Fewer than 5% of women fitted with contraceptive coils, known as IUDs, are given effective pain relief, says a leading sexual health doctor in the first issue of the Journal of Family Planning and Reproductive Healthcare to be published by BMJ Group.
But over half of women fitted with a coil experience some pain when the device is inserted through the neck of the womb (cervix) just as they would if having a dental filling without local anaesthetic, says Dr Sam Hutt of London’s Margaret Pyke Centre.
Sexism, misguided professional pride, and a lack of knowledge about the safe and effective pain relief options available, are all partly to blame, he suggests.
At a recent training update of GPs and family planning clinic doctors at the centre, it became clear that less than 5% of those attending ever used injectable local anaesthetic (ILA) for IUD fittings. This sort of response is common, he suggests.
Some doctors do use anaesthetic gel, but this is more painful to administer than injections, takes longer to act, and is largely ineffective, he says.
“As we now profess to be patient centred, this is difficult to comprehend,” Dr Hutt writes. “Let us not forget that if men were to have a device inserted through their genitalia they would demand general anaesthetic as a hospital inpatient,” he adds.
The Faculty of Sexual and Reproductive Healthcare, of the Royal College of Obstetricians and Gynaecologists, recommends that ILA is offered for the insertion of an IUD.
The reasons doctors give for ignoring Faculty guidance include: ‘no time’; ‘the pain only lasts a short time’ to ‘I am so good, I don’t cause pain,’ he writes. “Some even believe that the injections are more painful than the insertion, and the attitude that women are hysterical still persists,” he contends.
While ILA can’t prevent the cramping women often experience after a fitting, the cervical pain felt during the fitting “is the more extreme and overwhelming ... and is unnecessary and unavoidable,” he writes.
ILA is not only very simple and painless to administer, but it takes effect immediately and is safe and cheap. Not giving pain relief is likely to take more time, because the extreme pain can precipitate cervical shock, prompting a range of unpleasant consequences, including passing out, he says.
In an accompanying podcast, journal editor, Dr Anne Szarewski, of the Cancer Research UK Centre for Epidemiology, Mathematics and Statistics at the Wolfson Institute for Preventive Medicine, London, suggests that doctors simply don’t know how to use ILA.
“A lot of doctors don’t actually know how to do it. Because they are doctors, they don’t want to admit that. I think that is quite a significant barrier,” she says.
Some are also labouring under the misapprehension that ILA is synonymous with another type of anaesthesia - paracervical block - which can be dangerous, she adds.
But the more pain women experience, the less likely they are to recommend IUDs to others, says Dr Hutt. Currently only around 6% of eligible women have an IUD fitted.
In the podcast, he explains that doctors tend to dismiss the IUD as a form of contraception, because the device has not yet shaken off its legacy of being associated with a high risk of pelvic infection and infertility. But after screening, this risk is “as close to zero as we have in the modern world,” he says.
“It is now believed that some of the forms of long acting reversible contraception [of which the IUD is one] are probably better for health and certainly more effective at preventing pregnancy than the pill,” he says.
The Journal of Family Planning and Reproductive Healthcare