Pain Relief during IUD procedures

[1stWorldProblems]

Apologies if this has already been covered - the search facility doesn't seem to be working today on MN. I know that Caitlin Moran is a bit of Marmite person for Mumsnet (& even for me some days) but today's Times magazine is a) laugh out loud funny in parts and b) made think about something I'd just taken for granted as a given - why is it that coil insertions & removals are done with out any offer of pain relielf? It never just "hurts a bit" and leaves me feeling physically odd for several days after.
www.thetimes.co.uk/article/why-we-all-need-pain-relief-when-having-an-iud-fitted-7qks82srw

She has recently had a particularly bad procedure and has been tweeting about a petition by Lucy Cohen calling for more information & pain relief for the procedure. This bit made me laugh out loud

"Interestingly, several who worked in the medical industry pointed out that during colonoscopies – a unisex procedure – people are offered either gas and air or sedation. In many ways a colonoscopy is similar to an IUD insertion – doctors are putting something up one of your special, private holes. The big difference between the two is in scale and accessibility. The sphincter is essentially like the Blackwall Tunnel; it’s built for daily traffic. It’s a well-travelled route, open 24/7.

The cervix, on the other hand, is a bit like my nanna’s sitting room. The door was always closed, it was only used on “special” occasions, and she’d be quite agitated that someone might break something precious while they were in there. She was relieved when everyone left."

[CousinKrispy]

I wonder how much this varies for other procedures too from one practitioner to another? I certainly wasn't offered any pain relief for my colonoscopy a few years ago even though it was being carried out to explore a very painful anal fissure and I pointed out that it was painful as it was happening.....the practitioners were sympathetic, but it was definitely a "grin and bear it" approach and I wonder if that's partly down to the NHS being stingy with pain relief??

I'm not questioning the notion that IUD handling particularly ignores women's pain due to women's healthcare being shabby, I'm just curious about the wider picture too

[Ostara212]

I came on to see if there was a thread after reading this

www.bbc.co.uk/news/health-57551641

Why are women never told about this pain? My doctors try to sell me the coil every time I have a Pill check.

[AnotherVice]

The last time I had a coil fitted I was part of a trial using Entonox, it was bloody brilliant. I was instructed to use it constantly, so not like in labour and I couldn't feel a thing. I imagine it wouldn't be ideal for anyone with a history of abuse as you would feel very vulnerable but I think it should be offered to everybody.

[PawsQueen]

See it's even minimised in that article

Dr Dawn Harper, GP and broadcaster, said Naga's experience was not typical: "For most women, it's a little bit uncomfortable. It's a bit like period pain."

Uncomfortable to me is pins and needles, standing on a piece of Lego, catching a hangnail. And I'm decent with pain, I didn't even take paracetamol after 5hrs of spinal surgery!

[crosstalk]

I went in for a very welcome check up which was excellently done. HOWEVER I had to have a catheter insertion. I was told I wouldn't know about it but since the area was already sensitive it was very painful I would have welcomed valium to stop me screaming as would the doctor and nurse performing it.

I've walked on a broken toe and sprained ankle. I've produced two DC with little pain relief. So I have reasonably high pain tolerance.

It's also an invasive procedure like cervical smears. The sooner it gets done by blood tests or whatever the better.

[OverByYer]

Yes I’ve had two vaginal births including an episiotomy and ventous delivery but the pain I experienced having the Mirena was more traumatic in some ways. I think the lack of care and pain relief makes it so.

[TurquoiseLemur]

@PawsQueen

See it's even minimised in that article

Dr Dawn Harper, GP and broadcaster, said Naga's experience was not typical: "For most women, it's a little bit uncomfortable. It's a bit like period pain."

Uncomfortable to me is pins and needles, standing on a piece of Lego, catching a hangnail. And I'm decent with pain, I didn't even take paracetamol after 5hrs of spinal surgery!

Umm, that "For most women, it's a little bit uncomfortable" is absolutely minimising, isn't it? It also carries the unpleasant connotation (even if not intended) that a woman who does find insertion/removal painful or excruciating is somehow a neurotic or a time-waster. If this thread is anything to go by, such experiences aren't unusual.

I know what period pain feels like, fgs. And what I experienced was much worse than that. I'd have far more respect for health professionals if there weren't so many of them who use phrases such as "minor discomfort" or "slightly uncomfortable" when they mean "This will be painful." Most of us appreciate (I would think) a bit of honesty, rather than being misled by twee little phrases.

At least the doctor who pumped my stomach back in the day didn't claim that it was going to be anything other than horrendous.

[Pilcrow]

Dr Dawn Harper, GP and broadcaster, said Naga's experience was not typical: "For most women, it's a little bit uncomfortable. It's a bit like period pain."

This kind of sweeping statement really annoys me. How does she know how most women feel? Has she asked them all?

