'IUD insertion was worse than home birth': Canadians criticize lack of pain management, guidance during procedure

Misty Pratt, a 44-year-old mother of two, was eager to explore intrauterine devices (IUDs) as a birth control option in an effort to maintain her breastmilk supply. However, she says she was surprised by the level of intense pain during the insertion process.

This article is for informational purposes only and is not a substitute for professional medical advice, diagnosis or treatment. Contact a qualified medical professional before engaging in any physical activity, or making any changes to your diet, medication or lifestyle.

"I gave birth to both my children at home without any pain medication, and I would say the IUD was worse than that," she tells Yahoo Canada, explaining she had been told to expect pressure "like a pinch." "It was incredibly painful, even though it didn't last long."

IUD insertion can come with extreme pain — and even trauma — for people with little to no pain management options available.

In Pratt's case, she says she was asked if she had taken Advil — but only once she arrived at the clinic.

"There was some miscommunication, and I went in [for the procedure] without anything. I don't even know if Advil would have helped, but I didn't have any pain medication," Pratt, who lives in Ottawa, says. She added that the lack of clear communication left her unprepared for the pain she endured.

What pain management is used for IUD insertion in Canada?

A recent study examining the 100 most-viewed TikTok videos tagged #IUD reported personal experiences, most which had poor perceptions of the device.

Out of those, 37.8 per cent had a negative tone, while 19.4 per cent were positive and 27.6 per cent expressed distrust in health-care professionals. A deep dive into those videos also revealed an astonishing 96.8 per cent of the negative tone of videos highlighting pain and other side effects related to IUDs.

Recently, the United States health-care system became a hot topic of discussion after it revised the guidelines for administering pain medication during IUD insertions. While the Centers for Disease Control and Prevention's 2016 guidelines failed to address pain management for these procedures, the update now suggests numbing the cervix area, either with a topical ointment or through an injection.

Dr. Amanda Black, the former president of the Society of Obstetricians and Gynaecologists of Canada, says there are several pain management options available in Canada.

"We have tried various approaches to improve pain control during IUD insertions, but not all have been proven effective in studies. One option is taking an anti-inflammatory before and after the procedure to reduce cramping. While studies haven’t consistently shown its effectiveness, some patients have found it helpful," Black tells Yahoo Canada.

She says that research exploring the use of local anesthetic sprays or gels on the cervix have shown “mixed results.”

“Another approach is injecting a local anesthetic into the cervix, which I find to be quite effective, although the injection itself can be uncomfortable. Once administered, it often provides significant relief," she adds. "There's also a new inhaled anesthetic (sold under the brand name Penthrox) that patients can self-administer during the insertion, giving them control over their pain management."

In some U.S. clinics, IUD insertions are performed under conscious sedation, which has been shown to be effective. A study found that 75.36 per cent of participants placed under light sedation had successful insertions, with a success rate of 92.75 per cent. However, Black explains that this isn’t routine in Canada due to the "need for additional monitoring, and not all patients require it."

Why aren't IUDs more popular — despite high efficiency?

Despite being the most effective forms of contraception, IUDs remain least used in the country, particularly amongst younger people. According to a 2020 report from Statistics Canada, condoms are the most popular form of contraception among people aged 15-24, followed by oral contraceptives. IUDs or long-acting reversible contraceptives (LARCs) are least common.

So, why aren't more people choosing IUDs despite them having 99 per cent effectiveness in preventing pregnancy and, in some cases, even reducing the risk of some cervical cancers? The main concern seems to be pain associated with insertion process itself and potential IUD complications like an increased risk of pelvic inflammatory disease and ectopic pregnancies. In addition, some people fear that IUDs could cause infertility.

Steph Davidson was 34 when she decided to get an IUD. She was referred to a hospital where she says was prescribed Misoprostol medicine — a synthetic prostaglandin that helps in softening and dilating the cervix, which can be taken orally, or vaginally.

"They said that I would feel a 'little pinch' during the insertion, but that was not accurate," the Toronto resident, now 41, says. "They didn't say, 'Hey, you're going to feel a contraction. This is going to be pretty extreme pain.' I would have preferred that they had because when a doctor tells you what to expect accurately, it makes you trust them more."

Davidson has a tilted cervix, which she says required three separate measurements during the procedure. "Each time, I was more and more tense," she recalls.

According to Black, Misoprostol is not always effective at improving the insertion process. "At one time, we prescribed the medication because we thought it would help soften the cervix, making it easier to insert the IUD and less uncomfortable for the patient. However, studies showed the opposite — it actually made the cervix more sensitive," she explains.

Pratt says her experience took a frightening turn after the insertion. She says she was asked to wait in the clinic, and began feeling unwell.

"My blood pressure dropped very, very low. I started to get lightheaded and asked the nurse for a glass of juice. She questioned why I needed juice, and I explained that I was about to faint. They rushed into action," she explains.

"As healthcare providers, it's important to ensure that patients are well-informed before the procedure and understand they are in control. If at any time they want to stop or take a break, they should feel free to do so. There has been a tendency to downplay the pain experienced during IUD insertions, endometrial biopsies, and even labour," Black says. "We can't continue to minimize this pain, as it does a disservice to our patients."

While Pratt says she feels she had been adequately informed about the procedure's steps, Davidson says she wasn't. Her IUD removal was less painful, but the lack of communication during her insertion experience about the procedure and the pain that comes with it left her distrustful. "They said 'you'll just feel a pinch,' but it was significantly painful. So, it definitely eroded my trust in medical professionals and how they treat IUD insertion and pain."

How do IUDs work? Why are they so painful?

An IUD is a T-shaped plastic device that uses copper or hormones to prevent pregnancy. Most of the copper IUDs can be used for up to 10 years, while hormonal IUDs need to be changed every five years (time frames can change depending on the product). To get an IUD, patients need to consult their family physicians.

After a thorough pelvic examination for infections, in addition to a pregnancy test, the doctor will open the patient's cervix to measure the uterus and carefully place the IUD using a thin tube. Once the device is in place, the uterus reacts by contracting, leading to a sensation of pain. After the IUD is inserted, the doctor will trim the threads and explain how to check the IUD placement at home.

In some cases, doctors advise taking an over-the-counter painkiller to help manage cramps and pain during the placement process. Some medical professionals also take extra measures to ensure patients are comfortable. Davidson recalls her doctor used covers for the speculum to help her experience.

Black stresses that the insertion experience is different for everyone. She adds that she likes to "bring a local anesthetic in case the patient is at higher risk of discomfort or becomes uncomfortable during the procedure. We don’t always use it right away because, for some, the anesthetic injection can be more painful than the IUD insertion itself. However, it’s important to have it ready, especially for patients with a history of chronic pelvic pain, trauma, sexual abuse, or violence, as they’re more likely to experience pain during insertion."

Ultimately, it's crucial people conduct thorough research and discuss their options with their doctor or gynecologist. This includes understanding the potential side effects, along with IUD maintenance and pain management options.

Patients agree.

"I believe it's crucial to be honest and upfront with patients undergoing an IUD procedure. Saying 'you'll feel a little pinch' is not an accurate description," Davidson says. "Healthcare providers don't need to scare people, but they can provide better preparation."

“There's no one size fits all approach. You have to focus on the patient that's in front of you. I also think that the patients have done a great job over the last two years in bringing this forward and advocating for themselves,” concludes Black.

Let us know what you think by commenting below and tweeting @YahooStyleCA! Follow us on Twitter and Instagram.