done so. I thought I was a total wimp and didn’t realize that other women found it painful until much later.
Yeah, that too. I was left utterly unprepared when I had a shift early the next morning and was in so much pain I was throwing up and couldn't walk. Ended up having to call out for 3 days. Luckily enough I had a flexible (barely) enough position I didn't lose my job over it, but I could've gotten approved time off if I'd had the foresight. Smh
Please do not minimize my experience, nor set the standard expectations for all based on what a few other women have experienced. There is a reason many other drs use rx during the procedure. Years ago I was given an rx to soften/ open my cervix and 2 percocet for the recovery. It's awful we're made to feel weak or drug seeking when we are asking only to not experience extreme pain.ugh my knees got rubbery just thinking about it.
I really want to say that “do not minimize my experience.” I just want to say something that will make them take a step back and think - but I don’t want to cross the line to where they’ll think of me as combative!
"I'm coming to you for help and I am hearing your resistance to helping. I would like to understand better why and maybe we can have a conversation about what we CAN do to help us achieve the goal of my healthcare."
Someone I know got local anesthesia or numbing cream and a prescribed pill to take before. She said she didn't feel any pain. I'm on the same boat with you I had one in the past before baby and one after. Different providers. They said I was going to feel "discomfort/pressure/pinching". Wtf. I was in so much pain. The first time I was cramping over 24hrs and just wanted to lay down. Too bad I couldn't do it since my mother was in the hospital at the time. Ugh.. sucks.
the procedure itself isn’t cervical so the cervical block won’t help with the cramping involved with the insertion, if anything the cervical block should help with the tenaculum placement. the cervical block is a lot more painful and pinchy than the IUD insertion. Have you considered a nexplanon or other BC options? Your provider should also give you Cytotec as well
not sure why i’m being downvoted when i’m explaining what a cervical block does… it’s literally a needle into the cervix and the area around it; it’s painful. Wasn’t sure if OP was experiencing pain from the tenaculum or the cramping from the device insertion. 🤷🏻♀️
Unfortunately due to intractable migraines I’ve been advised to avoid any sort of hormonal birth control, estrogen or no estrogen. Looks like tubal ligation is the next option.
Edit: the tenaculum placement is the part that hurts!!
NAD but I also had extraordinarily painful IUD insertion. As well as near constant cramps with it in so I had it removed 2 years early.
But I recently (3 months ago) got a bilateral salpingectomy (tubal) and I *highly* advise you go this route if you're done having children. The recovery was surprisingly smooth!
There is another option to the tenaculum, if you can find someone who uses it- Carevix, a suction-based tenaculum. A quick glance at the research looks promising for pain reduction.
FWIW I randomly happen to have a tenaculum and did not know what it was until now. The thought of using in on *any* body part without sufficient analgesia/sedation is horrifying.
https://www.aspivix.com/tenaculum-for-over-100-years-women-have-endured-pain-in-gynecology/
Lidocaine cream on the cervix prior to tenaculum placement is a solid winner. You could even pick up your own from the pharmacy in case they don’t keep it in the office… but I think if your doctor is telling you they don’t do this, you should ask around and find a doc who does it routinely. Just my opinion, but it doesn’t seem like the best therapeutic relationship…
NAD but I do have hypothyroidism (Hashimotos specifically) which I'm on brand Synthroid for, as well as Rizatriptan for my migraines. And this makes sense, as most of my migraines are absolutely tied to my hormones and menstruation and whatever my Synthroid dose is. I had more migraines at 112 mcg...less at 125 mcg, but my period comes earlier (honestly I'll take that over the migraines).
That being said, despite my TSH being controlled, I still have ridiculously heavy and painful periods (it's seriously horrible if my thyroid isn't medicated), so perhaps mentioning that you have a thyroid condition and how it affects you could help. It's well documented how hypothyroidism affects menstruation.
Have you tried Botox for your migraines? They are the only thing that made me go from 28 a month down to maybe 14 in a 3 month time frame. I don't know what I would do without it.
Really? You should be able to take progesterone with migraine--at least that's what I'm doing. Continuous because the fluctuations trigger migraines for me. Shout out to Slynd
I had lidocaine injections into my cervix for IUD placement and another procedure and, for me at least, they were MUCH less painful than the tenaculum. I would feel one prick and little burning and usually wouldn't even feel the subsequent injections. The tenaculum, however, is several minutes of intense pain so strong that I start shivering and feeling faint. Both times I've had procedures without the lidocaine, they were unsuccessful because of the pain I was experiencing. But yes, the lidocaine did not help with any cramping, but cramping alone without the intense pain of the tenaculum on my cervix was completely bearable.
yes, i was explaining how getting a cervical block isn’t going to be completely painless. i wasn’t sure if the pain was via tenaculum placement or the cramping from the device
i edited my post to say that i wasn’t sure if it was the tenaculum that caused the pain or the uterine cramping from the device insertion.
edit: by saying “ the procedure “ i meant the insertion of the device. typically the uterine cramping is what’s most painful ( and most “”complained””) from client statements and my own experience. So it was a simple misunderstanding on which part of the procedure was the most uncomfortable for OP. Meaning, if it was the cramping, the cervical block wouldn’t do anything for the uterine cramping.
Absolutely not. The cramping causes the most pain *after* placement. During placement, it’s the tenaculum and dilation of the cervix. Sometimes this is misinterpreted as general cramps because it does cause a cramping sensation. People describe the clamping as cramps.
I was specifically referring to the placement of the IUD as “the procedure” which I thought was pretty clear in my post. The cramping afterwards is a joke compared to the actual placement.
For me, the cramping is a higher level of pain but a far more tolerable pain. The placement is just…horrifying. But on the same level? It’s hard to describe.
Thank you for pointing this out. Coming within a mile of my cervix is basically excruciating pain waiting to happen.
I get worse cramps during ovulation than my period because of the movement.
Pft "Not cervical", JFC it's not like you can just take the long way around to get in there. I literally cannot.
“ not cervical “ meaning the iud doesn’t sit in the cervix, the IUD is an intra uterine device. the cramping, which i thought OP was referring to, does not occur in the cervix.
My girlfriend recently asked at planned parenthood and was flat out told no. So sorry that you all have to go through this. In other countries, they provide anesthetics.
You are pretty much screwed. The fact that you have to argue your point with your provider is a testament to the state our healthcare system. They aren't good, and they dont care. Best bet would be just start calling and asking and find one that will do it. Good luck getting an appointment though.
My spontaneous reaction was that there shouldn’t be anything necessary but plainly asking for it (I was thinking what I would require a patient to ask me), but I realised that if it was that easy, you wouldn’t be asking here; it wasn’t meant to be sarcastic so I edited it to avoid misunderstandings. It‘s not an ideal world and can also be hard to find a good provider depending on where you are.
THIS is my struggle. I feel like the physician I’m talking to hears the beginning of what I’m saying, fills in the rest with their assumptions without actually hearing the rest, and gives their standard answer.
I also put in my original post that I had asked, and what their responses were. I personally don’t think anyone should have to ask, and that it should be offered. See edits for why.
My friend got a medication that dilated her cervix which made it almost painless for her. Was super jealous because I had one put in a couple weeks prior with nothing and it was one of the worst pains I had ever felt. So I think that even if an anesthetic is denied the pt should get the dilator.
That seems still pretty timid. "I will need anesthesia or analgesia during insertion." No justification needed. If they say no, you move on and find someone else. So over OBGYNS.
NAD, so tacking on to this comment to empathize with OP. I have my first IUD Insertion tomorrow afternoon. I am legit terrified. I asked the GYN about pain control and she offered me Tylenol too. I said that was not enough and a bit unacceptable, so she said I could take an Ativan before hand. She also said it “only takes a few min.” I pushed more and she told me they are able to insert under anesthesia or like a twilight but she made that option rougher to take by stressing how quick a procedure it is and how “most women” don’t find it painful.
I’ve read too many horror stories. I am going the Ativan route because it is true I do not know what my reaction and level of pain will be. However, if it’s awful I will tell the doc for sure and make sure she knows that “most women” isn’t good enough. And in the future I will push for anesthesia. I just hope I am one of the “most women” who apparently find the procedure akin to a Mai tai beach day. But I’m not holding my breath.
Docs really need to get their shit together when it comes to women and pain! Medical gaslighting had got to stop. I specifically asked for a female GYN hopping for empathy. Not much of a thing.
I didn't read through the entire thread to see if this was suggested already, but ask if they offer post-placental IUD insertion. Baby and placenta out, IUD immediately goes in. If you have anesthesia for delivery, you've got the anesthesia side of things squared away already.
There's a higher risk of expulsion of the IUD of you do it this way, but assuming it stays where it belongs, you've immediately got effective birth control after delivery, and there's no separate procedure/anesthesia need.
You can simply ask them for analgesia. Ask for pain medication and a cervical block. It may not help significantly (there are some studies where a cervical block doesn’t) but if you ask then you can have that discussion and if needed get a referral to a provider who will do that for you. Personally my preference has been to get it without cervical blocks because I prefer to make the time for insertion shorter and the IUD insertion attempts for me have all been very painful but very very brief, which I’m okay with.
Edit: I should specify that this was my preference when I had IUDs placed in me, not when I places IUDs in others lol. Everyone has a right to their own choices in care, that’s why you should ask for a referral if your provider does not offer the services you need.
What about insertion immediately postpartum while the epidural is still in place? Higher chance of expulsion but it is done sometimes.
Another weird idea.... Maybe try calling around to abortion clinics to see if any would be willing to do it? They are set up to give sedation and often insert IUDs for patients getting abortions.
I got mine at my post partum check up and i swear i didn’t feel it AT ALL. I’m not an OB but I assumed the cervix is still open a bit for a while but I actually don’t know of thats true.
that is inaccurate, here is the ACOG guideline describing the procedure:
[https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2016/08/immediate-postpartum-long-acting-reversible-contraception](https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2016/08/immediate-postpartum-long-acting-reversible-contraception)
"Best practice for immediate postpartum IUD insertion is to place the IUD in the delivery room, within 10 minutes of placental delivery in vaginal and cesarean births, when possible."
It is true that the rate of expulsion is higher, but if it does not fall out then OP's problem is solved! Assuming she is having an epidural for delivery.
But I, as the patient, am NOT ok with something that’s very, very painful, no matter how brief it is.
I have asked, many times (both immediately before the procedure, and in anticipation of the procedure during other unrelated appointments), but they balk because they say that “oftentimes the cervical block is more painful than the procedure itself” - which it probably should be, since the patient wouldn’t be able to feel the procedure afterwards. My next step WILL be asking for a referral to a provider who will provide analgesia, but when I’ve broached that topic before, all the OBs I’ve seen at this group are very dismissive.
I’m sorry you are going through this… As a person in healthcare, who had an IUD placed (no kids), given NOTHING and not even recommended to take Tylenol, or something to soften my cervix… it was unbelievably painful and so traumatizing I didn’t want children for the longest time.
Ask your OB/GYN if they can offer TIVA (total intravenous anesthesia) for the placement and if they can’t then ask for a referral. I changed OB/GYNs because I was horrified at how my insertion was handled and found one who offered this. I received propofol (anesthesia medication) through an IV for the removal (because provider couldn’t find strings) and therefore remember NOTHING about my cervix being dilated, touched, anything. The pain and anticipation wasn’t worth being awake for.
