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Negligence of women’s pain in healthcare: IUDs and their Daunting Preconceptions
By Zoe Kaiser March 2023
There are many examples of healthcare disparities women face and one of the most significant is the negligence shown toward their pain. While standards for care for all people may seem similar on paper, healthcare providers often use subconscious preconceived notions while making a diagnosis for women or jump to conclusions about their pain rather than asking the patient in question. Seen in everyday procedures and chronic conditions, doctors are consistently shown to be more dismissive of pain when it’s a woman experiencing it. While 70% of chronic pain has been shown to affect women, it’s shown that 80% of the pain studies that have been conducted were tested on male subjects (Kiesel, Laura.). Even more concerning, one in every five women receiving health care claim that they have felt their symptoms dismissed or misdiagnosed by physicians (Paulsen, Emily). Reproductive healthcare for people with uteruses is greatly dismissive of pain in general. These procedures apply to a large range of people with uteruses including some trans men and non-woman-identifying people. For this paper, I will mainly be addressing this disparity centered around cis women, resulting from a long history of discriminatory behavior and being ignored in healthcare. There are many cases for which this disparity becomes obvious, such as birthing procedures, treatment for chest or abdominal pain, and the insertion of IUDs, which will be the main focus of this paper. IUD stands for intrauterine device and is a contraceptive inserted into the uterus of a patient to prevent pregnancy, with over 99% effectiveness. Although this sounds like a great option, only 10.4% of the women using reversible long-term contraception methods are currently using an IUD (Faststats-Contraceptive Use). The reason for women avoiding this device can overwhelmingly be chalked up to fear of the pain associated with its insertion. Everyone has heard stories of women throwing up, passing out, and not being able to walk for days from the pain of this procedure. However, many of these same women weren’t even offered a local anesthetic to help with the pain, whereas men most likely would have been put completely to sleep for such a procedure. Many women fear IUD insertion and avoid it altogether to save themselves from this pain. Their fear along with the fear health care providers have of causing a painful or difficult insertion can influence doctors to recommend easier and less effective contraceptive methods such as condoms or the pill. When women go to their healthcare providers for counseling on birth control and bring up concerns about the pain, doctors often downplay the level of pain that often accompanies the procedure. The sensation is often described by healthcare providers as a quick pinch or as a cramping sensation, however, this is far from what patients have reported. There's a significant contrast between the procedure as described by a clinician and how it is described by women who have had it done. These women use phrases like “blinding pain” and “shocking agony” to describe the feeling, clearly contradictory to what they had been prepared for (Lpierson). In fact, in a study of nulliparous women (women who haven’t given birth to a child), 72% reported moderate pain accompanying the insertion of their IUD. 17% of the women in the study found that the procedure caused them severe pain (Gemzell-Danielsson, K, et al.). Healthcare providers often claim that this disparity is what’s best for the patient and is for the purpose of not scaring them out of a device with long-lasting benefits, however, this strategy undermines the validity of consent given by patients and underrecognizes their pain. There are some strategies that have been suggested and used by healthcare providers with the goal of decreasing women’s pain, however, there has been no standard established on this front. A few of these strategies include oral analgesia, cervical ripening, local anesthesia before the procedure, reactively administered local anesthesia, and post-procedure drugs. Even some non-pharmacological pain management strategies have been tested including psychological preparation and verbal anesthesia during the procedure. Of these methods, only oral analgesia, local anesthesia, and reactively prescribed drugs post-procedure have been found effective (Gemzell-Danielsson, K, et al.). Despite these findings, there has been little movement toward making these a standard of care, even though this could lead to many being forced to endure conditions such as unwanted pregnancies or the need for an abortion if less effective birth control fails. This is an issue that isn’t talked about enough, and will undoubtedly be detrimental to the health of a large portion of our population and our society as a whole.
References “FastStats - Contraceptive Use.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 7 Dec. 2022, https://www.cdc.gov/nchs/fastats/contraceptive.htm. Gemzell-Danielsson, K, et al. “Management of Pain Associated with the Insertion of Intrauterine Contraceptives.” Human Reproduction Update, U.S. National Library of Medicine, 2013, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3682672/. Kiesel, Laura. “Women and Pain: Disparities in Experience and Treatment.” Harvard Health, 9 Oct. 2017, https://www.health.harvard.edu/blog/women-and-pain-disparities-in-experience-and-treatm ent-2017100912562. Lpierson. “Disclosing Pain: The Case for Greater Transparency.” Bill of Health, 4 Oct. 2021, https://blog.petrieflom.law.harvard.edu/2021/10/05/pain-transparency-medicine/. Paulsen, Emily. “Recognizing, Addressing Unintended Gender Bias in Patient Care.” Duke Health Referring Physicians, https://physicians.dukehealth.org/articles/recognizing-addressing-unintended-gender-bias-p atient-care.