A (3:34)

I think it was. I was getting mixed signals. So if you look at the latest data from the CDC, IUD usage is up. You know, 20% of women relied on it between 2015 and 2019. And anecdotally, I was hearing from gynecologists across the country that, you know, more and more women are turning to the IUD because it is, it is long acting. You can keep it in there for five to eight years. And it is very effective. As you mentioned, 99% effective at preventing pregnancies. And, you know, it is much more effective and much more sustainable than using a pill because if you forget one pill or two pill, two pills, or, you know, you're run, you've run out of your prescription, you have to go back to the pharmacy. And so it's just, it's just a safer birth control method. But at the same time, if you look on social media, it is flooded with some of, you know, the. The loudest voices on there who are sharing their horror stories of getting an IUD inserted it. You know, as you mentioned in our comment section, it's the same kind of thing you see on Instagram, TikTok, which is, you know, women sharing that they passed out, they threw up, it was, you know, excruciating pain, and they were not offered any relief or they were dismissed. And there was actually a study published this year that scanned TikTok content about IUDs and found that 97% of them, you know, were talking about the pain of it and the negative side of it. So I was just sort of confronted with this, I guess, sort of disparity in messaging. You know, on the one hand, more women are getting it. On the other hand, more women are complaining about it and are, you know, rightfully sharing their experiences about it. And so we wanted to get to the bottom of sort of like what is happening here. And, you know, if it is painful for women, then why aren't we living in a world where pain relief is offered?

B (5:41)

Well, we're getting some calls right now with, with great People who. It sounds like they have stories. Let's hear from Irene in Jersey City. Hi, Irene.

C (5:49)

Hi, guys. So, yeah, I was. I had one inserted about seven or eight years ago, and it was incredibly painful. And as I was lying there for about five minutes afterwards, I couldn't speak, and I went pale. And the doctor just looked at me and said, don't worry, you're just in shock from the pain. So if it was enough to put me in shock from pain, why was it enough to give me some kind of pain relief? And when I asked her that, and she said, that's just not an option. That's not something that we offer, which I was very surprised about and felt very unfair at the least.

B (6:22)

Irene, thank you so much for that call. Let's hear from Michael in Yonkers. Hi, Michael.

C (6:29)

Hello. I'm an older person. I had an iud, more than one inserted on the east side in Manhattan when I was in my late 20s, early 30s. And my OB GYN simply said, Let me give you a muscle relaxer. Which she did. And half an hour later, we did the process. It was a slight cramp. It was zero. It was nothing. So a muscle relaxer is the way to go. I don't even understand the controversy at this point.

B (7:08)

Michael, thank you so much. So, Alicia, you know, we heard especially from Irene in the beginning, there being pain that's not being addressed by doctors. Why might doctors not fully address the potential pain a patient might experience?

A (7:21)

Yeah. Okay. So there are several reasons. The first, and I quote a source who I, who I have in the article, it does come down to gaslighting. It is sort of the historic dismissal and undermining of women's pain. That is sort of part of the equation. But there are other reasons. It's only recently that we've actually seen studies on effective pain relief relief for this procedure. So, you know, as Michael said earlier, that he had. That they had a muscle relaxer, and that might have been something that their gynecologist provided. But we. We didn't really have that data to support that practice up until very recently. And so I think a lot of physicians might be worried about providing something or might not even know what is the best way to relieve pain in. In this certain situation. The other thing is, I think a lot of OB GYNs, a lot of physicians, a lot of doctors, nurses, especially if you think of clinics that are, you know, not large clinics, that smaller clinics in remote areas, they might not be trained in providing pain relief for this procedure. It is a procedure that takes three to four minutes. And so for them, it's sort of like if I can just get this over and done with in the way that I'm trained, then maybe, you know, this patient will be fine and we can, we can get the show on the road. So there are different factors, but yes, it does. A lot of it does come down to gaslighting.

B (9:02)

I understand. Let's talk to Emma in Bushwick. Hi, Emma, welcome to the show.

C (9:07)

Hi. Thank you. Yeah, I actually, I had a positive experience I wanted to share.

B (9:12)

Great.