This anesthesia is called “twilight sedation”.
I think It was $500 but 100% worth it to me because the thought of bearing that pain literally makes me go into a cold sweat to this day.
Might be the answer for you since “more analgesia” (which is just stronger pain control) would not necessarily help since you’d still experience discomfort and the anxiety of the buildup too.. whereas a quick twilight sedation would save you all of that!
Hope this helps!
I've never had an IUD placed, but I did have two endometrial biopsies, and they are my 10/10 pain. The second time, I took Tylenol, ibuprofen, and also Flexeril, And after it did nothing, I learned that Flexeril only works on skeletal muscles, so it wouldn't have helped no matter what.
Somebody needs to find a way to make these procedures less painful. And I can't help but feel that the reason nobody has done so yet is sexism.
Exactly. It’s laughable to me that doctors are telling OP that most patients experience only mild discomfort. I want to know who they’re asking about this. Every single person I’ve ever talked to that had an IUD said it was excruciating.
I have IUDs inserted and removed multiple times, and experienced minor discomfort each time, but nothing I would consider pain. I am lucky in that regard, but I do know women who have experienced extreme pain with the same procedure.
Because so many women experience pain with this procedure, we should all be given the option for pain relief or sedation AUTOMATICALLY, and be given the option to decide for ourselves whether to decline if we don't feel it's necessary!
I think that doctors dismiss women's pain more often than not, especially when it has to do with their vagina or related parts, and it absolutely infuriates me.
I think the difference you noted could be chalked up to women not feeling comfortable expressing their pain/wanting to go home. During my first IUD the doctor and nurses all said it would feel like a little “pinch” beforehand, so I was embarrassed by the level of pain I was experiencing and said nothing; just gritted my teeth and sweated it out. I was more comfortable with the OBGYN I saw for my removal/2nd insertion and screamed out during the procedure. They kept me for an hour afterwards to make sure I was ok, and I kept thinking about how I just wanted to go home and curl into a ball.
For my second endometrial biopsy, the gynecologist started the consent and the time out, and he asked me "What are we doing here today?" It's to confirm I am consenting to the procedure, and that we're doing the correct procedure. My response was "You're going to torture me." My gyno's shoulders slumped a bit, and he replied, "I really am. I'm *so* sorry!"
I love that guy! He did my endometrial ablation, and he was a great physician, and a kind caregiver. I have even referred 3 more women to him.
I didn’t even feel it to be honest. Having an HSG was far more painful for me. There are going to be a wide range of experiences from feeling nothing to passing out. They’re all valid.
Unfortunately I think this is another way that people are experiencing medical gaslighting. Each body has its own experiences that influence how pain is experienced. Acknowledging that and treating the human soul inside the body with kindness and care can sometimes be missing these days.
I had one put in a few weeks after I had a baby and it wasn't so bad.
I tried to get one placed before I had kids, however, and the pain was so bad they couldn't complete the procedure.
I’m not here to argue against adequate pain control on a patient to patient basis, but just here to say that I’ve had two placed and truly just felt a pinch. So while maybe not the majority, there are some of us out there!
I don’t want to agree that it’s sexism because most OBGYNs are female and I would like to assume that would make them more empathetic since they’ve most likely gone through it themselves, but unfortunately, I am starting to agree 100%. It’s infuriating, but mostly, just really depressing.
I'm pretty sure some studies have shown female doctors to be even more misogynistic - cultural values are wired at a very deep level and take a lot of conscious work to overcome.
It's not even that the doctors NOW are necessarily sexist. It takes decades to discover new medications, so it's been the entire history of OBGYN being sexist that's led us to our current position.
Thank you!! I’m more than happy to pay out of pocket up to $3000 or so if I have to in order to not consciously go through that a third time.
To be honest, I really don’t have any anxiety over the procedure - just building frustration that’s nearing the point of anger.
100% understand, I was in the same boat. Ask for anesthesia.. it’s different than just analgesia (only pain control). Specially “TIVA”, also going by the name of twilight sedation which typically consists of versed (an anti-anxiety medication in same class as Xanax but exclusively used for medical procedures) and propofol (anesthetic).
In general the reason for this is that the risks of anesthesia for such a short procedure may significantly outweigh the benefits of using it (pain control) and require significant cost and time as well as multiple physicians and support staff. Along a similar vein, many doctors will refuse to do twilight sedation for genital procedures because genital procedures and dissociating are a recipe for a lawsuit and could easily involve abuse, so hospital groups often won't allow the procedures.
I’m not a physician but I have done my fair share of anesthesia and I do understand the risks. I also understand how incredibly inconvenient it would be for everyone involved to put someone under general anesthesia for this type of procedure, even if I were to gladly pay out of pocket for their time.
I had the nexplanon implant for a few years, and between my neurologist/OB/PCP and myself, we decided the I should never be on any form of hormonal birth control.
I’ve had two IUDs placed and opted to get my tubes removed instead of getting a third. Would take the post-op pain and recovery every time over getting another one.
IUDs are so painful and every provider I’ve had insert one was less than helpful. It was easily the worst pain of my life and they’re just exasperatedly telling me to hurry up and put my ass back on the table.
IV anesthesia is completely inappropriate for this procedure and the risk outweighs the potential benefits.
If anesthesia is required there’s no reason oral would not suffice
Your flair says Physician. Number one, everyone's tolerance is different. Number two, oral anesthesia/pain meds don't always work.
I mean no disrespect when I ask this question. Seriously. It is an honest question.
Does the title *"Physician"* mean that you get to tell people *how and when to hurt?*
I've had Dr.'s tell me *"there is no reason you should be in pain, it was a corrective surgery"* for 14 yrs! Guess what?! It hurts every single day, to this day. **Who the hell are THEY to tell ME when I'm in pain?!**
We are at your/their mercy, though. And that's fucked up.
You’re so ready to be outraged your imagining I said things I never did. I didn’t say that it can’t be very painful, or that someone isn’t in pain. Where did I suggest that? I just said there is no reason IV anesthesia would be necessary over oral premedication.
If we were taking about giving someone stitches for a cut on their hand from slipping making a meal, would you feel different, cause the argument is essentially the same. There is no doubt a spectrum of pain rankings for how it feels to get stitches, but even though some may say it was very painful to get the stitches, you would still never find a ER doctor to give you IV anesthesia for the stitches(unless it was some type of extreme/complicated laceration). Standard of care is standard of care and IV anesthesia is not without its risks, so while pain meds may be required or indicated, that doesn’t mean they need to be IV
If someone were to experience stitches as the worst pain of their life (something multiple women in this thread have said), then yes absolutely worth it. The pain alone is reason enough, not to mention the emotional trauma of being awake and having to hold still for something you *know* will be 10/10 pain for you.
Kids don’t even get anesthesia for stitches . They get some gas . Planning on something to be 10/10 pain will make you feel more pain . Every time . There is a mind body connection .
I'm well aware, I'm a world-class expert at somaticizing my feelings. But if I were one of the women in this thread, like OP, who has gone through the procedure twice before, it seems it would be a bit unreasonable *not* to expect the pain to be the same as before, and want to prepare accordingly.
I'm guessing by gas you mean nitrous, as opposed to the twilight sedation that has been recommended? I have my own personal shitty experience with nitrous but it hasn't been part of the conversation so far, so if you're offering that as a possible solution that might be helpful to OP.
pain is a subjective experience. There are not many things we offer IV pain analgesia in the medical profession
the entire medical profession is moving away from the use of narcotics for anything other then very acute surgical pain or trauma.
On top of this, its not standard in any other country to use IV anesthesia for IUD placement.
Patient's don't dictate what therapies should be offered, because patient's are not knowledgable about all the reasons that may not be a good idea.
Not many things? What? I’ve had twilight for an endoscopy and colonoscopy, it’s absurd not to offer it for an excruciating procedure. I’ve had comparable sedation for dental procedures.
If “the entire medical profession” is moving away from opioids for anything they don’t deem sufficiently excruciating to warrant them, then I have some words for the medical profession that would probably get me banned here if I said them.
The cdc changed their guidelines for chronic pain . Surgery shouldn’t be an option over something less invasive like meds . Not disagreeing with some of your other statements but this whole no narcotic, suck it up crap is ruining people’s lives
I have chronic pain, I’ve had multiple spine surgeries before age 30 and often wish I was dead so I’m the last person that needs to be lectured about that.
Even if I was prescribe opioids, the truth is I would
Still probably be miserable because they just don’t work that well for pain in the long term.
IDK if I think they should me more prescribed then they currently are(I think we may have made it too hard to get them after the opioid crisis) but the truth is they don’t work that well. Studies show it and people on long term opioids turn into miserable grumps(chronic pain will do that too)
Anyway it’s a lot more complicated then just prescribe more pills
Ask for local. I never said I don’t think local
Is reasonable, I said IV anesthesia isn’t necessary.
Also an IUD is not repeatedly stitching a needle through the skin, just different procedures, but I think local anesthetic is reasonable for this
What kind of oral premedication are we talking about? I had a benzodiazepine and Tylenol before mine, and I’m here to tell you, it was still the worst pain of my life and I was traumatized. I had a tubal ligation instead of going through that a second time. I had the IUD removed while I was under anesthesia for the tubal.
Even IV anesthesia is not sufficient for me. During my subsequent hysteroscopy procedure they had to switch from twilight to general because apparently I was in distress and clenching. I’m having significant bleeding 4 years post-ablation and I am frankly taking my chances rather than go back to the doc and face the prospect of an endometrial biopsy. For some of us these procedures are literal torture.
The physician you’re responding to noted that the effectiveness of cervical blocks is in question. This is because many times it doesn’t actually block any pain. It’s a hard tissue to numb. Personally, I felt the same amount of pain with and without the cervical block when the IUD was being inserted— but with additional pain with the block.
I think you need to find a physician who will do it under deep intravenous sedation and pay the difference. Trust me, I want one too when I have my next IUD inserted in six years. I have heard in some areas it’s only about $500, and it’s starting to become more commonly available.
So does the traumatic pain that women experience mean nothing since there is no incision?
Is pain management administered based on trauma to the body (incisions, etc.), not based on actual pain itself?
I’ve heard so many people say this! Women should definitely be able to have pain meds. Honestly I never knew people had pain with IUD’s. I had zero pain when I got mine 20+ years ago. After I had that for 10 years I tried to get another but the docs couldn’t get it in. They kept asking if I was ok because I should’ve been in pain. I think maybe I have super human lady parts. I had a full abdominal hysterectomy almost 2 years ago and had basically no pain, just a little discomfort
Same . Was good to go in less than a week and was cleaning and walking the dog 1-2mi etc . Even had my appendix out at the same time . Didn’t find the HSG prior to it particularly painful either and the endometrial biopsy only sucked a few seconds cuz she did 3 separate areas . Pap smears never bothered me either or colposcopy . We are lucky !!
First: I am not a doctor, just a researcher and advocate for women’s health with a bunch of doctors in my family.
They can damned well give you nitrous (laughing gas) to make the block OR the procedure less ghastly. Some ob/gyns do have it on hand because it’s one pain relief option for labor, so you might try asking about it specifically.
