PBS News Hour

JOHN YANG: Millions of American women use some form of contraception to prevent pregnancy and help with medical issues.

One of the most popular forms is an intrauterine device, or IUD.

It's a T shaped contraption slightly larger than a quarter, and it's inserted into the uterus.

Lately, IUDs have been going viral, not because of their popularity, but because of the pain associated with getting them.

Patients have been posting videos on TikTok and other platforms to show how traumatic it can be.

WOMAN: Didn't you let the lidocaine kick in?

WOMAN: It's kicked in already.

How's your pain?

WOMAN: Bad.

Bad.

Oh, I don't like that.

WOMAN: I don't like that.

WOMAN: It literally felt like I was being ripped open.

JOHN YANG: Following a surge in these videos, the CDC issued new recommendations about how doctors can better treat the pain.

Ali Rogin recently spoke with Yale School of Medicine Professor Dr. Aaron Lazorwitz.

ALI ROGIN: Dr. Aaon Lazorwitz, thank you so much for joining us.

Before we talk about these new CDC guidelines, can you tell me about your understanding of the types of pain that people can experience when getting IUDs inserted.

DR. AARON LAZORWITZ, Yale School of Medicine: There's a couple different types of pain and different time points during the IUD insertion where patients can experience pain.

Some patients have discomfort and pain just with the insertion of the speculum.

And then there's an instrument we place onto the cervix for insertion of the IUD called a tenaculum.

And placement of that instrument can also be painful.

And then the IUD insertion itself can also be painful.

All of these experiences differ quite a bit from patient to patient, with some having minimal pain and some having quite severe pain with some of these steps of the process.

ALI ROGIN: And then tell me about the spectrum of pain management that is available to doctors to use in these circumstances, whether or not they actually use them.

AARON LAZORWITZ: So right now we unfortunately have very limited options of pain management options that actually work.

You know, we all give non-steroidal anti-inflammatory drugs beforehand, like ibuprofen.

Does that really help?

Maybe, you know, but in terms of actual reliable medications or things we can do to reduce that pain, as the CDC guideline says, there's only a couple things that may help, and that includes lidocaine injections, which I do offer to my patients, but with the caveat of it may not help with the process.

ALI ROGIN: And it's my understanding that you do sometimes offer anesthesia to patients.

What are those conversations like before you might offer that option?

AARON LAZORWITZ: Yeah, I want to make sure my patients have the full spectrum of options, including going to the operating room with anesthesia if needed.

And so we have a discussion of what that entails.

That's a full day process for a lot of patients.

Could take four to five hours.

They have to fast beforehand, then they're going to have to recover.

It's a much more involved process.

But there are patients where that's necessary for them to be comfortable getting an IUD.

And that's OK. And that's something I talk with them about.

Of the risk, benefits, there's additional risks to anesthesia with the clear benefit of reduced pain.

ALI ROGIN: It does seem though like there's no happy medium here between taking an Advil before insertion and then going immediately to a much more intensive process of going under anesthesia.

What does that say about the way that medicine science treats the pain of women and other people with uteruses?

AARON LAZORWITZ: It underplays that for too long, we have been ignoring the pain that patients who need IUDs have been experiencing with these procedures.

You know, though, a lot of us in the complex family planning field have been trying to research ways to deal with this pain and make it better.

And there hasn't been widespread notice or care taken to make these things better for the patients, to improve that process, to find that middle ground, as you said.

And that's really where we've lacked the development of new methods for pain control that are sorely needed, not only for IUD insertions, but all the gynecological procedures that we do in the office that can all be painful.

ALI ROGIN: These CDC recommendations have two main components.

They recommend the use of lidocaine as a numbing spray, and they recommend against the use of misoprostol to help the cervix dilate.

What is the impact of these CDC recommendations?

AARON LAZORWITZ: So I'm a big proponent of these guidelines coming out because gives widespread attention to things that we've been doing in our field for a while, that we know that offering more pain management options is patient centered that discussion of either injectable lidocaine or topical lidocaine is something that we should be talking with our patients and that the misoprosto really is something that we should not be doing for everyone because it can definitely increase the pain.

And so it's great that now this is becoming a more widespread conversation because, you know, patients have been suffering and really attention needs to be paid.

ALI ROGIN: And what has the impact of these videos on TikTok and other social media sources been on the CDC putting out this guideline, but going way beyond that, just the general more attention being put on this issue.

AARON LAZORWITZ: I think what's actually good is the CDC coming out these TikTok videos is empowering patients to ask for more, to not accept when a clinician or whoever's doing the IUD or another procedure says, oh, this is fine, you're not going to feel any pain, that's not OK. And that's how we get this conversation going.

And that's how we put more pressure on the development of more pain management options when patients demand it.

And I have patients that come in and say, I want to talk about the pain management.

I'm like, great, let's talk about the options we have and the limitations thereof.

But I hope this encourages patients, wherever they go for their iud, to ask and empower themselves and be their own advocate, to say, hey, what do you offer for pain management?

ALI ROGIN: Dr. Aaron Lazorwitz, professor of obstetrics, gynecology and reproductive science at the Yale School of Medicine.

Thank you so much for joining us.

AARON LAZORWITZ: Of course.

Thank you so much, Ali.