[TurquoiseLemur]

@Pilcrow

Dr Dawn Harper, GP and broadcaster, said Naga's experience was not typical: "For most women, it's a little bit uncomfortable. It's a bit like period pain."

This kind of sweeping statement really annoys me. How does she know how most women feel? Has she asked them all?

Quite.

She hasn't asked them all.

Worse, if a health professional fits a coil and the woman finds it painful but the HP feels she is exaggerating or being a handful (which seems to be a common perception of women in pain and/or distress), that HCP is hardly likely to record it.

Nothing in the reactions of the nurses who fitted mine led me to think they'd record it. Quite the opposite: they were casually dismissive.

[NiceGerbil]

Mine was like naga- never been in Labour or given birth.

I said upthread- doc really struggled to get it in. She was quite angry with me about it. You need to relax. Why is this so difficult etc. As if it were my fault, I was doing something wrong or my body was wrong iyswim

[NiceGerbil]

The other thing I just thought of is that mirena seems very marmite. Some women love it. Some women have loads of side effects.

The difficulty with hormonal stuff is that it's usually fairly slow and subtle. Mood changes. Weight changes. Libido changes. All sorts of stuff but it's not the sort of stuff it's easy to say yep that's definitely to do with that.

For women who don't get on with it the side effects can be pretty severe. And they find it hard often to get them removed. The hormones are localised. Can't be that. You need to give it a few months etc. Women sometimes resort to taking it out themselves. Ditto the implants. Women have cut them out. Because docs won't remove it. Can't be that. You're imagining it. Give it time. Etc etc.

[NiceGerbil]

It's just one thing out of many really, and it's generally to do with our reproduction stuff.

Endometriosis takes something like 12 years to diagnose on average, women often given ADs etc. The pain etc is imaginary.

Childbirth, well I'm sure everyone knows the issues.

Letting hard sell people onto post natal wards. ???! When women are in pain, emotions all over the shop, worn out. I was on opiates, how is it ok to let salespeople in? When else would that possibly happen?

And so on and so on.

This is one aspect.

It never occurred to me before. It was incredibly painful but worse was this wrong feeling. Sick, faint, shaky.

The cervix prevents germs getting up into your body I assume. I expect having it forced open is something that naturally many women's bodies say nope to.

[sashh]

I’m sorry, I know I shouldn’t be laughing as this is a serious subject, but cheugy’s “titled” uterus cracked me up!

I read @Vinniepolis and wondered how/why an IUD was being fitted as she was driving. Sometimes Dyslexia is a real gift.

[rivierliedje]

I fit a lot of IUDs/IUSs and I wish we had gas and air, that would be brilliant. We do try to get women in on their periods as much as possible, give them disolvable tablets to use before hand to dilate the cervix and give them mefenamic acid (ponstan). We also have the injections of local anaesthetic to use, but don't use that as standard as it can sting and doesn't get rid of all the pain, but very useful if the cervix is not dilated or it's taking longer.
We also have water, tea, chocolate and hot water bottle on hand if a patient feels unwell afterwards and we recommend they get someone to take them home afterwards.
The range of pain is massive. Some women barely feel it, get up immediately afterwards and feel completely fine. Others are in very intense pain, feel faint and vomit.
What I would like is research in to pain relief that works well, is easy to take and has few side effects and research in to who will find the fitting a breeze and who would be better under sedation/general.

[rivierliedje]

Oh, and yes to PP who said bed with stirrups is more comfortable. In one of the clinics I work we have stirrups and in the other it is just a flat bed against a wall, and the stirrup bed is better all round.

[TurquoiseLemur]

@NiceGerbil

Mine was like naga- never been in Labour or given birth.

I said upthread- doc really struggled to get it in. She was quite angry with me about it. You need to relax. Why is this so difficult etc. As if it were my fault, I was doing something wrong or my body was wrong iyswim

Nothing more useless than being told "You need to relax!"

When I had mine, I had been in labour and given birth twice. Are the NHS saying that it's considerably less of an issue if the woman has been through labour? If so, this seems like further minimization. (Nothing in my own medical history, as far as I know, suggests that my cervix, womb etc are any different or more complicated than those of most other women.)

"As if it were my fault. I was doing something wrong or my body was wrong"-yes. I remember another thread here a while ago in which some posters had chosen (often on medical advice) to have a contraceptive implant, had subsequently had all sorts of problems with it and had asked for the implant to be removed. . . only to be dismissed and told "Oh, it's nothing. Most women cope with it perfectly well", yada yada.

There's a pattern to these testimonies.

