IUDs Are Best, So Why Do Doctors Make It So Difficult?

The average American woman spends 30 years of her life avoiding pregnancy — and study after study has shown the IUD is a superior, reversible, difficult to screw up way to safely plan the spacing and general arrival of children.

So why is getting an IUD so hard, and why do doctors ignore IUD insertion pain despite overwhelming evidence that the issue prevents many women from accessing this life-changing method of family planning?

I am not a doctor, nor do I play on on television. I am, however, a 34-year-old mother of two. For the past 12 years, I’ve been actively trying to obtain an IUD, and, even with insurance, it’s never worked out.

And when it does work out, the issue of IUD insertion pain is almost always ignored, or flatly denied as bearable despite an avalanche of conflicting information. (Google “IUD insertion experience” to get an idea of what women are made to endure in a world where capable painkillers are widely available, but not given.)

It’s not just doctors that are making IUDs difficult, though they do their share of lack of advocacy of this method. During my second pregnancy, I asked my OB-GYN for Mirena, now widely seen on commercials during primetime. She made a face and haughtily told me she did not prescribe weight loss medication, assuming I’d asked for the similarly named Meridia.

It didn’t matter. My insurance at the time covered the device but not the insertion, which was $1000, payable in full prior to the procedure. (A princely sum to a twenty something mother of two small kids.) Our HMO changed, and then the insertion was covered but not the device.

Two years later and living in New York City, I visited another OB-GYN with new insurance. Again, I was denied because I had separated from my husband. The doctor refused me an IUD because there was “no guarantee I’d be monogamous.”

Another four years passed, and a new doctor similarly was unwilling to allow me an IUD, this time because I smoked — though smoking and IUDs are not considered a risk to a patient. The next doctor declined on the basis of my low pain tolerance, fearing I’d be unable to tolerate the discomfort of the procedure.

IUD insertion pain is indeed not just an issue in women’s heads — several studies indicate a massive lapse in provider concern for patient comfort. Across the web, women who have endured IUD insertion pain with no anesthetic repeatedly describe the procedure as “the worst pain” they have ever felt, relaying stories of vomiting, fainting, passing out alone in the parking lot after having a vasovagal reaction — the number of stories about IUD insertion pain and side effects seem to pop up wherever the device is mentioned.

Interestingly, most of the IUD insertion pain stories culminate the same way — the woman says that she’d do it over again, because the IUD itself enables her to plan her family without fear of a missed pill and without forever robbing her of the ability to have more children. (Or to have any children, in the case of nulliparous IUD users.) But it seems cruel that just because pain (excruciating, overwhelming, vomit-inducing pain) can be tolerated providers decide it should be — can anyone think of another procedure as analogously painful where doctors allow patients to suffer so intensely, so preventably?

A recent study on IUD insertion pain and provider failure to recognize it was published in the journal Contraception, and data indicates that doctors really don’t understand how painful IUD insertion is for the patient. Scaling pain measurements between patient and doctor revealed significant dissonance, Ob.Gyn. Newsreports:

“Patients rated pain at four points during the procedure: tenaculum placement; uterine sounding; IUD insertion; and speculum removal. Patients and providers agreed about the timing of maximum pain 41% of the time – a very poor level of agreement, [Dr. Karla E. Maguire] said.”

It’s not always that IUD insertion pain is over and done with — some studies indicate IUD insertion failure rates may be as high as 20 percent in some clinics, which may suggest that severe pain or other difficulties in completing the procedure prevented the patient from accessing the form of birth control at all.

Ultimately, it would seem IUD insertion pain and provider reluctance or disinterest has prevented the IUD from reaching its full potential among women of reproductive age, and that’s a shame.

Do you think the lack of concern for IUD insertion pain is a lapse of care that needs to be addressed?