Last week I saw a tweet from an OB/GYN on Twitter questioning the lack of routine sedation options for women during Intrauterine Device (IUD) insertion and removal, and I was immediately transported to the worst physical pain I had ever experienced: having my cervix manually dilated during childbirth. It was by far the worst pain in a very long, painful induced labor with my daughter that ended in a C-Section, and ultimately the worst pain of my life to date.
I was lucky to have competent and compassionate care from everyone involved in my labor and delivery, and I consider myself to have a high pain tolerance. But this particular procedure made me cry actual tears of pain in a way that I hadn't since childhood. While not the same thing as an IUD insertion or removal, I’ve hesitated to get an IUD after experiencing someone monkeying around with my cervix.
Here's what Planned Parenthood--one of the best organizations in the country for accessible birth control and one that I support with my own wallet--says about the pain of IUD insertion:
How does it feel to get an IUD put in?
People usually feel some cramping or pain when they're getting their IUD placed. The pain can be worse for some, but luckily it only lasts for a minute or two.
Some doctors tell you to take pain medicine before you get the IUD to help prevent cramps. They also might inject a local numbing medicine around your cervix to make it more comfortable.
Some people feel dizzy during or right after the IUD is put in, and there's a small chance of fainting. You might want to ask someone to come with you to the appointment so you don't have to drive or go home alone, and to give yourself some time to relax afterward.
I posted something on Twitter and Facebook to start a conversation about this, and take sort of an informal poll of people's pain in IUD insertion and removal, which involves manipulation of the cervix.
Perhaps a third of the people who contributed to this conversation said it was painless, but about two-thirds said it was the most excruciating pain of their lives. Many described humiliating experiences of being told to “suck it up” and having the discomfort undersold to them, both before, during, and after the procedure. Some worried that the conversation itself could discourage folks from accessing effective birth control (which is the last thing I want to do).
But I think it’s still important to talk about women's (and trans men with uteruses) experiencing pain in reproductive procedures and birth control. I think it's important that we ask the question why people are made to endure the kind of pain that would never be tolerated for a second during a dental procedure or a vasectomy. I don't recall a dentist ever telling me to suck up any pain. I recall being given options for three different types of anesthesia for every dental procedure I've undergone.
So why is routine sedation like this not more common in IUD insertion and removal? I'm not a doctor, so I really don't know the answer. I'm really just posing the question, because I think at least some of the reason is plain vanilla misogyny.
I get that it’s become fashionable to blame The Patriarchy™️ for everything, but that’s because we live in a patriarchal society, and that fact infuses and informs every aspect of our lives, from the wages women earn to the research, time, and attention devoted to our healthcare. Reproductive health is an obvious flashpoint for this, regardless of the gender of the medical provider (or so says my informal poll).
I think as a society we subconsciously want to punish women for their sexuality. We want them to fight and suffer for reproductive autonomy, and we want them to feel pain and humiliation for seeking it out. We want them to associate sex with violence, trauma, and pain. Or, at a minimum, we are indifferent to it. Again, none of this is necessarily conscious. But it’s a reality that is reflected in the lived experience of countless women.
We need to at least entertain the possibility that this is the real reason why this procedure is so brutal for so many. Although it’s a small thing, acknowledging and addressing the very real pain of IUD insertion and removal is one way to chip away at a deeper form of medicalized and societal misogyny.