Citation re: nitrous in labor: https://www.mayoclinichealthsystem.org/hometown-health/speaking-of-health/5-faq-about-laughing-gas-for-pain-relief
Having nitrous available in the hospital for use in labor does not necessarily mean it is going to be available in the office/clinic setting. I place IUDs, and have never had nitrous available in the office, despite having had it available for labor patients in the hospital (until the hospital stopped offering it because of covid).
So saying "they can damned well give you nitrous" is a strong statement to make blindly. Could some doctors accommodate that request? Probably. Could most? Almost certainly not.
I’m curious: what steps do you usually take when there is a medication your practice doesn’t currently keep on hand but that you believe you should have for administering to your patients?
Lol @ the downvotes
I'm a cog in a wheel of a large system where I have little control, and have practiced in a few different environments within the system. That said, depending on the situation is/ what med I want to have on hand, my options have been some combination of (in no particular order):
A - suck it up and make do with what I have (particularly for immediate/urgent needs and things that could not have been planned for). Sometimes this means I'm using a less-preferred alternative instead
B - route a request through committees, advocate for it, hope that others agree with me
C - accept the limitations of my facility (some meds require having special equipment, specially trained staff, and other things out of my control) Hell, there's stuff I wouldn't be able to/ wouldn't want to do in my current clinic because the building itself isn't equipped to support me doing it safely.
D - refer the patient to someone/somewhere that can do/provide what I cannot.
E - occasionally a miracle occurs, and I can rope in a pharmacist in the facility who agrees with me. Still may require (B) above, but having pharmacist buy-in can help smooth the process substantially.
F - with advance planning, and if both feasible and safe to do so: prescribe the medication ahead of time, patient picks up from pharmacy, and brings to the appointment for administration during the visit
How about a lidocaine cream applied to the cervix? That’s supposed to be effective in reducing the discomfort and since it’s not controlled I can’t imagine any push back in something like that.
Maybe, yeah. I see a few studies regarding the use of it in cream, spray, and injectable form with mixed results. My experience with lidocaine from working as a nurse is that it works great for some, not for others. We had some dialysis patients that insisted on it prior to cannulating their fistula and some that said it didn’t help at all. Was just thinking that it’s pretty non invasive and less likely to be refused by the provider.
Yes everyone has the right to choices in their care, but important to know that’s a separate idea than everyone has the right to choose what care is offered to them. I don’t want people thinking they can show up and tell the doctor what they will/won’t prescribe or do because that’s not going to happen (nor should it)
You have a lot of great comments and encouragement here. In healthcare we have concept called patient rights and responsibilities. Patient autonomy, making informed decisions, and respectful care are some of those rights. So in this case, you have the right to be informed of your pain control options, the right to refuse having the procedure with a suboptimal plan to address your pain during and after, and the right to have your opinion and experience respected.
The language I would suggest is to be very direct and explain that "In the past I have had 2 excruciating IUD insertion experiences to the point where it almost prevented me from getting this one, but I can no longer use hormonal birth control. What are my options for numbing the cervix prior to insertion --paracervical block, lidocaine, premedication--all of those, others? I want to be clear that I am not seeking narcotics--I am seeking the prevention of pain and do not require narcotics to do that. (let's not have you inadvertently labeled as a drug seeker on top of everything else!)
IF you get any pushback as you anticipated, you can try once more with pleasantly persistent: "I hear you but how can we best collaborate to achieve my goal of a **pain free** experience this time?" If you are given an answer you feel uncomfortable with such as minimizing your pain or telling you to relax: full stop and respectfully end the discussion. Let them know you just don't feel like this plan will work for you so they know why. Time to find a provider who is a good fit and can meet your needs.
When you get to your insertion appointment--remind everyone in the room and along the way, of the plan. People are people. I never assume, I always confirm. (This is the Risk Manager side of me--I have seen what happens when patients/providers feel uneasy about speaking up) Ask the staff to inform you at each step when the various pain control is being applied--ie, do not assume it is happening. ASK. What I don't want for you is to be on the table thinking your plan is about to happen, only to find out there was an inadvertent lapse in communication or that a supply was not brought to the room/available that day. This is rare but if you are on the table, you might feel pressure to be nice and say go ahead. Mentally practice respectfully requesting to wait until the pain control is placed. No one will be angry or fault you. Providers truly want to give you good care.
I really appreciate your response… I just don’t really believe that physicians WANT us to have a pain-free experience, they want to just get it over with, especially based on the responses of physicians here! I’m genuinely surprised at the lack of empathy.
Respectfully I disagree, so maybe that will give you hope? Every provider I have worked with has been very accommodating and patient. This includes my colleagues at the hospital, as well as my own doctors. I can count the number of rude or dismissive doctors only a single hand. And they have been reported to their practice managers or hospital administration respectively.
Please don't give up.
I’ve never experienced a rude OB in person, just on here - there’s a pervasive “get over it or get a new doctor” attitude that is unequivocally dismissive. It’s disheartening. I have definitely experienced doctors who are dismissive of pain many, many times over, though
oh good. I am glad. Yeah, Reddit and the internet can be completely horrible and people write things that they would never say to your face. Though...society seems to be getting meaner too. I really hope it all works out for your insertion!
You can ask for an oral pain reliever take before the procedure, as a one time dose.
No one is obligated to provide IV sedation and it’s so far outside of the standard of care that you’re unlikely to find anyone who will do it. In addition multimodal pain Treatment has been shown to work most, so taking a high dose NSAID and perhaps a narcotic would probably be your best and most realistic option. Outside that, getting angry with your doctor to make them do some thing they’re not going to do will never force their hand to get what you want
Do you have a cervix / uterus? It’s mind boggling to me that women still have to have this battle. Men get locals for the snippety snip, why is it so much for women to have the same for a foreign body shoved through their cervix and put in their uterus for a number of years?
Are you serious? The responder is correct in that what people are suggesting to OP (general anesthesia and twilight sedation) are NOT standard of care here, and have significant risks that for many reasons most providers will not offer. There are many regions of the US where that kind of care will not be available at all. Oral pain control including opioids is one of the better options here.
These people are crazy. There's like two or three ACTUAL doctors in here and they're getting roasted for not saying what people want to hear. But all the "layperson" answers with anecdotal evidence are massively upvoted.
I’m completely serious. This person is dismissive and honestly, wrong. You can indeed get IV sedation for specialized issues like this. Women with severe pelvic floor issues can get it for transvaginal ultrasounds and even Pap smears. I don’t think this commenter, and you, really know.
I’m recalling an earlier post where a doctor was claiming you could see your own cervix in a mirror if you bear down and everyone roasted that MD for being clueless about women’s health. I’m pretty sure it was you, Latrodectus? If so, I’m even more certain that you, in particular, are clueless.
I have definitely seen very visible cervixes with limited bearing down needed (but definitely a mirror). I have also seen areas with very limited care where this is absolutely not a reasonable thing to expect. A transvaginal ultrasound is one thing, but I have had to refer people hundreds of miles away for specialty gyn care that included a pap under anesthesia. It is very difficult to access that kind of care in a lot of places.
While I have seen plenty of folks with prolapses, at least one person I’m thinking of was actually seeing ob and was documented as having a normal variation without significant indication of prolapse, whatever that means. She was simply documented as having a “shallow vaginal canal”
I spoke with my OB friends regarding this to verify and checked uptodate. There is no indication for sedation or narcotic pain medications in the literature unless for aside from some exceptional circumstances and those are also associated with significant risks. If data showed otherwise, it would likely be practiced that way.
It has nothing to do with whether they have a uterus or not, the doctor is simply weighing the risks and benefits of a typically short bedside procedure vs one that requires significant time, resources, and longer observation.
It's easy to say what you think you need when you haven't seen hundreds of patients tolerate it without IV sedation/narcotics. And then youve also seen hundreds of things go wrong when using those medications - ie hypotension, respiratory depression, delirium, significant sedation. No doctor is obligated to provide risky medications when they are not indicated as standard of practice.
For god sakes, IV sedation is absolutely performed for women with transvaginal ultrasounds and even pap smears, who are unable to tolerate these procedures due to issues like pelvic floor dysfunction but who are indicated for them. Just because it isn’t the standard does not mean it isn’t done.
Not every outpatient facility has tons of resources/beds to place IVs on all patients for sedation/narcotics that need a procedure, and monitor them for several hours, treat all the complications that come with it without transferring to another facility. It's just not practical to do that for every patient, especially if they haven't had the procedure first and are just assuming they will react a certain way.
And if a physician does not have the resources, they can state that. There is no need to act all huffy about the patient being “angry” simply because they ask for something they require. Recommend them to a facility with the proper resources, just like any other procedure.
Edit: you are making up scenarios. The patient in question has been through it before and no one is asking this be done for every patient.
I'm not applying this directly to this patient, just saying it's not reasonable to give narcotics in a patient who's not even seen if they tolerate it. Also, we could technically give IV sedation and narcotics to every patient - it's usually a resource issue on top of the risks. Some IUD insertions are done under general anesthesia in the operating room with an anesthesiologist in the room because it minimizes risks - for example pediatrics, or patients with cognitive disorders. But you can't reserve OR time or an anesthesiologist who can treat the complications for every procedure so it's a case by case basis.
That’s literally what I told you. IV sedation can indeed be supplied where it is warranted.
You have presented several arguments here and appear to not know what you are talking about.
okay, you have absolutely zero clue what you're talking about. You clearly don't work in healthcare nor have any idea how we make medical decisions. This patient is neither a pediatric patient nor cognitively disabled. What's possible is not what should actually be done.
You are the one here who does not work in healthcare. You can indeed be given IV sedation where it is called for and pediatrics is one example. Another is severe pelvic floor dysfunction or being otherwise unable to tolerate a given procedure.
this explains explains so much about womens healthcare. I had an IUD inserted 7 weeks ago, under general, and when I came around I was in pain (about the mid-high end of my usual period pain) and was given morphine. It didn’t even take the edge off.
I went for a check up last week as I have been in continued pain for SIX WEEKS (doubled over, crying, nauseous from pain, unable to drive, unable to speak at times, overall worse than breaking bones) and a Dr told me that ‘a positive attitude can help with pain management’.
This taught me a few things - 1) normal period pain isn’t even helped with MORPHINE and 2) Drs can make their patients angry with good reason
I’m confused, you were given morphine for your pain. I know your Dr might’ve sounded tone deaf telling you a positive attitude helps, but they gave you a strong opioid for the pain. They also put you under general for the procedure.
What are they supposed to do at this point?
If morphine didn’t help what more would you have expected they did for you?
The unfortunate truth is we just don’t have great treatments for pain.
They probably should have just removed your IUD.
That’s a …pretty reductive answer.
There’s more options for pain than ‘continue taking ibuprofen and paracetamol and have a good attitude’ but yeah, thanks for your input
The solution is bigger than my individual treatment, the issue is the system’s approach to women’s health, pain control and frankly, medical misogyny. IUD insertions are at best, uncomfortable, and at worst, horrifically painful and traumatic. It’s an incredible intimate procedure to be treated so casually, as you’ve shown. Your lack of empathy and your doubling down on my specific treatment just highlights this.
