“Stop telling women that their suffering is normal”: Lack of Uniform Guidelines and Research Surrounding Women’s Pain

Written by Angelina Gorbea & Nicole Munoz

In our last lab meeting, Dr. Ades concisely put into words the invalidating feeling that many women are a little too familiar with: “Stop telling women that their suffering is normal.”

Intrauterine devices (IUDs) are one of the most effective forms of modern contraception available. Having failure rates of less than 1%, IUDs have become a popular choice of long-term birth control. However, while they offer significant benefits, the experience of IUD insertion is often described as “intense” and “excruciating.” As university students, we continuously hear an outpouring of concerns from peers about how insertion pain varies from person to person - ranging from a “quick pinch” to the “worst pain of their lives.”

Discomfort and pain during insertion range variably among women, typically ranging from moderate to severe, yet there are no current standards for pain management care that have been able to truly encompass the range of pain that women experience during the procedure, often leading to underestimations of pain and discomfort. A 2013 study that asked patients to scale their pain during IUD insertion on a visual analog scale saw that patients typically rated it a 64.8 mm out of 100-mm, whereas providers typically perceived patients’ pain to fall around 35.5mm out of 100-mm. Not only do the pain women fear vary, but so does the pain management they receive.

For some, the pain and anxiety surrounding the procedure discourage women from even considering it as a birth control option, leading them to choose less effective birth control options or completely forgo birth control entirely. Pain management for this invasive procedure is currently minimal—while some clinicians offer their patients a range of pain management options (e.g. local anesthetic, twilight sedation on top of cervix openers, and extra strength ibuprofen), there seems to be no uniform guideline for pain management. This discomfort largely reflects the broader systemic issues of underfunded women's health research. With the absence of proper data understanding women’s health and pain management, medical professionals/ObGyns are left frustrated with unanswered questions and very minimal means of pain management for their patients. Women’s pain and discomfort during IUD insertion is not just a medical issue—it is the reverberations of systemic failures to prioritize women's health and well-being. It’s only now that the Centers for Disease Control and Prevention (CDC) published a provision of medications for IUD placement.

The lack of uniform pain management goes well beyond IUD insertion. Pain that women experience during endometrial biopsies, hysteroscopies, and pelvic exams is often labeled as pain that is just to be “dealt with.” The scarcity of adequate pain management options to optimize the comfort of insertion procedures is alarmingly indicative of the chronic underfunding of women’s health research as well as a dramatic gender gap in clinical research across the board. Women make up about half of the world’s population, yet clinical research on women’s health has historically been atypical, whereas men’s health has been the “standard” and interchangeable. The underrepresentation of women in medical research dismisses the physiological, metabolic, and hormonal differences that women experience with certain medications and treatments. In 2020, women were noted to experience harmful effects from medications at twice the rate of men. Inadequate testing on metal hip replacements in a 2013 study found that women were 29% more likely to have implant failure than men. This is especially seen in diseases disproportionately affecting women. Though women account for nearly ⅔ of Alzheimer’s cases, only 12% of Alzheimer’s research projects focus on women.

Similarly, cardiovascular disease is one of the leading diseases and causes of mortality for women in the United States, yet only ⅓ of patients in clinical trials are women. According to a 2000 study by The New England Journal of Medicine, women were seven times more likely to have cardiovascular disease and heart attacks misdiagnosed in the hospital, sometimes leading to early discharge while experiencing the heart attack. It wasn’t until 1999 when the American Heart Association published a Guide to Preventive Cardiology for Women, that medical professionals realized that women experienced a different set of symptoms than men—the reason for this being that medical understandings of many diseases are based on understandings of the male physiology. The absence of proper research contributed further to the perpetuation of dismissive medical myths and biases, such as the misconstrued beliefs that women are oversensitive to their discomfort and can simply "tolerate" invasive gynecological pain.

Though these painful experiences can be prevented and managed, invalidating women generally harms mental health outcomes and may lead to shame, depression, self-criticism, and low self-worth. Harmful biases like these may perpetuate a cycle of fear and avoidance around IUD procedures and effective forms of birth control. When research does not prioritize women's comfort and autonomy, healthcare practices struggle to be fully informed or individualized for their patients. In the case of IUD insertion, many women are not offered sufficient pain relief options and are often left to navigate a distressing experience with little support, putting them at risk for additional adverse health outcomes and increasing their distrust in medical interventions, all of which could be prevented if research started looking at women as individual beings worthy of needing comprehensive care not just when it comes to child-related reproductive means.

References:

https://www.cdc.gov/mmwr/volumes/73/rr/rr7303a1.htm

https://www.washingtonpost.com/wellness/2024/08/08/iud-pain-cdc/

Their IUD procedures were painful. Now they're scared to ...The Washington Posthttps://www.washingtonpost.com › iud-removal-pain

What is the Effectiveness of the IUD?Planned Parenthoodhttps://www.plannedparenthood.org › birth-control › iud

Women's pain often is dismissed by doctorsWashington Posthttps://www.washingtonpost.com › wellness › interactive

https://www.rand.org/pubs/commentary/2022/02/underfunding-of-research-in-womens-health-issues-is.html

https://www.aamc.org/news/why-we-know-so-little-about-women-s-health

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6294461/

https://www.sciencedaily.com/releases/2020/08/200812161318.htm#:~:text=Gender%20gap%20leaves%20women%20experiencing,often%20as%20men%2C%20study%20shows&text=Summary%3A,on%20men%2C%20suggests%20new%20research.

https://www.northwell.edu/katz-institute-for-womens-health/articles/gender-gap-in-health-research

https://abcnews.go.com/Health/wireStory/iuds-gynecologists-patients-focused-making-procedures-painful-113020128