Their IUD procedures were painful. Now they’re scared to have it removed.

Britten Rollo, 41, of Dumfries, Va. said the process of removing her IUD in 2018 was so painful, it left both her and her physician in tears. This summer, the 55-year-old asked her gynecologist for options to help manage the pain during removal, but was told there weren’t any. I’m not going to get it out,’ ” said Claxton, of Chandler, Ariz. Advertisement While it has been well documented that many patients experience severe pain when getting an IUD, less is known about how those painful experiences affect reproductive health care. Some women say that their worries about pain have deterred them from getting IUDs removed or replaced when needed, and they have become reluctant to return to the gynecologist, even for different procedures. The Centers for Disease Control and Prevention called for physicians to be more responsive to patient concerns about pain during IUD procedures, and to give women more information and options to deal with it. Most patients fare better when their health-care providers are transparent about the procedures, the possibility of pain and any available pain control options, said Nichole Tyson, a clinical professor and division chief of pediatric and adolescent gynecology at Stanford University. “Everybody wants to know what’s happening with their body,” Tyson said. I think that’s a legitimate thing we all have to think about and be compassionate about.” Avoiding the doctor because of IUD anxiety An estimated 1 in 5 sexually experienced women ages 15 to 44 have used an IUD, data shows. In the past, IUDs were primarily used by women who had given birth, but the device in recent years has become popular with younger women. But as the demographics of IUD use have changed, so have the challenges of pain management. Pain often is more common in women who haven’t given birth, because they may have a more narrow cervical canal and a smaller opening to the uterus. In one study, nearly eight out of 10 women who had never given birth reported moderate to severe pain with IUD insertion. One smaller study showed that women who had given birth reported a median pain score of five out of 10, versus seven for those who had never given birth. At 16, Andrea did not expect her IUD placement to hurt and her clinician didn’t warn her, she said. “I guess I have some mistrust there,” she said. “It exceeded any kind of pain that I’ve ever experienced,” said Romano, 41, of Queens. “This is going to die with me,” she said. Patients interviewed for this story said they do not want fears about pain to prevent people from using IUDs or getting them replaced, but they do believe IUD users should be more informed. What happens when an IUD is removed During an IUD removal, the clinician inserts a speculum into the vagina and looks for the IUD strings, which are typically about two to three centimeters long. The removal can be uncomfortable, but it’s not usually as painful because it doesn’t require manipulation of the cervix, said Eve Espey, chair of American College of Obstetricians and Gynecologists’ Contraceptive Equity Expert Work Group. Britten Rollo, 41, of Dumfries, Va., said her primary care physician couldn’t find the strings to her IUD. Removing it, in 2018, “was about a 15-minute process of her digging around in there, trying to find them,” she said. Clinicians often don’t agree on pain management When Rebecca Watkins, 44, of Raleigh, N.C., had her IUD replaced in 2019, she said it “felt like my insides were going to be pulled out.” After the procedure, her gynecologist suggested that she request a sedative the next time. Watkins said that second replacement was also painful, and afterward, the doctor conceded that she should have used the sedative after all. “It was infuriating to me,” Watkins said. For routine IUD removals, most clinicians do not offer pain management. But for complicated removals or when patients request pain control, the options are the same as for IUD insertions. While complications such as lost IUD strings or an embedded IUD can cause pain, other factors also can play a role. These include patients with greater pain sensitivity, chronic pain syndromes, past traumas or previous gynecological procedures that have caused cervical scarring, which can make the removal process more painful. Espey, chair of the OB/GYN department at the University of New Mexico, said the discomfort of IUD removal typically is quick and manageable. If complications arise or the patient asks to stop, clinicians should pause and be willing to abandon it or use pain control, she said. Patients who are anxious or who have had negative experiences with IUD procedures should discuss pain management options before the next procedure, said Aileen Gariepy, director of complex family planning at Weill Cornell Medicine. “People don’t have to have the procedure without any medication, but it does need a conversation.” Delaying care because of pain fears Holly Lee, 55, of Plymouth, Ill., said the nurse midwife for her first IUD removal told her it would be “a little pinch,” but it felt like “a branding iron or something hot and on fire had been stuck up there.” The next time, the removal pain was worse. “I was literally sobbing,” Lee recalled, saying she cried out for the nurse midwife to stop, instinctively dug her heels into the stirrups and pushed herself backward on the table to escape the pain, which she described as “something tearing out of you.” “I’m terrified to have it taken out,” she said. “It’ll stay in as long as I can leave it in, honestly.” Research shows that while hormonal IUDs lose effectiveness after their duration of intended use, some physicians said there is limited risk associated with leaving them in long term, assuming fertility is not a consideration. There are rare case reports of pelvic infection associated with IUDs, but many people keep in the devices without issue, physicians said. Some people remove their own IUDs Bianca Allison, a pediatrician and assistant professor at the University of North Carolina School of Medicine, recently co-wrote a commentary on barriers to removal of IUDs. “If people are doing it on their own, it’s possibly because they’ve experienced barriers,” she said. For a month after having her IUD placed in 2016, Kirby Lowenstein, 33, of Philadelphia, had unrelenting pain and cramping. She said the experience left her “feeling completely disempowered.” In a moment of desperation at home, Lowenstein grabbed the strings and pulled out her IUD, immediately passing out. “The pain got to a point where I couldn’t take it anymore, and I felt like I had no other choice in that moment,” she said. While some health-care providers said IUD self-removal may be safe in uncomplicated cases in which the IUD strings are easily accessible, others discouraged it. “I think it encourages them to leave us out of their health-care team,” said Megan Wasson, chair of the department of medical and surgical gynecology at Mayo Clinic in Arizona. Wasson emphasized that providers should encourage patients to exercise their autonomy, particularly during gynecological procedures — telling their clinician to stop when a procedure is too painful. “We need to build that relationship between providers and patients,” she said. “Not making them go through hoops to get the care they need, but making sure that they look to us as a resource and as a partner in their health, not an adversary.” About this story – This Summarize was created by Neural News AI (V1). Source: https://www.washingtonpost.com/wellness/2024/08/13/iud-removal-pain/