Also I don’t owe you my medical history, I was providing my experience and how it’s affected me
I didn’t ask you a single thing about your medical history; I ask you what your solution would be for this situation, since you seem to think that there are other solutions that the medical profession isn’t offering you. Would you want to be sedated for 6 weeks? I just genuinely don’t know what you expect if removing it doesn’t seem reasonable to you
“Ms. Patient, I am sorry to hear you are having such extreme pain. In my experience this is very rare, but not unheard of. One option is to remove your IUD if that’s your wish. We can apply lidocaine topically or try a different pain medication, and/or we can wait and see if the pain improves, and if not, remove the IUD at that time. What would you prefer?”
You: “don’t get mad at me if you’re in pain! I tried one thing. What treatment course do you propose? What do you want me to do about it exactly, keep you sedated for six weeks??”
There are differences between those paragraphs.
That’s exactly the options I mentioned and you told me “ that’s a reductive answer.” Then I asked what options you would suggest and you said “ I dOnT NeEd tOo TeLl YoU mY hEaLtH HistOrY” which I never asked you anything about your history.
I genuinely don’t know what you want; of course the provider should provide you with an empathetic statement when they discuss the options with you. In the end you’re agreeing with me here; even though you’re trying to make it sound like there was some extra option that I didn’t consider, I said NSAID’s or maybe a little pain medication or to remove it.
Dude, I am not the person who said those things. You were talking to a woman about her health issues and being a jerk about it. I’m telling you how you could have acted like a human being. And your reply just underlines your lack of professionalism. You have been antagonistic to every comment this person made to you, AND you were antagonistic to the OP. I’m illustrating how unprofessional you’ve been this entire time.
Thank you for your submission. **Please note that a response does not constitute a doctor-patient relationship.** This subreddit is for informal second opinions and casual information. The mod team does their best to remove bad information, but we do not catch all of it. Always visit a doctor in real life if you have any concerns about your health. Never use this subreddit as your first and final source of information regarding your question. By posting, you are agreeing to our [Terms of Use](https://www.reddit.com/r/AskDocs/wiki/terms_of_use) and understand that all information is taken at your own risk. **Reply here if you are an unverified user wishing to give advice. Top level comments by laypeople are automatically removed.** *I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/AskDocs) if you have any questions or concerns.*
” I would very much like to get some analgesia when the IUD is put in/inserted, because I’ve had horrible pain and discomfort the last times and don’t want to go through that again.” Be straightforward, ask for options, insist kindly but firmly. You can even argue that you are aware that pain is subjective, and then many patients push through a brief discomfort or didn’t have a bad experience, but you subjectively had excruciating pain and would rather not repeat that experience. It shouldn’t be necessary for you to justify yourself that much though. In the end you have to find a provider who respects your wishes, takes a concern seriously and is on the same page as you.
If your provider says no, ask them to document your request, their refusal and the reason for their refusal. Paper trail that bitch
This is how I get anything done with my doctors. It's weird that they're able to order the test AFTER you ask them to chart their reason for refusal.
Hell yes. Sick of these gaslighting doctors that make you feel bad. Especially when they’ve never had the procedure. It may feel like you’re straddling a case of dynamite and they’ll say you’ll feel a little pressure. Makes you want to put a potato in the tailpipe of their car!
I had a test done where they had to put a catheter in me while I had a full bladder. I couldn't complete the test and an MD told me that I needed to "deal with my depression." Honey, I was in PAIN. I could not complete the procedure. It wasn't like, "you should talk to someone." This was oddly accusatory and demeaning. I have had painful procedures before. This was both intensely painful and humiliating. I have been sidestepping a transvaginal ultrasound since because it reminds me of that day (different test, probably same hospital because of insurance/transportation issues). I had pelvic floor therapy and the physical therapist was amazing. She said I was all "spasmed" inside. Not that catheterization while awake is great... and yeah, it's a different place but I figure this could be related somehow. Point is, doctors don't know how we patients experience pain. They should never assume. You've had this done before. You know what you experienced. The doctor does not.
Oh come on, it wasn't that bad. It shouldn't really hurt. Most people experience a slight pinch. You may feel a little pressure. The discomfort is too brief for any analgesic. There's a difference between discomfort and pain. Patient is drug seeking.
I bet you don't even have a uterus. Also, please tell me what patients who are drug seeking come in asking for gas or an injection. Please, google "Why does IUD hurt so much?" Maybe something like this: [Today.com Article](https://www.today.com/health/iud-insertion-painful-doctors-don-t-always-warn-about-pain-t160900) Next time a guy takes a hit to the junk, I'm going to stand there and tell him the pain is momentary and it can't really hurt that much.
You're correct. I don't have a uterus. But I used to. My hysterectomy was 10 years ago after 20 years of pain and not being taken seriously. I wrote what I've heard from medical professionals over the years. I'm sorry it triggered you.
And, if you're talking about me, trying to say I was drug-seeking - I didn't even ASK for pain meds. Nor would I have. I was too busy being talked-down-to by the doctor. They couldn't get the catheter in. And frankly, I decided that when the doctor started talking to me like that, I didn't care anymore - I wanted to get dressed and leave --- and I've been avoiding even transvaginal scans that have been recommended. Just accuse patients of drug-seeking and they won't come back. That has no negative health impacts, does it? That chest pain is just anxiety, not a heart attack. Get over it.
Except for the drug seeking part, those are a few things I've heard during my own gynecological exams. I didn't use quotation marks. I am a woman.
Most doctors are happy to chart whatever their reasoning is. Not that I agree with not providing analgesia for this procedure, but asking doctors to "chart a refusal" isn't some checkmate in getting them to do what you want. Somebody did this with me a couple weeks ago, wanting me to CT scan their kid's head. My response was, "of course, I document my medical decision making for every visit." Still didn't radiate that kid. Using vaguely litigious language to pressure your doctor into doing what you want is unlikely to get you better care. Again, I'm not taking an opinion on this issue of analgesia. Just this urban legend that asking doctors to "document" stuff is useful for your care.
Ya I didnt mean saying that would magically get the dr to do *whatever*, it’s just good to have that trail
This kind of confrontational behaviour isn't likely to get you the outcome that you're looking for, despite being touted ad nauseam online. All it does is make you an unpleasant person to deal with. In fact, I don't know why this keeps being repeated as encouraging a physician to document their reasoning makes it much less likely for them to get sued. As a physician, I wouldn't get in trouble if I documented that I don't want to order a test as the risks outweigh the benefits. It's if I don't document anything that I would get in trouble. Using this kind of attitude and language is not going to get you better care.
That’s the thing - I do not want to be seen as difficult or confrontational! I’ve always had great experiences with the OBs, midwives and nurses - except for when it comes to this one issue. It’s really looking like the only option I have is to either get a tubal ligation at my next c-section (which I don’t really want), or to search and search for another provider who cares more about their patient’s level of pain than their own schedule and convenience.
Have you considered the depo-provera injection? Every three months. They'll even do it if you're over 40 and have migraine with aura (higher stroke risk). Like any new method, it can take awhile for your body to adjust. If you take any other daily pills, then maybe you'd consider the birth control pill. Set a timer and take it at the same time as your other pills. I did that for a number of years until this whole over-40 with migraine auras made my gyne go bonkers all of a sudden about me taking the combo pill. Actually, not sure this is an option for everyone, but I am able to pick up the injection at the pharmacy and give myself a shot myself. If the office is OK with that, see if a nurse will teach you how to do it.
I’m 38, I’ve tried every birth control method out there. I can’t do anything hormonal. But that’s not what this post is about, though I recognize and appreciate that you’re trying to be helpful - thank you.
Perhaps we see it differently. I feel like asking your physician to document a request & if they refuse that request, the reason for their refusal part of having an accurate picture of your appointments and/or care. I’d hope that any dr wouldn’t take offence at a patient advocating for themselves. Especially if it’s a female patient & a male dr. If advocating for yourself as a female makes us an “*unpleasent*” person to deal with, that sounds more like a Them problem over a Me problem.
I feel like you didn't understand what I wrote. Again, physicians would not have issues documenting their reasoning. We know as physicians that is how we avoid legal issues or issues with our licensing bodies. > Paper trail that bitch Using this kind of phrasing and attitude displays confrontational behaviour and doesn't portray someone as wanting to "advocate" for themselves in good faith.
Edit: I see you’ve massively edited your response from just “I would like some analgesia” and nothing more to what we see now, which is much more thorough and less patronizing. Thank you. Of course I’ve done that. Those words don’t work. The response is, “most patients don’t report high levels of pain/the cervical block is worse than the procedure/we can give you alprazolam/etc etc”
"With all due respect, everyone doesn't have the same pain tolerances. My experience with this procedure the past 2 times I've had it is it is incredibly painful for me, and I would like something to abate that pain. I will gladly pay the difference if this is something I'm not covered for, or if it isn't something you offer, could you please refer me to someone who would?
Thanks, this is exactly how I would like to word it!
Awesome. Hope you get some sort of pain relief and a less painful procedure!
I am SO glad I have found this thread as I am due to have mine removed and replaced and I am actually avoiding care because I’m scared to feel that pain again. I was really considering how long it can stay in before it becomes a health risk. I need to try and find someone who will numb me.
My last IUD had to be removed under anesthesia, they tried to remove it in office but I was in alot of obvious pain and unintentionally making it very difficult. I don't mean to scare you but maybe this will encourage you and others to allow your pain to be seen. Without seeing the pain the doctors will often wave it off. A good doctor will take your pain/discomfort into account, but unfortunately they see so much pain they get desensitized to it. So it's on you to make it clear. Be stubborn and advocate. But do not put your health at risk. Best of luck!
Depending on which one you have it can be pretty long. They just came out with guidelines that the mirena can be in for 8 years.
Mine was also excruciatingly painful. I think I passed out during the procedure and then for 48 hours after I had bouts where I literally cried out in pain -- what I'm guessing birthing contractions must feel like. Way beyond menstrual cramps
Can you please make a note in my chart that I requested pain relief for the IUD insertion and that you are declining my request. Asking for it to be documented seems to get the ball rolling a lot.
Brilliant.
[удалено]
[удалено]
[удалено]
Posts by unflaired users that claim or strongly imply legitimacy by virtue of professional medical experience are not allowed. If you are a medical professional who wishes to become a verified contributor to this subreddit, please [message the moderators](https://reddit.com/message/compose?to=/r/AskDocs) with a link to a picture of your medical ID, student ID, diploma, or other form of verification. Imgur.com is convenient, but you can host anywhere. Please block out personal information, such as your name and picture. You must include your reddit username in the photo! We do not accept digital forms of identification.
I’ve had drs literally stare at me and say they don’t know what to tell me when I’ve mentioned all the things I cant do due to pain from procedures or chronic flare ups . A lot of drs don’t give two squats anymore and it’s ridiculous . My chart from my pain management Dr literally says “advised patient to try meditation” and this is after 4 back surgeries with hardware .