[TurquoiseLemur]

@rivierliedje

I fit a lot of IUDs/IUSs and I wish we had gas and air, that would be brilliant. We do try to get women in on their periods as much as possible, give them disolvable tablets to use before hand to dilate the cervix and give them mefenamic acid (ponstan). We also have the injections of local anaesthetic to use, but don't use that as standard as it can sting and doesn't get rid of all the pain, but very useful if the cervix is not dilated or it's taking longer.
We also have water, tea, chocolate and hot water bottle on hand if a patient feels unwell afterwards and we recommend they get someone to take them home afterwards.
The range of pain is massive. Some women barely feel it, get up immediately afterwards and feel completely fine. Others are in very intense pain, feel faint and vomit.
What I would like is research in to pain relief that works well, is easy to take and has few side effects and research in to who will find the fitting a breeze and who would be better under sedation/general.

It sounds like you and your team are doing your best to help women. Thank you for that.

[Clandestinekitten]

Maybe the research evidence is that most women find insertion and removal an acceptable level level of discomfort. But I think there needs to be more data collected on women like me who find it a traumatising and excruciating experience. Very very far removed from the worst period pain I’ve ever had, and not quickly done and dusted. I could indeed have asked the (lovely) GPS to stop (which I eventually did and am now on the mini pill) but because we’re give the narrative that “most women” find it just a bit uncomfortable and can cope with taking a couple of paracetamol beforehand then you feel you should be able to push through. But it really wasn’t an acceptable level of pain for me. I don’t need it to be pain free. But if there are a proportion of women who feeling severe pain the there should be alternative methods of treatment. (I know there are because I’m on it - the mini pill), but the coil was great for the couple of times I did manage to have it.

[TurquoiseLemur]

@Clandestinekitten

Maybe the research evidence is that most women find insertion and removal an acceptable level level of discomfort. But I think there needs to be more data collected on women like me who find it a traumatising and excruciating experience. Very very far removed from the worst period pain I’ve ever had, and not quickly done and dusted. I could indeed have asked the (lovely) GPS to stop (which I eventually did and am now on the mini pill) but because we’re give the narrative that “most women” find it just a bit uncomfortable and can cope with taking a couple of paracetamol beforehand then you feel you should be able to push through. But it really wasn’t an acceptable level of pain for me. I don’t need it to be pain free. But if there are a proportion of women who feeling severe pain the there should be alternative methods of treatment. (I know there are because I’m on it - the mini pill), but the coil was great for the couple of times I did manage to have it.

You make a very important point. Once someone is told "Most women find it like this. . ." or "Most people don't have much trouble with such-and-such" , they find it much harder to then say "But I personally do have trouble with it" or "It was actually very painful" or whatever.

It's a use of language that tends to shut people up. That might not be intended (though I think in some cases it is) but that is the effect.

[JellySlice]

Once someone is told "Most women find it like this. . ." or "Most people don't have much trouble with such-and-such" , they find it much harder to then say "But I personally do have trouble with it" or "It was actually very painful" or whatever.

It's a use of language that tends to shut people up. That might not be intended (though I think in some cases it is) but that is the effect.

Add to this the fact that we have chosen to lie there with our legs spread, in an extremely vulnerable position, offering our most sensitive and private parts to this treatment. It sets up a huge emotional conflict in any woman who finds these procedures distressing, for whatever reason.

[IronTeeth]

@Vinniepolis

I nearly passed out after having the mirena coil fitted - unfortunately I was driving at the time so that was a bit scary.

[TurquoiseLemur]

@JellySlice

*Once someone is told "Most women find it like this. . ." or "Most people don't have much trouble with such-and-such" , they find it much harder to then say "But I personally do have trouble with it" or "It was actually very painful" or whatever.

It's a use of language that tends to shut people up. That might not be intended (though I think in some cases it is) but that is the effect.*

Add to this the fact that we have chosen to lie there with our legs spread, in an extremely vulnerable position, offering our most sensitive and private parts to this treatment. It sets up a huge emotional conflict in any woman who finds these procedures distressing, for whatever reason.

I agree.

[BaronessOfTheNorth]

It's not the insertion for me, it's the "sounding" which is making me nauseous is to even write down. I've had three coils inserted and pass out each time. Never again!

[BraveBraveMouse]

I've never had a coil, but had lots of fertility investigations and I always felt like it was cruel to not offer a woman something to relax her (like a valium) when being tense is known to make procedures accessing uterus via the cervix more painful. After one such instance where the doctor repeatedly struggled to get access via my cervix, telling me to try and relax through the pain, I decided I was taking matters into my own hands and would make sure to have some gin before procedures - I'd recommend anyone do the same.

[NiceGerbil]

BBC today

www.bbc.co.uk/news/health-57557296

It should not hurt say experts.

For me that wording reads as if, it is does, it's not the procedure it's something to do with you. That was certainly the vibe I got from the women who put (forced) mine in. She seemed quite pissed off with me that she struggled to get it in.