Breanna Reeves
The Centers for Disease Control and Prevention (CDC) published new recommendations to physicians about pain expectations and how to manage the pain during and after the process of inserting an intrauterine device (IUD).
An IUD is a t-shaped contraceptive device used to prevent pregnancy for up to 10 years. According to a 2022 report published by the United Nations, 161 million people use this form of contraceptive worldwide.
With the first IUD approved in 1984, the CDC’s new guidance comes decades after patients have complained about the traumatic procedure and sometimes painful symptoms that follow. While there are two types of IUDs: copper and hormonal, there are five different brands of IUDs that are approved for use in the United States by the U.S. Department of Food & Drug Administration (FDA). There are four hormonal IUDs: Mirena, Kyleena, Liletta and Skyla; and one copper IUD: Paragard.
“Before IUD placement, all patients should be counseled on potential pain during placement as well as the risks, benefits, and alternatives of different options for pain management,” the guidance states. “When considering patient pain, it is important to recognize that the experience of pain is individualized and might be influenced by previous experiences including trauma and mental health conditions, such as depression or anxiety.”
As horror stories about IUDs have been traded online, the CDC’s guidance comes years after patients have endured painful insertion, with others experiencing pain from the IUD dislodging. The updated guidance offers a suggestion of lidocaine as an option for IUD placement, noting that the use of the local anesthetic “might be useful for reducing patient pain.”
Prior to the new recommendation regarding the use of lidocaine, patients were recommended over-the-counter pain relief options such as ibuprofen, but for many, that did little to address the pain during the procedure. In a 2023 study that assessed the pain of IUDs by type among 1,076 women, 26 (2.5%) women reported no pain, 167 (16.4%) light pain, 319 (31.3%) moderate and 506 (49.7%) intense pain.
An article published in the National Library of Medicine reviewed published literature to examine the gap regarding official procedures for pain management during IUD implantation. The findings from the review “revealed a lack of uniformity across practices when performing IUD insertions,”
“Black women experienced the most anticipated pain compared to other races,” the report noted. “Regarding non-pharmacological methods, different insertion techniques, tools, and the use of a cold compress were found to not affect the level of pain during IUD insertion.”
The pain experienced by women during IUD insertion is one example of the pain gap that women experience compared to men within healthcare. Black and brown women experience the pain gap with an additional factor of race/ethnicity when compared to their white counterparts. A meta-analysis of 20 years worth of cumulative evidence on racial/ethnic disparities in pain reliever treatment in the United States concluded that Black people experienced both “a higher number and magnitude of disparities” than any other group in the study.
“Equitable access to the full range of contraceptive methods for all those seeking care is an essential component of high-quality sexual and reproductive health care,” the report noted. The 2024 report replaces the 2016 version as these new recommendations include new evidence and input from experts.
In addition to updating the guidance for IUDs, the CDC also published updated recommendations for other forms of birth control including the implants, injections, patches and vaginal rings.
Source: Black Voice News