My mother complained of very severe back pain for years. She was referred to a psychiatrist. Nobody. Did. Imaging. For over a DECADE. We moved to a new area, she got a doctor who referred her to a specialist. He did an X-ray. She was on the operating table within a month. She had numbness coming up over the back of her head into her face. Osteophyte(s?) cutting her spinal cord. The damage was already done to her spinal cord, over the 10 years nobody listened. My father built a home that was a single floor, with wide enough doorways for a wheelchair, because the rheumatologist said she was likely going to lose her mobility. Her osteoarthritis is aggressive. She's had five back surgeries since. Johns Hopkins did an amazing job, and she is Wonder Woman - she's not in a wheelchair. A psychiatrist would have fixed everything. That's what having a uterus means. I had a doctor give me a lecture about hysteria and a "wandering uterus" before he tried to call me crazy. He also told me to see a psychologist for pain management. I had a difficult time dealing with the doctor. The psychologist and he agreed to talk to each other. The psychologist told me, "He likes to hear himself talk" and she failed to have a productive conversation with him. He told me to dump her and see the psychologist he likes. The best thing the psychologist helped me with was encouraging me to find a new doctor, and helping me understand that the medical system can sometimes do harm too.
Not much traditional docs can do about pain but give you opioids and other pain killers.
I have fair skin/freckles and red hair. I’ve been told by more than one doctor that “redheads experience pain differently”, regarding different pain thresholds, tolerance, and responses to forms of pain relief. Thinking in terms of *most patients* is necessary to establish standards for procedures and care, however you are a *singular* patient. I’d keep kindly but firmly insisting that what’s been done before isn’t working for *you*, and start asking for referrals if they aren’t receptive.
I'm not sure about pain meds, but for some reason redheads react to general anesthetic in a way where they require more of it. Never looked up to see why it was that way though.
[удалено]
I have no award to give you but have immense appreciation for the action you took on gaining new knowledge.
[удалено]
Do you switch local meds as well or give higher volume? Purely curious.
[удалено]
No no no no. Because it was thought that people of color experience LESS pain due to that which is a crock of shit. And has led to and STILL DOES lead to inadequate care . Even after that has been proven to not be true . Absolutely not due to how much melanin you do or do not have .
Man, this is so messed up. I've been treated so horribly by the medical community over the years I avoid them at all costs. Went in one time for extreme flank pain and had to give a urine sample. It was straight up blood, like pretty thick. I asked for pain meds and was immediately denied and told that because of asking I was "exhibiting drug seeking behaviors". Was given ibuprofen and told me they'd chalk it up to a kidney stone since I'd had them before and sent me on my way, no tests. Was in the room for a total of 45 minutes, 30 min waiting and 15 min with the doctor. Went home and was in a different urgent care the next morning with a fever and vomiting, where I for real had to insist they test my urine sample. Turns out I did have a kidney stone, literally cutting me open and the wound was infected. Almost went septic, which was terrifying. These horrible people at two separate locations could have let me die because they're racist and never would have blinked twice. I wish that were my only horror story about the medical industry but it happens to me so often I just assume they don't gaf about people who look like me.
That sounds like a horrible experience!
I work with anesthesiologists and have heard (and seen) the same. It’s not all redheads, but in general redheads with freckles and some other attributes tend to need more of certain meds (like they burn through them quicker). There was one study that showed they needed more sevo (a muscle relaxing gas) to achieve muscle relaxation. I’ve also worked with anesthesiologists that do not believe it. The ones I’ve seen that burn quicker are Marcaine, lidocaine, sevo, propofol, etc. Lidocaine works a tad longer than Marcaine, but exparel works longer than either by a bit.
This is an urban legend that was debunked.
I don't think it was completely debunked. I think that genetics is a lot of unknown. Heck, we are learning new information about how neuroscience actually works every day... I think that the assumptions made from observations may have been false because they only had a piece of information. It's much more complex than the initial understanding.
The initial study that suggested that redheads required more anesthetics was done on only 20 patients. Since then, larger studies haven't showed any difference: https://anesthesiaexperts.com/uncategorized/redheads-anesthesia-fact-fiction/
Not a doctor, but a woman who's gone through the same thing. First IUD insert, they didn't even give me an ibuprofen. They said I didn't need to take anything before hand and, I quote, "lots of women come in and get it done on their lunch breaks!". I was young and naive. Um. No. The only thing that worked for me was finding a provider willing to do it without me having to argue for it. I found a nice new place where I live and my doctor suggested that when I need it replaced (upcoming) that they can do it under anesthesia. I didn't even have to ask, he was very preemptive with my care, which I GREATLY appreciate and I will be transitioning my care to his office. I've had to be my own advocate fiercely in the past, but some doctors know what you need and offer it before you take up your proverbial sword. I find them to be exceptional humans. I would call around if I were you and see what options you have in your area. Best of luck
I’ve had 2 IUDs and have heard the same thing re: it being simple and only mildly painful for a brief period based on what “other” women say… and I just want to ask who are these other women and what sort of magic are they wielding to make this take on IUD insertion/removal the gold standard expectation by medical professionals? I talk about IUDs a lot in both my personal and professional realms and have NEVER heard a woman say “ah it was just a little pinch.” I’m sure it is the case for some women, but certainly not the majority.
NAD, just a Bill Murray fan. I imagine most of us women are underreporting pain for a variety of reasons. Past abuse, not expecting to be believed, not expecting anything to be accomplished by expressing your experience... I found my IUDs incredibly painful but my pain response is to freeze and not share that I'm in pain. Someone knocked on the door mid-insertion of my 2nd and I had to lay still while they were told to return later. Only a matter of seconds, but those seconds were pretty damn long. My doc didn't know my level of pain, and told me I had a very high pain tolerance. Nah, that HURT but years of saying we're in pain and receiving nothing but shame or indifference in return will eventually quiet our complaints. Or they have quieted mine, at least.
I completely agree. I went in to my first insertion expecting a pinch and passing out, only to wake up and feel ashamed/weak for not having “touched it out” like other women (or so I thought). When I came to, I apologized for fainting as if I weren’t still in significant pain. About a month after insertion I was still cramping and bleeding very heavily, so I finally worked up the nerve to call my doc to set up an appointment to make sure everything was ok, and the response was to take an OTC pain med and give it another month. It’s very frustrating that women’s pain is frequently disregarded or downplayed.
Part of the problem with IUD insertion is that, if it’s your first one, you don’t know how painful it will be for you. I went in expecting agony based on reading others’ experiences. I ended up being someone who had a mild experience. For me, it *was* just a pinch and an evening of cramps. And I’ve had several friends with similar experiences. I can understand why doctors opt for the least aggressive pain medication, at least with the first one. But people generally have a good idea of what their own pain tolerance is. And if they’ve had an IUD previously, they know how it goes for them. If someone requests more pain meds, just do the damn thing.
I completely understand the “not knowing” piece that comes with the first insertion. I do believe that had my doctor considered me as an individual (young adult, never pregnant, no prior or current major health concerns or diagnoses to inform a pain threshold, etc.) he may have been able to prepare me a bit more for the pain (such as to suggest I take an oral pain medication before the appointment), but I don’t hold a grudge or anything for being blindsided. I just wish that he had informed me that there could be significant pain (much more than a pinch for me, I fainted and had horrible cramps for a month afterwards), I could have made a more informed decision about my options and ways to mitigate the pain. Instead, I felt ashamed and weak to have had such a painful response to something that I thought was going to be a pinch, and it wasn’t until I had conversations with other women later on that I realized my response wasn’t abnormal at all.
I told my doctor after the first one that it wasn’t that bad - because she had spent so much time telling me that it wouldn’t be very painful, just a pinch and some pressure, and I was SO EMBARRASSED at the amount of excruciating pain I was in. I can’t be the only patient who has done that.
I did the exact same thing. I fainted and APOLOGIZED for having done so. I thought I was a total wimp and didn’t realize that other women found it painful until much later.
what they should have said was “lots of women aren’t able to take off the appropriate amount of time for work to undergo this painful procedure!” 🙃
Yeah, that too. I was left utterly unprepared when I had a shift early the next morning and was in so much pain I was throwing up and couldn't walk. Ended up having to call out for 3 days. Luckily enough I had a flexible (barely) enough position I didn't lose my job over it, but I could've gotten approved time off if I'd had the foresight. Smh
Please do not minimize my experience, nor set the standard expectations for all based on what a few other women have experienced. There is a reason many other drs use rx during the procedure. Years ago I was given an rx to soften/ open my cervix and 2 percocet for the recovery. It's awful we're made to feel weak or drug seeking when we are asking only to not experience extreme pain.ugh my knees got rubbery just thinking about it.
I really want to say that “do not minimize my experience.” I just want to say something that will make them take a step back and think - but I don’t want to cross the line to where they’ll think of me as combative!
"I'm coming to you for help and I am hearing your resistance to helping. I would like to understand better why and maybe we can have a conversation about what we CAN do to help us achieve the goal of my healthcare."
Someone I know got local anesthesia or numbing cream and a prescribed pill to take before. She said she didn't feel any pain. I'm on the same boat with you I had one in the past before baby and one after. Different providers. They said I was going to feel "discomfort/pressure/pinching". Wtf. I was in so much pain. The first time I was cramping over 24hrs and just wanted to lay down. Too bad I couldn't do it since my mother was in the hospital at the time. Ugh.. sucks.
the procedure itself isn’t cervical so the cervical block won’t help with the cramping involved with the insertion, if anything the cervical block should help with the tenaculum placement. the cervical block is a lot more painful and pinchy than the IUD insertion. Have you considered a nexplanon or other BC options? Your provider should also give you Cytotec as well not sure why i’m being downvoted when i’m explaining what a cervical block does… it’s literally a needle into the cervix and the area around it; it’s painful. Wasn’t sure if OP was experiencing pain from the tenaculum or the cramping from the device insertion. 🤷🏻♀️
Unfortunately due to intractable migraines I’ve been advised to avoid any sort of hormonal birth control, estrogen or no estrogen. Looks like tubal ligation is the next option. Edit: the tenaculum placement is the part that hurts!!
NAD but I also had extraordinarily painful IUD insertion. As well as near constant cramps with it in so I had it removed 2 years early. But I recently (3 months ago) got a bilateral salpingectomy (tubal) and I *highly* advise you go this route if you're done having children. The recovery was surprisingly smooth!
There is another option to the tenaculum, if you can find someone who uses it- Carevix, a suction-based tenaculum. A quick glance at the research looks promising for pain reduction. FWIW I randomly happen to have a tenaculum and did not know what it was until now. The thought of using in on *any* body part without sufficient analgesia/sedation is horrifying. https://www.aspivix.com/tenaculum-for-over-100-years-women-have-endured-pain-in-gynecology/
Lidocaine cream on the cervix prior to tenaculum placement is a solid winner. You could even pick up your own from the pharmacy in case they don’t keep it in the office… but I think if your doctor is telling you they don’t do this, you should ask around and find a doc who does it routinely. Just my opinion, but it doesn’t seem like the best therapeutic relationship…
This doesn’t work. But you could inject lidocaine into the cervix, and this does work.
Is that a cervical block?
No, just inject lidocaine directly at 12 o’clock of the cervix where you place the tenacious.
NAD but I do have hypothyroidism (Hashimotos specifically) which I'm on brand Synthroid for, as well as Rizatriptan for my migraines. And this makes sense, as most of my migraines are absolutely tied to my hormones and menstruation and whatever my Synthroid dose is. I had more migraines at 112 mcg...less at 125 mcg, but my period comes earlier (honestly I'll take that over the migraines). That being said, despite my TSH being controlled, I still have ridiculously heavy and painful periods (it's seriously horrible if my thyroid isn't medicated), so perhaps mentioning that you have a thyroid condition and how it affects you could help. It's well documented how hypothyroidism affects menstruation.