C (9:15)

So when I had my IUD inserted about five years ago, it was, I was really lucky. It was not that painful. It wasn't much worse than regular menstrual cramps. And for me, it marked the end of a very long, like almost two year period of trying to determine with my doctor what birth control method would work best for my mental, mental and physical health. I am like, so, so sorry for all, like to all the women who have had different experiences than mine in terms of the pain level. But I worry that this current discourse is going to discourage a lot of women from even considering IUDs as an option. And the reality is there are so many different birth control methods and everyone's mental and physical health is different. And I hope everybody will. I wish everybody had the opportunity to work with a doctor to figure out what would work best for them.

B (10:05)

Emma, thank you so much for that call. And an important point that I hear you talking about is that idea of it discouraging women from what might be a truly viable option. Alicia, how do you sort that? There's a whole spectrum of experiences here.

A (10:20)

Yeah. You know, and I actually investigating that very question. Is the messaging on social media actually deterring teenagers and young girls from getting the iud, which again, as we mentioned, is a very, very effective form of birth control. I don't know the answer to that because the data only goes to 2019, but anecdotally I don't think it is. So there is that. I think a lot of, as I said earlier, the loudest voices are the ones who are, who have gone through horrific pain. And a large portion of women do get it and don't feel terrible about it. And actually they love their iud. I think it's one of those things that women are very passionate about. If they do get it, they love having their IUD because they can just forget about it, forget about birth control once they're on it. And so it's so far I'm not seeing a drastic Drop in usage or I'm not hearing that. But again, we don't have national data on that.

B (11:27)

If you're just joining us, we're talking to Alicia Haridasani Gupta, a New York Times health reporter. We are talking about IUDs, specifically the pain that can come from IUD insertion and why so many women are having difficulty when they feel pain, getting the relief that they need through treatment or otherwise. And also just about the spectrum of experiences related to having an iud. And listeners, we want to hear from you. What was your experience with an IUD insertion like? Was it painful? What instructions or treatment did you receive from your doctor? How did you navigate making that decision? Call us, text us 212-433-9692. That's 212433, WNYC. Or you can hit us up on Instagram DM us at all of it WNYC. Alicia. We're getting a lot of texts as well. I want to read from you, Ian in New Jersey saying, I am a trans man and I had a copper iud. I found the insertion cripplingly painful. I missed work next day. I'm lucky that marijuana was legal in my state because it was the only thing that gave me relief. I want to emphasize that not only women get IUDs, and transgender patients are already less likely to speak up to doctors. We're part of this conversation, too. Alicia, do you have any thoughts on that, ways that some folks might be left out of this conversation?

A (12:49)

Normally, of course, there's always front of mind when I'm reporting on this, but I just want to add that a lot of the data we have is focused on women. So when I cite that 20% of women are using it, I'm quoting the CDC on that. So I don't have data on LGBTQ folks, but I'm fully aware and it is always front of mind in my reporting.

B (13:18)

And Ian, thank you so much for sending that text as well, bringing all perspectives to the conversation. We have another caller, Lawrence from Queens. Hi, Lawrence, welcome to the show.

C (13:29)

Hi. Thank you for taking the call. My name is Lawrence. I'm a woman's health nurse practitioner, and I've done multiple insertions, and my women have not really complained about of pain. I usually would ask them to take ibuprofen 800 before the appointment, and if they were having difficulties with the insertion, then I would hold it, give them a muscle relaxant, have them come back for the insertion. Usually the ones that tended to have a lot of cramping with menstruation were asked what medication they were taking for the cramping and asked to take that prior to coming for the insertion. And I've maybe counted on my hand how many people have had to stop insertion because of pain.

B (14:15)

Laurence, thank you so much for that perspective as a nurse practitioner. Let's go to Angelique from Clayton, North Carolina. Hi, Angelique.

C (14:24)

Hi. Thanks for taking my call. So I had, when. When I had my first IUD done, I was like 25, and I went to see this old Jewish man who was wonderful and told me, oh, you haven't had kids yet. Well, if you want me to implant an iud, you can come in on the two days of the month that the anesthesiologist is here, otherwise, I'm not doing it for you. And, like, that was so, like, looking back at how I was treated by him versus every other practitioner, he was a gem. Like the fact that he knew that it was so painful that it should be something that you have anesthesia for. And then my next experience was getting it taken out seven years later, where contrastingly, I had a young white woman, which, like, you know, just difference in appearance and age and everything else. And she held open my cervix for 12 minutes, 10 to 12 minutes while she fished for the. For the strings. And I was sweating, I was shaking on the table. And she just dismissed everything. And it was so painful that when she went to go insert the new one, she got a bad placement. And then she dismissed all the pain that I was having afterwards. So it kind of traumatized me. I didn't want to go back to, like, when I started having digestive issues. I didn't want to go to a. My gynecologist or any gynecologist because I lost trust in gynecologists after that experience. So, like, this is something serious. You should not just do this without any anesthesia.

