Post-publication editor’s note: The bill to require pain management notification for IUD insertions died on Friday, February 21 after the House Committee on Health Care & Wellness failed to hold a vote to pass the legislation to the next committee.
“Very intense pressure, so intense I actually almost passed out from it.”
“The highest level of pain I’ve ever experienced.”
“10/10 painful.”
That’s how three women RANGE interviewed described the insertions of their intrauterine devices (IUDs), a contraceptive that provides birth control for between three and 10 years.
IUDs are small, T-shaped and flexible. They’re inserted into the uterus up through the vagina and the cervical opening. Many medical websites describe the procedure as taking just a few minutes and causing patients “highly variable discomfort.”
But for many people, like the women we talked to, insertions can be extremely painful and take more than half an hour. Often, the procedure is completed without offering patients a single pain management option.
“It hurt, and it didn’t need to,” said Cassie, the woman who described her insertion in 2012 as “10/10 painful.” (We’re using first name references for them to protect their medical privacy.)
“They told me to take ibuprofen ahead of time,” Melinda said. Doctors warned her the procedure could be painful, but she was “ not at all prepared for the actual experience of the insertion and the level of pain,” she said.
For Melinda’s procedure roughly 10 years ago, it took almost half an hour, a stop-and-start process.
“I was in the highest level of pain I’ve ever experienced for like five minutes at a time,” she said.
It’s still the most painful thing she’s ever gone through.
But House Bill 1077, which is currently stalled in the Washington State House Committee on Health Care & Wellness, aims to empower patients like Cassie and Melinda to make informed decisions about IUD procedures. It would require healthcare providers to notify patients about any pain management options before they schedule placement or removal appointments.
‘Scissors, scissors’
State Rep. Amy Walen (D-48) saw just how painful an IUD insertion can be firsthand when a close family friend, nervous about the procedure, asked Walen to sit with her during her insertion.
“She had anxiety about it, even though it was her second IUD placement,” Walen said. “She said, ‘It’s really rough.’ So I actually flew to another city to do it with her.”
It was a routine medical procedure, and one where no pain management options were offered to her friend, so Walen assumed it couldn’t really be that rough. “I thought it was kind of like a pap smear.”
She was wrong.
“I was blown away by how awful it was,” Walen said. “It took a long time and she was sobbing in pain. I was sobbing, it was traumatic for both of us.”
Walen stayed with her friend that night and comforted her as she continued to experience agonizing pain. “She just kept saying, ‘Amy, scissors, scissors!’ That was the word she used to describe the pain of it.”
Walen was so rattled by the experience, she talked to her own gynecologist about it, and was shocked to learn that what happened to her friend didn’t have to happen that way.
Her gynecologist told her providers can offer pain control options like numbing medication for the cervix, local anaesthetic or Valium, a sedative. Providers like Planned Parenthood also offer nitrous oxide and ultrasound-guided insertions, which can quicken the process.
The whole experience inspired her to introduce HB 1077, which is co-sponsored by 16 other representatives, including local representatives Timm Ormsby and Natasha Hill.
Walen hopes that if the bill passes, it will help patients go into their IUD insertions or removals with “their eyes open,” and give informed consent to the procedure.
“I want doctors to just do exactly what my gynecologist already does,” Walen said. “[Tell patients] if you’re thinking about an IUD, we’re going to have a talk about pain and how it might be uncomfortable, and here are the options.”
Eyes wide open
The first time Cassie got an IUD inserted, she thought she was going in with her eyes wide open. In 2012, she decided to book an appointment with her college campus health clinic.
She’d done her research and found that an IUD was the best birth control method for her: she could get a no or low-hormonal device, it would be long-term but not permanent and it’s effective for people of all body sizes. Some birth control options, like the patch or emergency contraception, can be less effective for people over a certain weight.
Cassie’s mom was an obstetrician-gynecologist (OBGYN), and before Cassie went in, she tried to give her an idea of what to expect.