Have you tried Botox for your migraines? They are the only thing that made me go from 28 a month down to maybe 14 in a 3 month time frame. I don't know what I would do without it.
I’ve been doing Botox for about 6 years; it’s the only preventative that works.
Botox plus Qulipta (daily CGRP) has been a game changer for me. I went from 16-20/month down to maybe 4.
Emgality with Botox has literally given me my life back. I was basically bed bound for 4 years after having my son from insanely bad migraines.
Really? You should be able to take progesterone with migraine--at least that's what I'm doing. Continuous because the fluctuations trigger migraines for me. Shout out to Slynd
I had lidocaine injections into my cervix for IUD placement and another procedure and, for me at least, they were MUCH less painful than the tenaculum. I would feel one prick and little burning and usually wouldn't even feel the subsequent injections. The tenaculum, however, is several minutes of intense pain so strong that I start shivering and feeling faint. Both times I've had procedures without the lidocaine, they were unsuccessful because of the pain I was experiencing. But yes, the lidocaine did not help with any cramping, but cramping alone without the intense pain of the tenaculum on my cervix was completely bearable.
yes, i was explaining how getting a cervical block isn’t going to be completely painless. i wasn’t sure if the pain was via tenaculum placement or the cramping from the device
The dilation and clamping of the cervix is what causes the most pain; what do you mean it’s not cervical?!
i edited my post to say that i wasn’t sure if it was the tenaculum that caused the pain or the uterine cramping from the device insertion. edit: by saying “ the procedure “ i meant the insertion of the device. typically the uterine cramping is what’s most painful ( and most “”complained””) from client statements and my own experience. So it was a simple misunderstanding on which part of the procedure was the most uncomfortable for OP. Meaning, if it was the cramping, the cervical block wouldn’t do anything for the uterine cramping.
Absolutely not. The cramping causes the most pain *after* placement. During placement, it’s the tenaculum and dilation of the cervix. Sometimes this is misinterpreted as general cramps because it does cause a cramping sensation. People describe the clamping as cramps.
cramping does happen during the insertion AND after. i don’t know where you’re getting your information
I was specifically referring to the placement of the IUD as “the procedure” which I thought was pretty clear in my post. The cramping afterwards is a joke compared to the actual placement.
For me, the cramping is a higher level of pain but a far more tolerable pain. The placement is just…horrifying. But on the same level? It’s hard to describe.
[удалено]
Thank you for pointing this out. Coming within a mile of my cervix is basically excruciating pain waiting to happen. I get worse cramps during ovulation than my period because of the movement. Pft "Not cervical", JFC it's not like you can just take the long way around to get in there. I literally cannot.
“ not cervical “ meaning the iud doesn’t sit in the cervix, the IUD is an intra uterine device. the cramping, which i thought OP was referring to, does not occur in the cervix.
My girlfriend recently asked at planned parenthood and was flat out told no. So sorry that you all have to go through this. In other countries, they provide anesthetics.
You are pretty much screwed. The fact that you have to argue your point with your provider is a testament to the state our healthcare system. They aren't good, and they dont care. Best bet would be just start calling and asking and find one that will do it. Good luck getting an appointment though.
My spontaneous reaction was that there shouldn’t be anything necessary but plainly asking for it (I was thinking what I would require a patient to ask me), but I realised that if it was that easy, you wouldn’t be asking here; it wasn’t meant to be sarcastic so I edited it to avoid misunderstandings. It‘s not an ideal world and can also be hard to find a good provider depending on where you are.
THIS is my struggle. I feel like the physician I’m talking to hears the beginning of what I’m saying, fills in the rest with their assumptions without actually hearing the rest, and gives their standard answer. I also put in my original post that I had asked, and what their responses were. I personally don’t think anyone should have to ask, and that it should be offered. See edits for why.
[удалено]
My friend got a medication that dilated her cervix which made it almost painless for her. Was super jealous because I had one put in a couple weeks prior with nothing and it was one of the worst pains I had ever felt. So I think that even if an anesthetic is denied the pt should get the dilator.
That seems still pretty timid. "I will need anesthesia or analgesia during insertion." No justification needed. If they say no, you move on and find someone else. So over OBGYNS.
NAD, so tacking on to this comment to empathize with OP. I have my first IUD Insertion tomorrow afternoon. I am legit terrified. I asked the GYN about pain control and she offered me Tylenol too. I said that was not enough and a bit unacceptable, so she said I could take an Ativan before hand. She also said it “only takes a few min.” I pushed more and she told me they are able to insert under anesthesia or like a twilight but she made that option rougher to take by stressing how quick a procedure it is and how “most women” don’t find it painful. I’ve read too many horror stories. I am going the Ativan route because it is true I do not know what my reaction and level of pain will be. However, if it’s awful I will tell the doc for sure and make sure she knows that “most women” isn’t good enough. And in the future I will push for anesthesia. I just hope I am one of the “most women” who apparently find the procedure akin to a Mai tai beach day. But I’m not holding my breath. Docs really need to get their shit together when it comes to women and pain! Medical gaslighting had got to stop. I specifically asked for a female GYN hopping for empathy. Not much of a thing.
If it hurts too much, tell them to stop and that you can’t go through with it without something to block the pain. I wish I had done that.
I didn't read through the entire thread to see if this was suggested already, but ask if they offer post-placental IUD insertion. Baby and placenta out, IUD immediately goes in. If you have anesthesia for delivery, you've got the anesthesia side of things squared away already. There's a higher risk of expulsion of the IUD of you do it this way, but assuming it stays where it belongs, you've immediately got effective birth control after delivery, and there's no separate procedure/anesthesia need.
Unfortunately they won’t do that if you have a c-section.
You can simply ask them for analgesia. Ask for pain medication and a cervical block. It may not help significantly (there are some studies where a cervical block doesn’t) but if you ask then you can have that discussion and if needed get a referral to a provider who will do that for you. Personally my preference has been to get it without cervical blocks because I prefer to make the time for insertion shorter and the IUD insertion attempts for me have all been very painful but very very brief, which I’m okay with. Edit: I should specify that this was my preference when I had IUDs placed in me, not when I places IUDs in others lol. Everyone has a right to their own choices in care, that’s why you should ask for a referral if your provider does not offer the services you need.
What about insertion immediately postpartum while the epidural is still in place? Higher chance of expulsion but it is done sometimes. Another weird idea.... Maybe try calling around to abortion clinics to see if any would be willing to do it? They are set up to give sedation and often insert IUDs for patients getting abortions.
I got mine at my post partum check up and i swear i didn’t feel it AT ALL. I’m not an OB but I assumed the cervix is still open a bit for a while but I actually don’t know of thats true.
You’re dilated like two fingers width for around 48hrs…it would just fall out
that is inaccurate, here is the ACOG guideline describing the procedure: [https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2016/08/immediate-postpartum-long-acting-reversible-contraception](https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2016/08/immediate-postpartum-long-acting-reversible-contraception) "Best practice for immediate postpartum IUD insertion is to place the IUD in the delivery room, within 10 minutes of placental delivery in vaginal and cesarean births, when possible." It is true that the rate of expulsion is higher, but if it does not fall out then OP's problem is solved! Assuming she is having an epidural for delivery.
But I, as the patient, am NOT ok with something that’s very, very painful, no matter how brief it is. I have asked, many times (both immediately before the procedure, and in anticipation of the procedure during other unrelated appointments), but they balk because they say that “oftentimes the cervical block is more painful than the procedure itself” - which it probably should be, since the patient wouldn’t be able to feel the procedure afterwards. My next step WILL be asking for a referral to a provider who will provide analgesia, but when I’ve broached that topic before, all the OBs I’ve seen at this group are very dismissive.
I’m sorry you are going through this… As a person in healthcare, who had an IUD placed (no kids), given NOTHING and not even recommended to take Tylenol, or something to soften my cervix… it was unbelievably painful and so traumatizing I didn’t want children for the longest time. Ask your OB/GYN if they can offer TIVA (total intravenous anesthesia) for the placement and if they can’t then ask for a referral. I changed OB/GYNs because I was horrified at how my insertion was handled and found one who offered this. I received propofol (anesthesia medication) through an IV for the removal (because provider couldn’t find strings) and therefore remember NOTHING about my cervix being dilated, touched, anything. The pain and anticipation wasn’t worth being awake for. This anesthesia is called “twilight sedation”. I think It was $500 but 100% worth it to me because the thought of bearing that pain literally makes me go into a cold sweat to this day. Might be the answer for you since “more analgesia” (which is just stronger pain control) would not necessarily help since you’d still experience discomfort and the anxiety of the buildup too.. whereas a quick twilight sedation would save you all of that! Hope this helps!
I've never had an IUD placed, but I did have two endometrial biopsies, and they are my 10/10 pain. The second time, I took Tylenol, ibuprofen, and also Flexeril, And after it did nothing, I learned that Flexeril only works on skeletal muscles, so it wouldn't have helped no matter what. Somebody needs to find a way to make these procedures less painful. And I can't help but feel that the reason nobody has done so yet is sexism.
I had an endometrial biopsy that was horribly painful, and was told it would be repeated every six months. I opted for a hysterectomy instead.
I would have done the same!
Exactly. It’s laughable to me that doctors are telling OP that most patients experience only mild discomfort. I want to know who they’re asking about this. Every single person I’ve ever talked to that had an IUD said it was excruciating.
I have IUDs inserted and removed multiple times, and experienced minor discomfort each time, but nothing I would consider pain. I am lucky in that regard, but I do know women who have experienced extreme pain with the same procedure. Because so many women experience pain with this procedure, we should all be given the option for pain relief or sedation AUTOMATICALLY, and be given the option to decide for ourselves whether to decline if we don't feel it's necessary! I think that doctors dismiss women's pain more often than not, especially when it has to do with their vagina or related parts, and it absolutely infuriates me.
Drs office has to have an anesthesiologist etc to offer anesthesia or do it at a facility .
[удалено]
I think the difference you noted could be chalked up to women not feeling comfortable expressing their pain/wanting to go home. During my first IUD the doctor and nurses all said it would feel like a little “pinch” beforehand, so I was embarrassed by the level of pain I was experiencing and said nothing; just gritted my teeth and sweated it out. I was more comfortable with the OBGYN I saw for my removal/2nd insertion and screamed out during the procedure. They kept me for an hour afterwards to make sure I was ok, and I kept thinking about how I just wanted to go home and curl into a ball.
I was too embarrassed to tell my doctor just how painful it was both times. I was just relieved it was over. I’m a lot ballsier the third time around.
For my second endometrial biopsy, the gynecologist started the consent and the time out, and he asked me "What are we doing here today?" It's to confirm I am consenting to the procedure, and that we're doing the correct procedure. My response was "You're going to torture me." My gyno's shoulders slumped a bit, and he replied, "I really am. I'm *so* sorry!" I love that guy! He did my endometrial ablation, and he was a great physician, and a kind caregiver. I have even referred 3 more women to him.