B (15:57)

Angelique, thank you so much for calling and sharing what sounds like a difficult experience. And Alicia, I hear from, you know, first nurse practitioner and then from somebody experiencing pain, it makes me think about doctors and the way that they interact with their patients. What have you heard about how doctors respond when women experience pain or say they're experiencing pain?

A (16:21)

So, as I mentioned, a lot of physicians are not trained actually in pain management for this particular procedure. I think it was something like 80% of trained doctors offered just over the counter painkillers, and only 4% of trained physicians actually offered sort of an injection of a local anesthetic. So really, again, like, the caller said it is rare to find someone who, who understands that it could be extremely painful for you and you do need anesthetics. And, you know, I should point out that many of the people in our comments, in our very lively comment section have mentioned that if this is something that men went through, there would be so many options available to them.

B (17:11)

Yeah, it's interesting you bring that up because we did just get a message on Instagram. It reads, regarding IUD pain relief. My husband recently got a vasectomy, which is also a quick procedure under 15 minutes, and, and was offered full anesthesia. So frustrating that women are not given the same options. So that goes exactly. Yeah. And, you know, your. Your beat is women's health care. And, and I wonder how this story fits into your larger reporting on women's treatment in the healthcare system, especially when it comes to how women's pain is believed and treated. Can you talk about that a little bit?

A (17:44)

Yeah. I mean, it's a tragic pattern that I see in every story I do that 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. We live in 2024, and it's only now that we have good data on pain relief for this. You know, it's. It's kind of. It's shocking. And it's. We know that historically, studies into women's health have been underfunded. They. The medical industry has always treated women as simply smaller men, and so they just apply the same sort of thinking around male bodies to female bodies. Right. If you think about a heart attack, it's long assumed that female bodies have the same symptoms as male bodies when having a heart attack, but we now know that that's not true. We also know that metabolism is different in female bodies. And so all of this is now coming and piling up. And so for decades, we just had the wrong assumptions about female bodies. And we, and we. We. Because of that, we never took women and queer folks seriously when they complained about pain.

B (19:05)

We have another positive experience. We've got Valerie in Brooklyn. Hi, Valerie. Welcome to the show.

C (19:10)

Hi.

B (19:12)

Hi. Tell us about your experience.

C (19:13)

Yeah. Yes. So I got the copper IED put in about two months after having my daughter. That was three years ago. And I was on my period, and it was like I didn't even realize that they were doing it. Honestly. It was so fast and so painless. I heard that getting it put in right after childbirth and also while in your period is kind of like a best case scenario because your cervix is like really kind of ready for insertion. And I just got taken out in January and I am now pregnant with my second child. So altogether very positive experience. Thank you. Yes, I loved it. I didn't have any bad side effects or anything.

B (19:55)

Well, thank you so much for calling. Congratulations on the pregnancy. And we also have just to round it out, we've got another text coming in here similar to Valerie. It reads, love my iud. The insertions and removals I've had over decades have been memorably painful, but it's still worth it. Why don't the manufacturers pharma talk more to patients about the pain management options? Alicia, great question from your perspective. One, why doesn't that conversation happen more often? And two, from your reporting, is there anything that women or other people getting the IUDs can do to advocate for themselves?

A (20:35)

So again, why is the conversation not happening? It comes back to sort of, you know, why isn't women's pain taken seriously? That's the answer. But you know, I do see glimmers of hope because I have heard from a few companies, I'm totally blanking on their names, but a few companies that are innovating in this space and creating new instruments for this procedure that would theoretically reduce pain during insertion and removal. So they haven't come to market, they haven't yet gone to the fda, but they could be on the horizon. And so, you know, this is what happens when you do take women's pain seriously and you do have people who want to do something about it.

B (21:24)

We've been talking to Alicia Haridasani Gupta, a New York Times health reporter. Alicia, thank you so much. And thank you to everybody who was calling in and texting us. If you'd like to continue, you can definitely hit us up on Instagram. Our handle is oflonyc. Alicia, thank you again.

A (21:41)

Thank you.

B (21:42)

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