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Good news if you go to a gynecologist: IUD insertions, colposcopies and other in-office procedures might get a lot less painful.
Women and people assigned female at birth have long known that their pain is often minimized by doctors and other medical providers. But now, new guidelines not only formally acknowledge that, but also offer recommendations for doctors on how best to manage patients’ pain.
What the new guidelines say about pain management
Maybe you’ve seen the IUD insertion reaction videos on social media. Or maybe you’ve always dreaded getting a Pap smear. The pain that often accompanies in-office gynecologic procedures is nothing new; women have been speaking out about it for decades.
“There are many nerve endings in the cervix and the top of the vagina, and even more in the top of the uterus,” says Aparna Ramanathan, MD, an OB-GYN at UW Medical Center – Roosevelt. “More nerve endings often mean a greater possibility to feel pain in that area.”
The American College of Obstetricians and Gynecologists (ACOG) recently released official guidelines outlining how doctors should handle pain management for in-office gynecologic procedures with patients. Here are some important highlights you should be aware of:
- The guidelines cover common procedures, including IUD insertion, Pap smear, cervical or endometrial biopsy, hysteroscopy and uterine aspiration for abortion or miscarriage.
- The guidelines include a list of evidence-based, research-backed pain management options for each procedure, including recommended dosages.
- The guidelines encourage doctors to be trauma-informed and make sure they are being sensitive to the past experiences and potential extra needs of patients who have a history of being abused or assaulted.
The new recommendations also reinforce how important it is for doctors to take into account a patient’s full medical and personal history — such as if someone experiences mental health issues like an anxiety disorder — and ensure that shared decision-making takes place.
Why these guidelines didn’t exist before
You might be wondering: Um, why is this just happening now? Shouldn’t these guidelines have been established a long time ago?
There’s a long, long history of women’s pain being dismissed, justified or just not taken seriously. (For example, doctors used to think there were no nerve endings in the vagina. Seriously.) It happens in everyday life and also in the medical world, and not just in gynecology but in every medical specialty.
This inequity is further complicated by racism and other biases, too. Black women are often offered fewer pain management options than white women. Teenagers and younger adults may have their pain more readily dismissed.
Along with this bias, research in gynecology doesn’t receive the same funding or attention that research in other areas does, especially conditions that more commonly affect men, says Ramanathan.
Lastly, pain is a unique and subjective experience. Something that is extremely painful for one person might not be for someone else. Personal history, past experiences, mental health, other medical conditions, past pregnancies — so much can affect how much pain someone feels on a given day for a given procedure. It can be a tricky thing to get right, even when doctors are doing everything they can (though that shouldn’t stop them from trying).
What this all means for you
If gynecologic procedures are often painful for you — or if you’re afraid they will be — know that you absolutely have the right to ask for pain management options if your doctor doesn’t bring it up. There are solutions available — such as painkiller pills, lidocaine spray or cream, or local anesthesia like a paracervical block, depending on the procedure — and it is absolutely your doctor’s job to help you be more comfortable during your visit. (And if they aren’t willing to do this, well … you probably need a new doctor.)
“One caveat is that we have to preface things with an acknowledgment that the research is not as robust as we’d like it to be on pain management options, but we can still give info based on what we do know — including the benefits and drawbacks of each option — and then make a decision together,” Ramanathan says.
Your doctor should discuss this with you before the exam begins, when you’re fully clothed. They should also ask you to let them know if you’re feeling too much pain during the procedure and make it clear that you’re in control the whole time — if you ask them to stop, they should stop.
If you’ve been having abnormal bleeding and have a doctor’s appointment scheduled for a hysteroscopy — a procedure that allows your doctor to look inside your uterus and diagnose (and potentially remove) uterine fibroids or polyps — it might be worth asking if your doctor can send you info about the procedure ahead of time.
“A lot of times, patients are waiting months to come in for appointments, and it’s really hard for them to be given all these options on the same day they’re expected to have a procedure,” Ramanathan says. “Sometimes they want more time to digest the information, but at the same time they don’t want to make another appointment and have to wait again.”
While the new guidelines are great, they don’t fix the generations of pain women have endured; they only offer potential solutions that can help relieve some of that pain going forward. There’s still much more research to be done — and not just for women, but for transgender and gender nonbinary patients, too.
“As hard as it is, I hope people will feel empowered to ask for what they need and talk about their previous experiences when they come into the doctor’s office,” says Ramanathan. “I know it can be hard because medical offices aren’t the most comfortable spaces, but most doctors will be open to having those conversations and will want to make the experience as comfortable as possible for you.”
