Guest Post: "Why is pain still the cost of contraception?"

[RhiannonEMumsnet]

The week before I sat down to write this, I heard that the great journalist, presenter and advocate for women Dame Jenni Murray had died. Many of her obituaries recalled her playing I Am Woman to close her last Woman’s Hour, a programme she’d presented for decades on Radio 4. The music may not be everyone’s cup of tea, but the lyrics will chime with women everywhere:

Yes, I am wise
But it's wisdom born of pain

But pain shouldn’t be part of the plan, and, frankly, women have got wise to it. We shouldn’t have to experience pain during medical procedures, and our voices should be heard when we do. Even as someone working in and around healthcare for more years than I care to admit to, I’ve been told that I was mistaken about my experiences of medical procedures, gaslit about what I’ve requested and warned that non-compliance will probably see me ending up on a long waiting list.

The College of Sexual & Reproductive Healthcare (CoSRH), which represents doctors, nurses, midwives and pharmacists, is actively seeking to change this around the fitting of intrauterine devices (IUDs or coils). We produced guidelines back in 2021 to ensure both that pain is no longer normalised, and that women have access to appropriate pain relief during coil fittings. Those guidelines make it clear that pain relief should be discussed and offered – and that women should be able to pause or stop at any time.

However, we know that five years on from publishing those guidelines, this is not everyone’s experience. In fact, it wasn’t my experience. The couple of paracetamol that were suggested, not as part of a consultation but via a standard form, were woefully insufficient.

Most women having a coil fitted will experience a bit of discomfort, perhaps, but nothing untoward. But everyone’s experience of pain is different — and the relentless amplification of negative fitting stories on social media can add to existing fear long before the appointment. We need to ensure that this is borne in mind, before, during and after the fitting.

In an ideal world, the clinician - whether a GP, a nurse practitioner or a doctor in a sexual health service – has time to discuss options, to talk about the procedure and to address any concerns. We know, though, that time is a luxury that many NHS services simply they don’t have. That’s why we are working with services, and the NHS across the four nations, to ensure proper time is allocated to coil fitting appointments and that women are given the reassurance, including the discussion of pain relief options, they need.

Our guidance also makes it clear that an assistant should also be present to support the patient. We don’t talk enough about the invaluable role HCAs and nurses play in coil fittings. The HCA who supported my coil fitting was brilliant. She held my hand – literally – throughout and she kept me talking, not just for my sparkling conversation, but so that she could make sure that I was doing OK. All of this enabled the doctor to focus on what she needed to do. Making sure there are the right staff available to support patients is vital. However, we know that, on paper, it may look like overstaffing. Ensuring NHS managers understand the value of ‘alongside’ support is crucial.

We’ve also heard from our members that they are often restricted in the pain relief they are able to offer, sometimes because the time allocated to the appointment doesn’t give enough time for it to take effect or because appropriate methods simply aren’t authorised by their service. There are some great options available, including sprays, gels and creams, but services have been slow in making them available. This must change, and the College is leading those discussions. We want women to know that if their preferred pain relief option isn’t available, they can be referred to a service where it is.

Getting this right – for women and for clinicians – is vital, because coils can be absolutely game-changing. Again, I’m speaking from personal experience: having a hormonal IUD fitted during perimenopause improved my quality of life exponentially. For younger women, it can reduce period pain and heaviness and lasts up to eight years. Copper coils are hormone-free and last between five and 10 years. Both allow an immediate return to fertility after removal.

Coils have the potential to make women’s lives so much better – but we shouldn’t have to experience pain to achieve that potential. There are some brilliant clinicians up and down the country who are desperate to offer appropriate pain relief and to improve women’s experience. We need services to make this available.

Because pain shouldn’t be part of the plan.

Find out more and explore CoSRH’s patient toolkit here.

The support HCAs can give is vastly under-rated. They are as important as the practitioner, whether doctor or nurse, having the time to consider the patient’s needs and not whether she can be wedged into the cheapest NHS algorithm.

I have had an HCP hold my hand, press it gently and rub the back of my hand with her thumb while the doctor inserts the IUD. Such a tiny thing to do, so cheap, all it costs is a few minutes of time, but so massively helpful to a distressed patient.

It’s really not that painful. Short term discomfort

Part of the problem is people really don't realise that we are all different. Shoes that are comfy for me aren't for you, and exercise I find easy might be difficult for you.
Depending in the conditions you have, anything from a smear test to coil fitting might be very painful-and let's remember, it can take nearly a decade for a woman to be diagnosed with endo, so it's not as simple as checking your medical records. That's not even taking mental health conditions, or past trauma, into account.
Too many of us have dismissed other people's pain. I always had painless periods, smears and contraception fitting until developing a gynae condition, but that does not mean I don't believe other women don't have very real pain.

For you.

I won't have another smear test unless sedated. I had a coil fitted as part of another procedure under sedation. If it needs to be removed I'll need sedating for that. Far too painful.

