Podcast Summary: IUD Insertion Can Really Hurt. What Is Being Done About It?

Podcast: All Of It | Host: WNYC
Episode Date: March 26, 2024
Guest: Alicia Haridasani Gupta, New York Times Health Reporter

Overview of the Episode’s Theme

This episode tackles the sharp disconnect between the rising popularity of IUDs (intrauterine devices) for birth control and the widely varied—and often excruciating—pain experiences during their insertion. Host Kushan Avadar (standing in for Alison Stewart) speaks with health reporter Alicia Haridasani Gupta, author of a recent New York Times article on IUD pain. Listener calls and texts provide a broad spectrum of perspectives, from positive experiences to stories of severe pain and medical dismissal. The episode explores why pain is not routinely managed in IUD procedures, the broader societal pattern of dismissing women's (and trans patients’) pain, and what may be changing on the horizon.

Key Discussion Points & Insights

1. The Paradox of IUD Popularity and Pain

• IUDs: Among the most effective (99%) long-term birth control methods; increasingly chosen by women due to convenience and shifting restrictions on abortion.
• Disparity: Despite their effectiveness, many report severe, undertreated pain during insertion—a phenomenon widely discussed on social media and in reader comments (03:34).
• Alicia Haridasani Gupta (03:58):
  “If you look on social media, it is flooded with... horror stories of getting an IUD inserted. ... Women sharing that they passed out, they threw up, it was excruciating pain, and they were not offered any relief or they were dismissed.”

2. Real Patient Experiences: The Spectrum of Pain

• Severe Pain & Lack of Relief:
  • Callers describe trauma, shock, and even medical dismissal:
    • Irene from Jersey City recalled (05:49):
      “I went pale… the doctor just looked at me and said, ‘Don’t worry, you’re just in shock from the pain.’ … why wasn’t I given any kind of pain relief?”
  • Angelique from North Carolina shared a positive early experience with an anesthetist but, years later, severe pain and lasting trauma from a new practitioner who dismissed her suffering (14:24).
• Minimal Pain:
  • Some, like Emma and Valerie, report little to moderate discomfort or even painless procedures, especially post-childbirth or during menstruation (09:07, 19:10).
  • Emma expresses concern that public focus on pain could deter women from an otherwise excellent birth control option (10:05).
    • “I worry that this current discourse is going to discourage a lot of women from even considering IUDs as an option.”

3. Why Don’t Doctors Offer More Pain Relief?

• Historic Dismissal & “Gaslighting”:
  • Gupta cites systemic underestimation of women’s pain, both historically and in medical practice (07:21).
    • “It does come down to gaslighting... the historic dismissal and undermining of women's pain.”
• Knowledge Gaps & Lack of Training:
  • Until recently, little research or guidance existed on effective pain relief during IUD insertion.
  • Many providers give only over-the-counter painkillers (ibuprofen), with just 4% offering local anesthetic injections (16:21).
• Practical Issues:
  • Small clinics or overbooked practitioners treat IUD insertion as a quick, routine process (07:56).

4. Broader Patterns in Women’s Health Care

• Historic Under-Study:
  • Gupta flags the long-standing lack of medical research on women’s bodies and pain—often treating women as “smaller men” (17:44).
    • “It’s a tragic pattern... so many of the concerns around women's health comes down to basically: A, we don’t believe women, and B, we simply have never studied women, and so we don’t know the answers.”
  • Calls out contrast with men’s procedures: Vasectomies, by comparison, routinely offer anesthesia (17:11).

5. LGBTQ+ and Trans Patient Experiences

• Text from Ian in NJ highlights that not only women get IUDs; trans patients often face unique barriers and more reluctance to speak up to providers (12:34).
  • “I found the insertion cripplingly painful... I want to emphasize that not only women get IUDs, and transgender patients are already less likely to speak up.”

6. Positive Practitioner Experiences

• Laurence, a women’s health nurse practitioner, reports few complaints of pain among his patients—attributes this to pre-insertion pain planning (ibuprofen, muscle relaxants as needed) and willingness to stop if the patient was suffering (13:29).

7. Possible Improvements and Advocacy

• Industry Innovation: Gupta mentions companies now developing new instruments to make insertion less painful, but these have not yet come to market (20:35).
• Advice for Patients: Self-advocacy is critical—ask about pain management options, and seek out practitioners attuned to patient comfort.

Notable Quotes & Memorable Moments (with Timestamps)

• On Social Media and Pain Narratives:
  “97% of [TikTok videos about IUDs] were talking about the pain… the negative side.” — Alicia Haridasani Gupta (04:47)
• Patients Left in Shock:
  “I couldn’t speak, and I went pale. The doctor just looked and said, ‘don’t worry, you’re just in shock from the pain.’” — Irene, Caller (05:49)
• The Gaslighting & Systemic Dismissal:
  “It does come down to gaslighting... the historic dismissal and undermining of women’s pain.” — Alicia Haridasani Gupta (07:21)
• Vasectomy Comparison:
  “My husband recently got a vasectomy… and was offered full anesthesia. So frustrating that women are not given the same options.” — Listener via Instagram (17:11)
• On Medical Research:
  “We simply have never studied women, and so we don’t know the answers. ...The medical industry has always treated women as simply smaller men.” — Alicia Haridasani Gupta (17:44)
• Trans Patients’ Needs:
  “I want to emphasize that not only women get IUDs, and transgender patients are already less likely to speak up.” — Ian, Listener Text (12:34)
• Product Innovation:
  “I have heard from a few companies that are innovating in this space and creating new instruments for this procedure that would theoretically reduce pain… they could be on the horizon.” — Alicia Haridasani Gupta (20:35)

Segment Timestamps

• Opening Discussion & Guest Intro: 01:10–03:34
• IUD Popularity vs. Pain Reports: 03:34–05:41
• Caller Experiences: Severe & Minimal Pain: 05:41–11:27
• Exploring the Pain Disparity: 11:27–13:18
• Trans and LGBTQ+ Perspectives: 11:27–12:49
• Provider Perspective (Nurse Practitioner): 13:29–14:15
• Medical Dismissal & Lasting Trauma: 14:24–15:57
• Systemic Issues in Women’s Health Care: 16:21–19:05
• Positive Experiences & Self-Advocacy: 19:10–21:24

Conclusion

This episode draws vital attention to the need for better pain management and patient-centered care in IUD procedures—a microcosm of the larger issue of how women's (and non-cis patients’) pain has long been minimized in healthcare. While some have easy, positive IUD insertions, frequent stories of trauma, dismissal, and lack of pain relief point to a systemic failure. Positive changes may be on the horizon with new medical devices and rising awareness, but until then, the best advice is for patients to advocate for themselves and demand better care.

For more listener perspectives and ways to be part of the conversation, contact the show via phone, text, or Instagram (@allofitwnyc).