Some U.S. clinics offer routine sedation for IUD pain, saying it 'shouldn't feel traumatizing'

The painhas been described as agonizing, searing and excruciating.

Having a highly effective contraceptivecalledan intrauterine device (IUD) inserted can cause significant discomfort for some people, and a growing chorus of health-care professionalsand patientshas been calling for better pain management during the procedure.

Now, a Planned Parenthood locationin the U.S. has made headlines for announcingit will start offering routine sedation to patients during IUD insertions and removals, explaining that accessing reproductive health care shouldn't invoke fear, and that theprocedure "shouldn't feel traumatizing."

But as some people applaud the move, the president of the Society of Obstetricians and Gynaecologists of Canada (SOGC) says routine sedation hasthe potential to limit access to a highly effectiveform of contraception.

While sedation can be offered to some patients here who can't tolerate the insertion in an office setting, itrequires more monitoring, emergency servicesandanoutpatient surgical suite or an operating room, said Dr. Amanda Black.

That can belimiting, she said.

"We don't do it routinely," Black told CBC News.

She said sedation is not something most providers can do inan officesetting, and not all practitioners have easy access to an operating room.

"We can't minimize the fact that people have had unpleasant experienceswith IUDinsertions. What we needto do isfigure out how to improve that experience for them moving forward."

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'Way too common' for patients to not get any pain management

About 159 million people worldwide use IUDs, according to 2019data compiled by the United Nations. It was the third most common form of contraceptionglobally, after female sterilization and male condoms, and just above the pill.

It's alsoone of the most effective forms of birth control, and a"recommended first-line contraceptive method," according to the SOGC.

The SOGC describes IUDinsertion as a rapid outpatient procedure that can be completed in five to 15 minutes.

During the procedure, a small, T-shaped device is inserted through the cervix into the uterus. In its insertion guide, the SOGC mentions the possibility of "brief moments of sharp pain," especially when the device passes through the cervix.

Some small studieshave found most people describe moderate to severe pain during insertion. Socialmediaplatforms likeTikTok are full of people describing their negative experiences.

One study of the top 100 videos tagged #IUD on TikTok found that all of the videosconveying patient experiences had a negative or ambiguous tone, and almost 97 per cent highlighted painand otherside effects.

It's "way too common" for patients not to get any pain management while undergoing the procedure,Dr. Joss Reimer, the Winnipeg Regional Health Authority's chief medical officer, said in a2023 interview with CBC Manitoba's Information Radio.

"It's a long-standing practice where we just don't value the pain of women the same way we do men, and expect them to go through painful procedures that we wouldn't expect in other circumstances."

In a statement on April 2,Dr. Colleen McNicholas, the chief medical officer at Planned Parenthood of the St. Louis Region and Southwest Missouri, said the organization has been listening to people calling for better pain management solutions and will now offer sedation for "patients who prefer it."

"We're offering sedation to give patients a greater sense of power and control over their bodies and their care," McNicholassaid.

Several other Planned Parenthood locations in states in the U.S.,such as Massachusetts and Arizona, appear to offer oral and intravenous sedation, as well.

They note that sedation carries increased risk, and patients will not be able to drive themselves home afterward.

Pain management options

Every patient is different, and it's important not to dismiss the pain and discomfortsomeone mayexperience, said Black, with the SOGC.

"We can definitely do better thanwe have in the past, and we are making changes to how we do our IUD insertions because of that," she told CBCNews.

Those changes include taking a more individual approach, she said, and telling patients ahead of time that they may experience discomfort and cramping some much more than others. Doctorsshould alsomake surepatients understand that they're in control, and can stop the procedure or take a break at any time.

"In the past, we were somewhat reluctant to use any type of pain medication or anesthetic to try to help with the procedure, because we thought it would actually hurt more to do that, but I don't think that's necessarily the case for all patients," Blacksaid.

But there are options.

Patients can take anti-inflammatory medications ahead of time or immediately after the insertion,she said, and doctors can be ready to inject a local anesthetic or use an anesthetic spray.

And just recently, there's the option to use an inhaledpainmedication that the patient controls themselves during the procedure, Black said.

"Atthe end of the day, the majority of patients do well."

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