Mine wasn’t painful but smears can be, depending on who’s doing them. I think a lot depends on the expertise of the person fitting them. The gynae who did mine was amazing and nothing ever hurt on her watch. Others - well, that’s a wholly different story!

I had my first baby at home without pain relief. The copper coil removal caused me significant pain.I do not want emotional support for a needlessly painful procedure. I want proper pain relief. Equivalent to the pain relief offered to every man for every procedure.

Good for you! The procedure had to be aborted for my daughter because of the severity of her pain. She has adenomyosis. She could not stand or walk for over an hour and we barely made it back home. She needed complete bedrest for 3 days. We are both traumatised by the experience.

My other daughter had a coil fitted as emergency contraception after being raped. She says it was the most painful thing she ever experienced, and she has chronic migraine.

Seriously! Your experience is just that: your experience. For girls and women with adenomyosis and endometriosis, women and girls who have been raped, or women and girls whose nerves lie differently to yours the experience can be excruciatingly painful.

I am still absolutely furious with the sexual health clinic that they even attempted the procedure. Women are not cattle. In other countries coils in girls and young women are routinely fitted under general anaesthetics. Why do you think that is?

For some procedures the pain is significantly related to the woman’s stress or anxiety. A comforting hand and presence can reduce that stress and therefore reduce the distress. Even when I know that I am not going to feel any pain because I am about to be anaesthetised or sedated, I still want to be treated with compassion and consideration, like an individual, not a case to be moved on as efficiently as possible. Patient-centred treatment, right?

This is a really odd take in the OP ‘and the relentless amplification of negative fitting stories on social media can add to existing fear long before the appointment’. I get the point being made, but aren’t you also gaslighting women to imply that those relaying their experience are somehow creating hysteria and being unhelpful?! Presumably it’s more helpful to have a range of views, rather than the overly euphemistic ‘it may be a little uncomfortable’ rhetoric that many doctors peddle, which presumably leaves women very underprepared to advocate for pain relief (through no fault of their own) and not expecting it to be at all traumatic.

Then go and rub the back of a man getting a vasectomy and withhold his actual pain relief.

I had a coil fitted once and I had not had children. The Dr did not tell me it would be painful and I expected it to feel like a smear. This was 2000 before we had internet phones to research these things.

The nurse who was chaperoning as it was a male GP held my hand so that should’ve been my first clue. The pain was excruciating. So much so that when I needed it changing a few years later, I had it removed but not replaced as I couldn’t go through that pain again.

Similarly, I know many women who have needed biopsies after abnormal smears and they have told me how painful they are. Yet no pain relief is offered.

I can’t believe in 2026 it is still acceptable to let women have these procedures without pain relief or sedation.

My husband recently had very minor surgery on a finger under local anaesthetic. He told them he was nervous and they gave him tablets that made him high as a kite plus sedation. I said if I’d had the same surgery, there’s no way I’d have been offered any of that.

Everyone has different pain thresholds.

I've had 3 now because they suit me so well, much more so than tablets or injections or implants. But I have to steel myself for weeks when due to be replaced and the pain is awful at the time even though its only for a short period. I haven't been offered anything other than paracetamol and was told the only other option was to be fully anaesthetised at a gynecology appt which has a very long waiting list.

Surely this OP is rage bait?!

I had my coil inserted with gas and air and it was brilliant, I was floating on the ceiling! When it fell out I was quite looking forward to having another one fitted!
I think the PP is right, we know that fear heightens pain and a step-wise approach to pain relief is always appropriate. It should of course be stepped up when necessary.
I don’t think it’s fair to say this is sexist though. Men have catheters inserted, often tricky ones past an enlarged prostate, without any pain relief either.

Do you know what really hurts? Not being believed.

I don't understand why the options I've been given for a coil is either (a) bite down or (b) a general anesthetic.

I can have other operations with morphine and IV painkillers to manage pain, but also to prevent the risks of a GA - so why not gynae procedures?

I'm currently on the waiting list again for a GA for a gynae procedure because I've passed out twice having it attempted. But instead of a lower-risk anesthetic, a GA is all I'm offered? It makes no sense to me and I'd love someone to explain it!

Did you even read the article or didn’t you bother?

For. You.

I had a biopsy with no pain relief and no warning last year. I was told there “may be some discomfort”. When they’d got me down from the ceiling I assured them there had in fact been rather more than discomfort.

I’ve had 2 babies. Nothing prepared me for the pain.

this sort of comment is a massive part of the problem. And it’s So disappointing to hear it from another woman.

Exactly. Everyone has different pain thresholds, and women who suffer from central sensitisation experience pain in an amplified way. While a healthy woman might feel a 3/10 level of pain, someone with central sensitisation may genuinely experience that same stimulus as a 9/10. This doesn't mean they are being hysterical or dramatic - pain is an alarm signal, and their pain pathways in the brain have become more reactive, causing the sensation to feel far more intense to them. Women with migraine, fibromyalgia, chronic pelvic pain, IBS - lots of conditions really - often have central sensitisation. Endometriosis makes nerve endings more sensitive. Women with these conditions should never be offered the coil without GA.