“My mom said it would be uncomfortable, but I have a high pain tolerance. It didn’t even cross my mind that it would be as bad as it was,” Cassie told RANGE. “When [physicians] say it’s easy, I think they mean easy for them, because it definitely was not easy for me.”
It took 30 minutes to place her IUD and doctors left Cassie in stirrups with a clamp on her cervix for 20 of those minutes. She wasn’t offered a single pain management option.
Ten years later, when her IUD expired, it was time to take it out. Cassie got another IUD. She still didn’t know if she wanted kids and besides the insertion, her first had worked well for her. Her second was nearly as painful as the first, and she still wasn’t offered anything in advance for her pain.
Recently, through social media platforms like Tiktok and Instagram, Cassie learned that “it just did not have to be like that.” There were other options out there, like nitrous oxide at Planned Parenthood.
It left her feeling “totally furious.”
“We’re ignored when we say something is painful,” Cassie said. “We’re expected to just put up with it, keep our mouth shut and handle it, and I just don’t think that that level of discomfort is necessary to inflict on a person if there are safe options to reduce it.”
Like Cassie, Melinda had undergone a painful 30-minute IUD insertion with no pain management. She remembers shaking from the pain in her car afterwards, unable to drive herself home for a while.
Two and a half years ago, it was time for Melinda to make the same choice as Cassie: replace her IUD, switch birth control methods or go off birth control. And like Cassie, she made the same choice: despite the pain, the IUD was still the best fit for her.
Unlike Cassie, though, Melinda’s second insertion was “a very positive experience.” This time, she went to the Spokane Planned Parenthood and was offered an ultrasound-guided process, where doctors used ultrasound imaging to navigate Melinda’s internal anatomy while placing the IUD.
Because of the way Melinda’s uterus is shaped, IUD insertion can be difficult for her providers, but having the ultrasound to guide them made the procedure “way faster.”
“That made a night-and-day difference,” Melinda said. “I had the pain for 90 seconds, maybe two or three minutes.”
But then it was over.
“I didn’t have as much bleeding. I didn’t have as much pain. It wasn’t as traumatizing,” Melinda said. “I had no idea that they could use modern technology to guide them.”
Being offered or even taking advantage of pain management options doesn’t mean an IUD insertion will be painless. Devyn, the third woman RANGE spoke with, told us that even with a shot of lidocaine, a local anesthetic, in her cervix, it was still painful.
The lidocaine was the only thing offered to Devyn when she got her IUD placed last fall at her primary care provider in Spokane. She wished they would have given her more information about the lidocaine’s effectiveness, other options or even just an idea of what level of pain she could expect from the insertion.
“ They could have prepared me a little bit better for it,” Devyn said. “ I don’t know if there were better options for me, but what I received just wasn’t sufficient for my pain.”
Because of how painful the insertion is, Devyn said she is terrified of the inevitable removal process when it expires.
If HB 1077 were to pass, she would be entitled to more detailed information from her providers about options to reduce her pain.
Walen, the representative who introduced the bill, said while the bill has resonated with “a lot of young women,” she doesn’t think it will ultimately pass. Healthcare providers have lobbied against it. Walen said they told her, “We don’t want to be told how to practice medicine.”
But patients like Melinda, Cassie and Devyn feel that requiring pain management notification is necessary.
Melinda called it the only “humane thing to do.”
Cassie was more blunt: for people, especially men, who don’t think pain management options are necessary for IUD procedures, “I hope that they would be willing to forego their pain management for [a vasectomy].”
(Vasectomies are typically done under a local anaesthetic.)
If it doesn’t pass out of the House committee it’s in by Friday, Walen said it will die. She’s still working hard to get her fellow legislators to care about it, which is a bit of an uphill battle: 51 of the 98 House representatives are men and Walen joked that she’s had to explain what dilation of the cervix means.
“The medical establishment is a part of the old school patriarchy,” Walen said. “And we have to keep banging away at knocking down barriers.”
