Pain relief lacking for women fitted with coils

21^st December 2010 - Fewer than 5% of women fitted with contraceptive coils (IUD/IUS) receive effective pain relief during the procedure, according to a leading sexual health doctor. That’s despite more than half of those fitted with a coil experiencing some pain when the device is inserted through the neck of the womb (cervix).

‘Worst pain ever’: Patient

Dr Sam Hutt of the NHS contraceptive clinic, London’s Margaret Pyke Centre, says the pain of the procedure taking place without pain relief can be compared with the pain associated with having a filling at the dentist without a local anaesthetic. He says many women describe it as “the worst pain I have ever experienced”.

Writing in the Journal of Family Planning and Reproductive Healthcare, Hutt says the rare use of pain relief became clear at a recent training update for GPs and family planning clinic doctors at the centre.

Hutt says doctors gave a number of explanations for why they did not administer pain relief. These ranged from ‘no time’ or ‘the pain only lasts a short time’ to ‘I am so good, I don’t cause pain,’ he writes. “Some even believe that the injections are more painful than the insertion, and the attitude that women are hysterical still persists,” he writes, adding: “This is all nonsense.”

Sexism

Hutt - who is also well known as the country and western singer Hank Wangford - contends that sexism may be the reason. “Let us not forget that if men were to have a device inserted through their genitalia they would demand general anaesthetic as a hospital inpatient,” he says.

Some doctors do use anaesthetic gel, but this is more painful to administer than injections, takes longer to act, and is largely ineffective, says Hutt, who proposes “that the use of injectable local anaesthesia (ILA) should be the default position for IUD/IUS fittings from which women can if they wish opt out”.

“Lignocaine is a wonderful thing,” writes Hutt, referring to the commonly used injectable local anaesthetic. “Why ignore it and its great advantages?”

In an accompanying podcast, journal editor, Dr Anne Szarewski, of the Cancer Research UK Centre for Epidemiology, Mathematics and Statistics at the Wolfson Institute for Preventive Medicine, London, suggests that doctors simply don’t know how to use ILA.

“A lot of doctors don’t actually know how to do it. Because they are doctors, they don’t want to admit that. I think that is quite a significant barrier,” she says.

‘Disappointing’: FPA

Rebecca Findlay spokesperson for the sexual health charity FPA (Family Planning Association) tells us by email: “Although every woman’s different, some women experience severe pain and discomfort during an IUD fitting. This is exactly why the FPA Helpline encourages women to talk to their doctor or nurse about pain management before having the procedure and why it’s in all our patient information leaflets.”

Findlay continues: “Therefore it’s disappointing to find such a low number of doctors in this sample administering pain relief, and we’d urge all professionals to follow Faculty [Faculty of Sexual and Reproductive Healthcare, of the Royal College of Obstetricians and Gynaecologists] guidance on the matter.”