Women's healthcare is so often overlooked- from not just the subject of side effects & risks associated with birth control, but also pain management. For years it was thought that the cervix does not contain any sensory nerve endings, and therefore procedures performed such as IUD insertion, colposcopies, and cryotherapy of precancerous cells were performed without anesthetic. This information was eventually disproven, however, it is still a commonly held belief in older physicians: perpetuating the spread of misinformation. A study performed as recently as 2021 (crazy!) tested whether the use of 10% lidocaine spray was effective in reported pain during IUD insertion (Panichyawat et al., 2021). The results of the study did support that administering topical anesthetic had a significant improvement of pain during the procedure (shocker). It amazes me than an entire study needed to be performed in order for changes to be made- of which some providers still do not offer anesthetic- and for women's voices to be heard. Personally, I was not provided with any pain relief when I had my IUD insertion; I was told to take 800mg of ibuprofen an hour before my appointment. This was shown to be an ineffective form of pain management; in a trial there was no difference in pain score between the group of women with ibuprofen and the group without ibuprofen during IUD insertion (Bednarek et al., 2015).
The risks of birth control are often minimized during contraceptive counseling. I had the unfortunate experience of being negatively affected by long-term oral contraceptive use. In 2024 during my yearly gynecology exam my doctor found a lump in my left breast. I went in for an ultrasound, and was pulled into a room with the radiologist. She told me that the results were inconclusive; I would need a mammogram. They brought me into a room with several other patients who so aptly called it "the cancer room" while I waited. All of the women in the room looked at me with pity- how could someone so young be sitting in the room with them? The mammogram was also inconclusive, and I would require a biopsy to confirm a diagnosis.
Thankfully, the results of my biopsy determined I had a benign breast tumor. I was told it was mostly likely caused by my long-term use of birth control pills. The surgeon was shocked that I had begun oral contraceptives so young, and was never informed of the risks of taking birth control before the completion of puberty (I was 13 when I started birth control for PCOS). Despite my relief, I was angry; angry that this is the quality of care I was provided by someone who is supposed to be working in my best interest. The very first study that I found was titled "Oral contraceptives and breast disease" studying epidemiologic data collecting data as early as the mid 70s (again- absolutely insane!). It concluded that the risk of developing a tumor- benign or malignant- was greatest in those who used oral contraceptives for over 7 years. Women who used oral contraceptives starting under the age of 25 for longer than 5 years were at five times the risk (McGonigle & Huggins, 1991).
There is an extreme lack of urgency and priority in research into the specialty especially in minority groups. Even with my personal experiences, I cannot even imagine what it is like for women of color in similar situations- black women especially. For an embarrassingly long time it was believed that black people did not feel pain to the same extent as white people, and were denied adequate pain management during procedures. Research has shown that in white women 13.0 deaths occur per 100,000 births, conversely, in black women there are 42.8 death per 100,000 births (Saluja & Bryant, 2021) (for a 3rd time- why did this take so long? 2021! Are you kidding???). It is not due to genetic predisposition or difference in anatomy; it is purely the effects of racial biases on the quality of care.
As future providers, scientist, and researchers enter the workforce it is imperative to continue these discussions and fight the normalization of the current state of women's healthcare. I am hopeful that the upcoming generation of providers will be better informed and serious when addressing symptoms and concerns raised by female patients. Maybe we are ovary-acting, but when it comes to healthcare, a little drama might just save lives!
Sources
Bednarek, P. H., Creinin, M. D., Reeves, M. F., Cwiak, C., Espey, E., Jensen, J. T., & Post-Aspiration IUD Randomization (PAIR) Study Trial Group (2015). Prophylactic ibuprofen does not improve pain with IUD insertion: a randomized trial. Contraception, 91(3), 193–197. https://doi.org/10.1016/j.contraception.2014.11.012
McGonigle, K. F., & Huggins, G. R. (1991). Oral contraceptives and breast disease. Fertility and sterility, 56(5), 799–819. https://doi.org/10.1016/s0015-0282(16)54647-0
Panichyawat, N., Mongkornthong, T., Wongwananuruk, T., & Sirimai, K. (2021). 10% lidocaine spray for pain control during intrauterine device insertion: a randomised, double-blind, placebo-controlled trial. BMJ sexual & reproductive health, 47(3), 159–165. https://doi.org/10.1136/bmjsrh-2020-200670
Saluja, B., & Bryant, Z. (2021). How Implicit Bias Contributes to Racial Disparities in Maternal Morbidity and Mortality in the United States. Journal of women's health (2002), 30(2), 270–273. https://doi.org/10.1089/jwh.2020.8874
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