Prioritizing pain management during IUD insertions and other gynecologic procedures

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On this episode of the CMAJ Podcast, Dr. Blair Bigham and Dr. Mojola Omole explore effective ways to manage pain during intrauterine device (IUD) insertions. They also address a broader issue: how women’s pain is often neglected during gynecologic procedures, and the failure of physicians to adequately seek consent. They are joined by Dr. Kristina Arion, an obstetrician and gynecologist at the Children's Hospital of Eastern Ontario, and Dr. Nadia Von Benzon, a lecturer and social geographer at Lancaster University.

The episode begins with Dr. Arion discussing the CMAJ article she co-authored, which outlines strategies for better management of pain during IUD insertions. She explains that the IUD is recommended as the first-line therapy for birth control and period management by the Canadian Pediatric Society and the Society of Obstetricians and Gynaecologists of Canada. Dr. Arion highlights how patient anxiety, lack of sedation options, and inconsistent practices contribute to unnecessary pain.Her key advice to doctors: listen to patients, explain each step of the procedure, and provide adequate pain management options.

Dr. Von Benzon broadens the discussion beyond IUD pain management to the neglect of women’s pain and autonomy during other gynecologic and obstetrical procedures. Her research article "My doctor just called me a good girl, and I died a bit inside: From everyday misogyny to obstetric violence in UK fertility and maternity services," illustrates how women’s pain is frequently dismissed and their consent overlooked. She discusses the long-term impact of these practices, with some women opting out of future pregnancies due to trauma. She advises healthcare professionals to clearly explain procedures, seek consent, and prioritize patient comfort and autonomy.

Dr. Omole and Dr. Bigham reflect on how patriarchal structures and time constraints within healthcare systems often lead to the failure to prioritize women’s pain and autonomy. The episode closes with a powerful call for healthcare providers to take the time to listen to their patients, ask questions, and ensure that consent and comfort are prioritized at every stage of care.

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