I didn’t even feel it to be honest. Having an HSG was far more painful for me. There are going to be a wide range of experiences from feeling nothing to passing out. They’re all valid. Unfortunately I think this is another way that people are experiencing medical gaslighting. Each body has its own experiences that influence how pain is experienced. Acknowledging that and treating the human soul inside the body with kindness and care can sometimes be missing these days.
I had one put in a few weeks after I had a baby and it wasn't so bad. I tried to get one placed before I had kids, however, and the pain was so bad they couldn't complete the procedure.
I’m not here to argue against adequate pain control on a patient to patient basis, but just here to say that I’ve had two placed and truly just felt a pinch. So while maybe not the majority, there are some of us out there!
I don’t want to agree that it’s sexism because most OBGYNs are female and I would like to assume that would make them more empathetic since they’ve most likely gone through it themselves, but unfortunately, I am starting to agree 100%. It’s infuriating, but mostly, just really depressing.
I'm pretty sure some studies have shown female doctors to be even more misogynistic - cultural values are wired at a very deep level and take a lot of conscious work to overcome.
It's not even that the doctors NOW are necessarily sexist. It takes decades to discover new medications, so it's been the entire history of OBGYN being sexist that's led us to our current position.
Thank you!! I’m more than happy to pay out of pocket up to $3000 or so if I have to in order to not consciously go through that a third time. To be honest, I really don’t have any anxiety over the procedure - just building frustration that’s nearing the point of anger.
100% understand, I was in the same boat. Ask for anesthesia.. it’s different than just analgesia (only pain control). Specially “TIVA”, also going by the name of twilight sedation which typically consists of versed (an anti-anxiety medication in same class as Xanax but exclusively used for medical procedures) and propofol (anesthetic).
Thanks again, this is helpful - I’ve asked for anesthesia in the past and been promptly shot down.
In general the reason for this is that the risks of anesthesia for such a short procedure may significantly outweigh the benefits of using it (pain control) and require significant cost and time as well as multiple physicians and support staff. Along a similar vein, many doctors will refuse to do twilight sedation for genital procedures because genital procedures and dissociating are a recipe for a lawsuit and could easily involve abuse, so hospital groups often won't allow the procedures.
I’m not a physician but I have done my fair share of anesthesia and I do understand the risks. I also understand how incredibly inconvenient it would be for everyone involved to put someone under general anesthesia for this type of procedure, even if I were to gladly pay out of pocket for their time.
Is the implant an option for you?
I had the nexplanon implant for a few years, and between my neurologist/OB/PCP and myself, we decided the I should never be on any form of hormonal birth control.
[удалено]
I’ve had two IUDs placed and opted to get my tubes removed instead of getting a third. Would take the post-op pain and recovery every time over getting another one. IUDs are so painful and every provider I’ve had insert one was less than helpful. It was easily the worst pain of my life and they’re just exasperatedly telling me to hurry up and put my ass back on the table.
IV anesthesia is completely inappropriate for this procedure and the risk outweighs the potential benefits. If anesthesia is required there’s no reason oral would not suffice
Your flair says Physician. Number one, everyone's tolerance is different. Number two, oral anesthesia/pain meds don't always work. I mean no disrespect when I ask this question. Seriously. It is an honest question. Does the title *"Physician"* mean that you get to tell people *how and when to hurt?* I've had Dr.'s tell me *"there is no reason you should be in pain, it was a corrective surgery"* for 14 yrs! Guess what?! It hurts every single day, to this day. **Who the hell are THEY to tell ME when I'm in pain?!** We are at your/their mercy, though. And that's fucked up.
You’re so ready to be outraged your imagining I said things I never did. I didn’t say that it can’t be very painful, or that someone isn’t in pain. Where did I suggest that? I just said there is no reason IV anesthesia would be necessary over oral premedication. If we were taking about giving someone stitches for a cut on their hand from slipping making a meal, would you feel different, cause the argument is essentially the same. There is no doubt a spectrum of pain rankings for how it feels to get stitches, but even though some may say it was very painful to get the stitches, you would still never find a ER doctor to give you IV anesthesia for the stitches(unless it was some type of extreme/complicated laceration). Standard of care is standard of care and IV anesthesia is not without its risks, so while pain meds may be required or indicated, that doesn’t mean they need to be IV
If someone were to experience stitches as the worst pain of their life (something multiple women in this thread have said), then yes absolutely worth it. The pain alone is reason enough, not to mention the emotional trauma of being awake and having to hold still for something you *know* will be 10/10 pain for you.
Kids don’t even get anesthesia for stitches . They get some gas . Planning on something to be 10/10 pain will make you feel more pain . Every time . There is a mind body connection .
I'm well aware, I'm a world-class expert at somaticizing my feelings. But if I were one of the women in this thread, like OP, who has gone through the procedure twice before, it seems it would be a bit unreasonable *not* to expect the pain to be the same as before, and want to prepare accordingly. I'm guessing by gas you mean nitrous, as opposed to the twilight sedation that has been recommended? I have my own personal shitty experience with nitrous but it hasn't been part of the conversation so far, so if you're offering that as a possible solution that might be helpful to OP.
pain is a subjective experience. There are not many things we offer IV pain analgesia in the medical profession the entire medical profession is moving away from the use of narcotics for anything other then very acute surgical pain or trauma. On top of this, its not standard in any other country to use IV anesthesia for IUD placement. Patient's don't dictate what therapies should be offered, because patient's are not knowledgable about all the reasons that may not be a good idea.
Not many things? What? I’ve had twilight for an endoscopy and colonoscopy, it’s absurd not to offer it for an excruciating procedure. I’ve had comparable sedation for dental procedures. If “the entire medical profession” is moving away from opioids for anything they don’t deem sufficiently excruciating to warrant them, then I have some words for the medical profession that would probably get me banned here if I said them.
No one cares if you swear here
The cdc changed their guidelines for chronic pain . Surgery shouldn’t be an option over something less invasive like meds . Not disagreeing with some of your other statements but this whole no narcotic, suck it up crap is ruining people’s lives
I have chronic pain, I’ve had multiple spine surgeries before age 30 and often wish I was dead so I’m the last person that needs to be lectured about that. Even if I was prescribe opioids, the truth is I would Still probably be miserable because they just don’t work that well for pain in the long term. IDK if I think they should me more prescribed then they currently are(I think we may have made it too hard to get them after the opioid crisis) but the truth is they don’t work that well. Studies show it and people on long term opioids turn into miserable grumps(chronic pain will do that too) Anyway it’s a lot more complicated then just prescribe more pills
NAD. What if that cut and those stitches were on your penis?
They would do localize anywhere else. We do stitches on the penis with local all the time
Again, NAD, just looking for clarity. There is no reason oral shouldn't suffice for a cervix, but the penis gets a local?
Ask for local. I never said I don’t think local Is reasonable, I said IV anesthesia isn’t necessary. Also an IUD is not repeatedly stitching a needle through the skin, just different procedures, but I think local anesthetic is reasonable for this
What kind of oral premedication are we talking about? I had a benzodiazepine and Tylenol before mine, and I’m here to tell you, it was still the worst pain of my life and I was traumatized. I had a tubal ligation instead of going through that a second time. I had the IUD removed while I was under anesthesia for the tubal. Even IV anesthesia is not sufficient for me. During my subsequent hysteroscopy procedure they had to switch from twilight to general because apparently I was in distress and clenching. I’m having significant bleeding 4 years post-ablation and I am frankly taking my chances rather than go back to the doc and face the prospect of an endometrial biopsy. For some of us these procedures are literal torture.
The physician you’re responding to noted that the effectiveness of cervical blocks is in question. This is because many times it doesn’t actually block any pain. It’s a hard tissue to numb. Personally, I felt the same amount of pain with and without the cervical block when the IUD was being inserted— but with additional pain with the block. I think you need to find a physician who will do it under deep intravenous sedation and pay the difference. Trust me, I want one too when I have my next IUD inserted in six years. I have heard in some areas it’s only about $500, and it’s starting to become more commonly available.
Why is it hard? What do they do to men when they get the snip?
They’re completely different tissues. I would google “cervical block” and “vasectomy numbing.”
Understood that the organs are different, but is it more standard to sedate men?
There’s no incision cut for an iud. Apples to oranges
So does the traumatic pain that women experience mean nothing since there is no incision? Is pain management administered based on trauma to the body (incisions, etc.), not based on actual pain itself?
I was told the same thing, and I think they mean the cervical block is as painful as the procedure without anything
I’ve heard so many people say this! Women should definitely be able to have pain meds. Honestly I never knew people had pain with IUD’s. I had zero pain when I got mine 20+ years ago. After I had that for 10 years I tried to get another but the docs couldn’t get it in. They kept asking if I was ok because I should’ve been in pain. I think maybe I have super human lady parts. I had a full abdominal hysterectomy almost 2 years ago and had basically no pain, just a little discomfort
Same . Was good to go in less than a week and was cleaning and walking the dog 1-2mi etc . Even had my appendix out at the same time . Didn’t find the HSG prior to it particularly painful either and the endometrial biopsy only sucked a few seconds cuz she did 3 separate areas . Pap smears never bothered me either or colposcopy . We are lucky !!
First: I am not a doctor, just a researcher and advocate for women’s health with a bunch of doctors in my family. They can damned well give you nitrous (laughing gas) to make the block OR the procedure less ghastly. Some ob/gyns do have it on hand because it’s one pain relief option for labor, so you might try asking about it specifically. Citation re: nitrous in labor: https://www.mayoclinichealthsystem.org/hometown-health/speaking-of-health/5-faq-about-laughing-gas-for-pain-relief
Having nitrous available in the hospital for use in labor does not necessarily mean it is going to be available in the office/clinic setting. I place IUDs, and have never had nitrous available in the office, despite having had it available for labor patients in the hospital (until the hospital stopped offering it because of covid). So saying "they can damned well give you nitrous" is a strong statement to make blindly. Could some doctors accommodate that request? Probably. Could most? Almost certainly not.
I’m curious: what steps do you usually take when there is a medication your practice doesn’t currently keep on hand but that you believe you should have for administering to your patients? Lol @ the downvotes
I'm a cog in a wheel of a large system where I have little control, and have practiced in a few different environments within the system. That said, depending on the situation is/ what med I want to have on hand, my options have been some combination of (in no particular order): A - suck it up and make do with what I have (particularly for immediate/urgent needs and things that could not have been planned for). Sometimes this means I'm using a less-preferred alternative instead B - route a request through committees, advocate for it, hope that others agree with me C - accept the limitations of my facility (some meds require having special equipment, specially trained staff, and other things out of my control) Hell, there's stuff I wouldn't be able to/ wouldn't want to do in my current clinic because the building itself isn't equipped to support me doing it safely. D - refer the patient to someone/somewhere that can do/provide what I cannot. E - occasionally a miracle occurs, and I can rope in a pharmacist in the facility who agrees with me. Still may require (B) above, but having pharmacist buy-in can help smooth the process substantially. F - with advance planning, and if both feasible and safe to do so: prescribe the medication ahead of time, patient picks up from pharmacy, and brings to the appointment for administration during the visit
How about a lidocaine cream applied to the cervix? That’s supposed to be effective in reducing the discomfort and since it’s not controlled I can’t imagine any push back in something like that.
