Why don't they offer anaesthetic for coil fitting on the NHS?

[OneBluntZebra]

I had a coil fitted a few years ago (since taken out) and it was incredibly painful. My sister had one fitted privately and they gave her anaesthetic. Why don't they do that on the NHS? I have to have another one fitted soon and I am dreading it.

Do you think it's more painful for some due to the practicioner?

I wish I hadn't looked at the tray of tools, but she measured my womb (aargh!) didn't feel it, then popped it in somehow. She was sat on a stool face to vag at 8am on a Monday morning! Well basically she was in there, not like a smear if that makes sense!

I've had two and they haven't been particularly painful but it sounds as though that's not the case for many. There are risks with GA, as well as significant costs but I do think women's concerns and previous experiences should be taken seriously.

I don't have a low pain threshold. I've had gallstones and a botched c-section (during which the anaesthetic started wearing off!) and walked on fractured bones etc etc and coped. Smears don't bother me at all. But for me, coil insertion was genuinely traumatisingly painful.

It's different for everyone and hand-waving it away with "take a couple of paracetamol, you'll be fine" is supremely unhelpful.

It's very much dependent on the skill of the fitter.

I've had two I didn't feel go in, and two where it hurt so much my instinct was to get off the bed and run out (I didn't obviously...)

The two that didn't hurt were by the same doctor, the two that did were a prescribing nurse and a different GP

I was given a numbing gel on the NHS and encouraged to take pain killers before and after.

TBH painful wasn’t the right way to describe it for me, although I did get some pretty hideous cramps a few hours later. It was more like a feeling of being desperate for a poo!

Hope it went ok @OneFrenchEgg

You don’t have to!

There is widespread minimisation of pain by medical staff and some patients. In other countries GA is a usual option but here it boils down to money and the discourses follow from that. Making out as if people are fussing, the gaslighting of being offered paracetamol, the encouragement to be strong/fake positivity and compassion fatigue. It’s a disgrace

@OneFrenchEgg i don’t know if you’ve been told before or after the coil but abstaining from sex for 21 days really isn’t the recommendation. You will be told to use contraception/condoms or abstain from your LMP until fitting to ensure you’re not pregnant and then the coil takes 7 days to take effect.

@Notinthemood12 I would disagree with that, very few other countries routinely offer a GA for coils. In reality a lot of coils especially Mirenas are fitted during investigation (eg laproscopy for endometriosis or ablation) where it makes sense to fit it while the patient won’t feel it and it will help manage their symptoms. It’s unusual to have a GA specifically for a coil fitting as it comes with a lot of risks of its own and given the long wait for gynae you’d wait a long time. Some countries cervical block is routine but this doesn’t guarantee pain free insertion.

Had 3 births barely any pain. Never feel a thing from a smear. However the hysteroscopy was extremely painful. It's the uterus that hurts not the cervix (for me)

Sedation should be offered and doesn't involve theatre or anything more than some tablets and a Sedation trained practitioner (I believe).

Women are expected to put up with pain.

Worst thing is other women (in healthcare) telling you it's not that bad when they've never actually had it done themselves

It's the uterus that hurts not the cervix (for me

Me too. Opening the cervix is fine. My doctor told me that I was feeling pain in the wrong bit

The pinching that everyone talks about is universal, it's from the cervical clamp, which feels exactly like you would imagine a metal clamp on your cervix to feel like! The insertion of the device through the cervix is what varies between woman - some don't feel a thing, and for some it is incredibly painful and causes the uterus to contract, like in labour. Unfortunately, the local anaesthesia spray only helps with the pinching, not with the uterine contractions or vagal nerve activation symptoms.

Yes, these 😡

I had an anaesthetic for a cervical biopsy and that was more painful (the injection) than my coil fittings. I guess everyone is different and different fitters are better/worse although the most recent time i had a trainee and it was fine. I’d recommend taking ibuprofen, paracetamol and codeine all together (i took this combination for a medical managed mc and it helped a lot).

@GotMooMilk oh that’s probably it, i just skim read the text messages and understood otherwise but your explanation makes sense
@whatsitcalledwhen thank you, lovely GP, sadly unsuccessful so trying again later. Prob unpleasant rather than constant pain. A couple of ouch moments. But I felt very listened to, and options all explained.

It’s not just cost that prevents more sedation/GA coils though really. Firstly the appointments for both would have to be much longer and probably not in a primary care setting so less accessible. As a nurse I wouldn’t be able to sedate my patient in a normal clinic room so you’d need additional staff, the right equipment and effectively a recovery area.
There aren’t loads of coil fitters so the wait for a coil would become much much longer even if you didn’t want any pain relief beyond topical analgesia on the cervix.
At the moment the options are either attempt a coil fitting in an accessible setting and accept limited analgesia being effective or be referred to a more specialist service eg gynae but have a long wait. It’s not ideal but it’s not because HCPs hate women or don’t care about their pain. I care so much for all my patients, I hate causing them pain but I also want to make it a quick, easy and accessible procedure and for most I’d say it’s a quick and manageable procedure.

I had one fitted under GA almost 3 years ago at the same time as an endometrial biopsy and the gynae consultant (male) said in his opinion it's barbaric for women to be expected to have it fitted without pain relief. He said GA would be his preference for his patients.

Having mine replaced at the GP surgery in a few weeks and I'm dreading it!

Because all methods of pharmacological anaesthetic have potential side effects and it’s a risk vs benefit trade off.
I didn’t find having either 2 copper or 2 mirena coils insertion or removal painful at all.

Try without first and then if it’s painful ask for some pain relief.

Because society does not care about or believe in women's pain.

I’ve had two mirenas now at the GPs. All fine, slightly uncomfortable for a moment certainly not painful ☺️

Some of these posts make pretty horrific reading. What women go through to prevent pregnancy and/or manage period or menopausal symptoms.

I agree women are expected to deal with pain related to their fertility. Because misogyny but also because there are side effects from pain relief. Both could and should be managed. It's a scandal they are not.

If contraception was managed through inserting a plastic and metal device up the man's penis, embedding it in the scrotum, with risks such as pain, perforation, sterility and pregnancy things would look very different.

And I say that as somebody on a 5th mirena. Which dealt with very painful flooding periods, acted as reliable contraception and now supports my HRT.

I love the freedom I get from my mirena. However the experience of fitting is something I dread.

I’m finding this fascinating reading..

Slightly different experience here - went to have a mirena put in today but they couldn’t find the opening to my cervix so had to abandon. I’ve had a cone biopsy before (over 10 yrs ago) so my cervix is quite flat so apparently there wasn’t enough for them to get hold of to then find the opening. Wondering if anyone else has had this and if might be worth asking for a referral to either a gynae or sex health clinic? Not sure if I was fobbed off too soon but equally not sure I want someone else trying if it’s going to be painful/diffixult.

I wouldn’t say I’ve got a high pain threshold. I wasn’t offered anything by the dr but took 2 paracetamol beforehand. It felt a bit painful for me and that was with her just clamping the cervix and trying to find the opening 😬

It's money, and time that means that local not offered. Additionally, many women do not find it very painful. For those that do, numbing spray or local can be offered in specialist services (GU clinic or Gynae).
As for fainting, that's actually a recognised reflex from cervical irritation rather than pain necessarily. Horrid if it happens, but they will be expecting it and will have you lying down.
One thing that is extremely painful is childbirth, especially if it's unwanted. Please do not put off contraception due to fear. Speak to your nurse or Dr and get it sorted!