NPR’s Ailsa Chang talks with Dr. Aileen Gariepy of Weill Cornell Medicine about the new federal guidance that advises doctors to consider pain management for IUD insertion pain.
AILSA CHANG, HOST:
It’s well-documented that the insertion of an IUD, that is an intrauterine device, can be painful, really painful. And now the Centers for Disease Control and Prevention have issued guidance recommending that doctors share options for pain management with their patients. It might seem obvious that if a medical procedure causes pain, steps should be taken to reduce that pain. But in this case, it took a public outcry about extreme stabbing discomfort to bring the issue to the foreground.
Joining us now to discuss the new recommendations and what they mean for patients is Dr. Aileen Gariepy. She’s a family planning specialist at Weill Cornell Medicine. Welcome.
AILEEN GARIEPY: Thank you, Ailsa. I’m thrilled to be here.
CHANG: Well, thank you for being here. So what I want to understand is the CDC already has mentioned the option for pain management in the past when it comes to IUD insertion. So how does this new guidance go beyond previous recommendations?
GARIEPY: The new guidance is helpful because it provides even more data to support that recommendation about offering and discussing a variety of pain management options for IUD insertion.
CHANG: Got it. And how effective are the available options for pain management?
GARIEPY: I mean, in my experience, I would say they’re incredibly effective, where I have – someone had an IUD, one IUD, and they’re coming in for a second IUD. And I offered them a paracervical block, which is one method of pain control, and they didn’t have it previously. You know, what people say is it’s night and day.
CHANG: Well, if we know what works to manage pain with IUD insertion, should these recommendations from the CDC be more specific?
GARIEPY: The CDC and everyone who’s doing kind of a collection or a systematic review of evidence tries to couch it in all the terms of where some of the weaknesses might be in the science. But I think the data shows that, especially for people who’ve never given birth, the addition of either a topical anesthetic to the cervix, which is the doorway into the uterus that we pass through in order to place an IUD in the uterus, whether that’s topical or the paracervical block, that that significantly decreases the pain with insertion.
CHANG: OK. But can you just back up for a moment? Because why was it necessary for the CDC to issue this guidance in the first place? Like, why weren’t doctors who insert these devices into patients while these patients are crying out in pain, why weren’t they already offering pain management to begin with?
GARIEPY: Yeah. I think that part of the reason is that the experience is so individual. If I have 10 people in front of me, you know, seven would have no pain with IUD insertion, and those other three would have, you know, maybe significant pain with insertion. And so I think what we’re learning from women, from better research, from the when we know better, we do better, is that pain is a subjective, individualized experience, and that it is different for people. And talking about it ahead of time, making it patient centered, giving patients options for what their pain management might be is essential. Now, does that mean that some people would get pain medicine that they didn’t need? You know, potentially, but there’s no way to know that until after the fact.
CHANG: Yeah. But let me be honest. I have never gotten an IUD because I’ve always heard my friends talk about the pain that they have experienced. So yeah, it’s deterred me.
GARIEPY: Yes.
CHANG: But do you think an IUD is worth it with or without pain management?
GARIEPY: I would say, based on patient feedback and these studies, I would say, based also on my experience of women who didn’t have access to pain medication, had a difficult and painful IUD insertion, who come back for it a second time, that for some people, it is worth the discomfort, even if there’s not a pain management plan there.
CHANG: So tell me. What do you say to people who are considering IUDs and how might that change now, what you say to them?
GARIEPY: I would say, great news.
(LAUGHTER)
CHANG: Good.
GARIEPY: Great news. We now have federal guidelines that help physicians to do an even better job of meeting patients’ needs for pain management. And hopefully that makes IUD access increase for those who want it.
CHANG: Meanwhile, I’m just waiting for menopause to take over at my age.
GARIEPY: Well lucky, you.
(LAUGHTER)
CHANG: Dr. Aileen Gariepy, director of complex family planning at Weill Cornell Medicine, thank you so much for joining us.
GARIEPY: Thank you, Ailsa. The pleasure was mine.
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