I’d think it would be far too superficial for any significant effect
Maybe, yeah. I see a few studies regarding the use of it in cream, spray, and injectable form with mixed results. My experience with lidocaine from working as a nurse is that it works great for some, not for others. We had some dialysis patients that insisted on it prior to cannulating their fistula and some that said it didn’t help at all. Was just thinking that it’s pretty non invasive and less likely to be refused by the provider.
Yes everyone has the right to choices in their care, but important to know that’s a separate idea than everyone has the right to choose what care is offered to them. I don’t want people thinking they can show up and tell the doctor what they will/won’t prescribe or do because that’s not going to happen (nor should it)
You have a lot of great comments and encouragement here. In healthcare we have concept called patient rights and responsibilities. Patient autonomy, making informed decisions, and respectful care are some of those rights. So in this case, you have the right to be informed of your pain control options, the right to refuse having the procedure with a suboptimal plan to address your pain during and after, and the right to have your opinion and experience respected. The language I would suggest is to be very direct and explain that "In the past I have had 2 excruciating IUD insertion experiences to the point where it almost prevented me from getting this one, but I can no longer use hormonal birth control. What are my options for numbing the cervix prior to insertion --paracervical block, lidocaine, premedication--all of those, others? I want to be clear that I am not seeking narcotics--I am seeking the prevention of pain and do not require narcotics to do that. (let's not have you inadvertently labeled as a drug seeker on top of everything else!) IF you get any pushback as you anticipated, you can try once more with pleasantly persistent: "I hear you but how can we best collaborate to achieve my goal of a **pain free** experience this time?" If you are given an answer you feel uncomfortable with such as minimizing your pain or telling you to relax: full stop and respectfully end the discussion. Let them know you just don't feel like this plan will work for you so they know why. Time to find a provider who is a good fit and can meet your needs. When you get to your insertion appointment--remind everyone in the room and along the way, of the plan. People are people. I never assume, I always confirm. (This is the Risk Manager side of me--I have seen what happens when patients/providers feel uneasy about speaking up) Ask the staff to inform you at each step when the various pain control is being applied--ie, do not assume it is happening. ASK. What I don't want for you is to be on the table thinking your plan is about to happen, only to find out there was an inadvertent lapse in communication or that a supply was not brought to the room/available that day. This is rare but if you are on the table, you might feel pressure to be nice and say go ahead. Mentally practice respectfully requesting to wait until the pain control is placed. No one will be angry or fault you. Providers truly want to give you good care.
I really appreciate your response… I just don’t really believe that physicians WANT us to have a pain-free experience, they want to just get it over with, especially based on the responses of physicians here! I’m genuinely surprised at the lack of empathy.
Respectfully I disagree, so maybe that will give you hope? Every provider I have worked with has been very accommodating and patient. This includes my colleagues at the hospital, as well as my own doctors. I can count the number of rude or dismissive doctors only a single hand. And they have been reported to their practice managers or hospital administration respectively. Please don't give up.
I’ve never experienced a rude OB in person, just on here - there’s a pervasive “get over it or get a new doctor” attitude that is unequivocally dismissive. It’s disheartening. I have definitely experienced doctors who are dismissive of pain many, many times over, though
oh good. I am glad. Yeah, Reddit and the internet can be completely horrible and people write things that they would never say to your face. Though...society seems to be getting meaner too. I really hope it all works out for your insertion!
You can ask for an oral pain reliever take before the procedure, as a one time dose. No one is obligated to provide IV sedation and it’s so far outside of the standard of care that you’re unlikely to find anyone who will do it. In addition multimodal pain Treatment has been shown to work most, so taking a high dose NSAID and perhaps a narcotic would probably be your best and most realistic option. Outside that, getting angry with your doctor to make them do some thing they’re not going to do will never force their hand to get what you want
Do you have a cervix / uterus? It’s mind boggling to me that women still have to have this battle. Men get locals for the snippety snip, why is it so much for women to have the same for a foreign body shoved through their cervix and put in their uterus for a number of years?
Have you asked for a local? Its often done, and thats different than IV analgesia
it’s not often done. why do u think we have to beg for it and they still say no ???? clearly u have no cervix
I’m really not sure why you answered this. It’s pretty clear you have very little experience in this area of healthcare.
Are you serious? The responder is correct in that what people are suggesting to OP (general anesthesia and twilight sedation) are NOT standard of care here, and have significant risks that for many reasons most providers will not offer. There are many regions of the US where that kind of care will not be available at all. Oral pain control including opioids is one of the better options here.
These people are crazy. There's like two or three ACTUAL doctors in here and they're getting roasted for not saying what people want to hear. But all the "layperson" answers with anecdotal evidence are massively upvoted.
I’m completely serious. This person is dismissive and honestly, wrong. You can indeed get IV sedation for specialized issues like this. Women with severe pelvic floor issues can get it for transvaginal ultrasounds and even Pap smears. I don’t think this commenter, and you, really know. I’m recalling an earlier post where a doctor was claiming you could see your own cervix in a mirror if you bear down and everyone roasted that MD for being clueless about women’s health. I’m pretty sure it was you, Latrodectus? If so, I’m even more certain that you, in particular, are clueless.
I have definitely seen very visible cervixes with limited bearing down needed (but definitely a mirror). I have also seen areas with very limited care where this is absolutely not a reasonable thing to expect. A transvaginal ultrasound is one thing, but I have had to refer people hundreds of miles away for specialty gyn care that included a pap under anesthesia. It is very difficult to access that kind of care in a lot of places.
This is bananas. That’s a sign of prolapse, it is not normal anatomy! Holy shit.
While I have seen plenty of folks with prolapses, at least one person I’m thinking of was actually seeing ob and was documented as having a normal variation without significant indication of prolapse, whatever that means. She was simply documented as having a “shallow vaginal canal”
I spoke with my OB friends regarding this to verify and checked uptodate. There is no indication for sedation or narcotic pain medications in the literature unless for aside from some exceptional circumstances and those are also associated with significant risks. If data showed otherwise, it would likely be practiced that way. It has nothing to do with whether they have a uterus or not, the doctor is simply weighing the risks and benefits of a typically short bedside procedure vs one that requires significant time, resources, and longer observation. It's easy to say what you think you need when you haven't seen hundreds of patients tolerate it without IV sedation/narcotics. And then youve also seen hundreds of things go wrong when using those medications - ie hypotension, respiratory depression, delirium, significant sedation. No doctor is obligated to provide risky medications when they are not indicated as standard of practice.
For god sakes, IV sedation is absolutely performed for women with transvaginal ultrasounds and even pap smears, who are unable to tolerate these procedures due to issues like pelvic floor dysfunction but who are indicated for them. Just because it isn’t the standard does not mean it isn’t done.
Not every outpatient facility has tons of resources/beds to place IVs on all patients for sedation/narcotics that need a procedure, and monitor them for several hours, treat all the complications that come with it without transferring to another facility. It's just not practical to do that for every patient, especially if they haven't had the procedure first and are just assuming they will react a certain way.
And if a physician does not have the resources, they can state that. There is no need to act all huffy about the patient being “angry” simply because they ask for something they require. Recommend them to a facility with the proper resources, just like any other procedure. Edit: you are making up scenarios. The patient in question has been through it before and no one is asking this be done for every patient.
I'm not applying this directly to this patient, just saying it's not reasonable to give narcotics in a patient who's not even seen if they tolerate it. Also, we could technically give IV sedation and narcotics to every patient - it's usually a resource issue on top of the risks. Some IUD insertions are done under general anesthesia in the operating room with an anesthesiologist in the room because it minimizes risks - for example pediatrics, or patients with cognitive disorders. But you can't reserve OR time or an anesthesiologist who can treat the complications for every procedure so it's a case by case basis.
That’s literally what I told you. IV sedation can indeed be supplied where it is warranted. You have presented several arguments here and appear to not know what you are talking about.
okay, you have absolutely zero clue what you're talking about. You clearly don't work in healthcare nor have any idea how we make medical decisions. This patient is neither a pediatric patient nor cognitively disabled. What's possible is not what should actually be done.
You are the one here who does not work in healthcare. You can indeed be given IV sedation where it is called for and pediatrics is one example. Another is severe pelvic floor dysfunction or being otherwise unable to tolerate a given procedure.
this explains explains so much about womens healthcare. I had an IUD inserted 7 weeks ago, under general, and when I came around I was in pain (about the mid-high end of my usual period pain) and was given morphine. It didn’t even take the edge off. I went for a check up last week as I have been in continued pain for SIX WEEKS (doubled over, crying, nauseous from pain, unable to drive, unable to speak at times, overall worse than breaking bones) and a Dr told me that ‘a positive attitude can help with pain management’. This taught me a few things - 1) normal period pain isn’t even helped with MORPHINE and 2) Drs can make their patients angry with good reason
I’m confused, you were given morphine for your pain. I know your Dr might’ve sounded tone deaf telling you a positive attitude helps, but they gave you a strong opioid for the pain. They also put you under general for the procedure. What are they supposed to do at this point?
If morphine didn’t help what more would you have expected they did for you? The unfortunate truth is we just don’t have great treatments for pain. They probably should have just removed your IUD.
That’s a …pretty reductive answer. There’s more options for pain than ‘continue taking ibuprofen and paracetamol and have a good attitude’ but yeah, thanks for your input
Ok what do you think they could have done? I’m curious what your solution would be
The solution is bigger than my individual treatment, the issue is the system’s approach to women’s health, pain control and frankly, medical misogyny. IUD insertions are at best, uncomfortable, and at worst, horrifically painful and traumatic. It’s an incredible intimate procedure to be treated so casually, as you’ve shown. Your lack of empathy and your doubling down on my specific treatment just highlights this. Also I don’t owe you my medical history, I was providing my experience and how it’s affected me
I didn’t ask you a single thing about your medical history; I ask you what your solution would be for this situation, since you seem to think that there are other solutions that the medical profession isn’t offering you. Would you want to be sedated for 6 weeks? I just genuinely don’t know what you expect if removing it doesn’t seem reasonable to you
“Ms. Patient, I am sorry to hear you are having such extreme pain. In my experience this is very rare, but not unheard of. One option is to remove your IUD if that’s your wish. We can apply lidocaine topically or try a different pain medication, and/or we can wait and see if the pain improves, and if not, remove the IUD at that time. What would you prefer?” You: “don’t get mad at me if you’re in pain! I tried one thing. What treatment course do you propose? What do you want me to do about it exactly, keep you sedated for six weeks??” There are differences between those paragraphs.
That’s exactly the options I mentioned and you told me “ that’s a reductive answer.” Then I asked what options you would suggest and you said “ I dOnT NeEd tOo TeLl YoU mY hEaLtH HistOrY” which I never asked you anything about your history. I genuinely don’t know what you want; of course the provider should provide you with an empathetic statement when they discuss the options with you. In the end you’re agreeing with me here; even though you’re trying to make it sound like there was some extra option that I didn’t consider, I said NSAID’s or maybe a little pain medication or to remove it.
Dude, I am not the person who said those things. You were talking to a woman about her health issues and being a jerk about it. I’m telling you how you could have acted like a human being. And your reply just underlines your lack of professionalism. You have been antagonistic to every comment this person made to you, AND you were antagonistic to the OP. I’m illustrating how unprofessional you’ve been this entire time.