Gynecological procedures can be a real pain

While Sarah *, 32, suffered from pain during a colposcopy – a procedure to examine the cervix, vagina and vulva for possible cervical cancer – the provider Health Care Officer (HCP) performing the procedure made a comment Sarah said she will never forget.

“These are the things that we are meant to go through as women.”

The doctor had been kind and comforting throughout the entire procedure, and Sarah understood that the doctor was trying to be sympathetic, but she was stunned by the words.

“The women who have had the colposcopy have treated me very well and have been wonderful and supportive, yet it was still one of the most painful and traumatic experiences of my life,” said Sarah.

Fortunately for Sarah, the results of the procedure were mild. Months later, when she got an appointment with another OB-GYN, the new doctor mentioned that sedation and anesthesia were available options for invasive procedures, such as a colposcopy, if ever. she needed it again – all Sarah had to do was ask.

She recalled past experiences with other providers, such as the severe pain she felt during a previous IUD insertion, and again when another provider removed the device. Sarah was not offered pain management every time. At this point, Sarah was considering another IUD and, although she was relieved that there were options to make the process more comfortable, she wondered why pain management was not offered regularly unless it was. a patient does not ask.

“A lot of it is just systemic,” she said.

The burden of pain on women

If you visit an online forum about gynecological procedures, from Pap smears to biopsies, you will find that many women share similar stories of feeling severe pain despite feeling little more than mild cramps. or discomfort. Women who had not given birth wondered if they felt more pain for this reason and had not been made aware of this possibility. In many cases, pain management was rarely offered, and some women reported that healthcare professionals refused to stop the procedure or rejected the pain expressed.

A review of the American literature on pain management procedures encourages the management of pain control for the comfort of the patient during gynecologic procedures, but the general consensus in online discussions is that women’s pain in general has historically been rejected or often under-treated, leading to gynecological practices that minimize or reject pain. potential for pain during invasive procedures.

“One of the major problems with our current medical system is that there is so little time usually allotted for an exam, and a lot of people don’t want to get into long drawn out but very important issues surrounding these procedures,” Dr Mary Jane said. Minkin, clinical professor of obstetrics, gynecology and reproductive sciences at Yale University School of Medicine and a member of the Healthy Women’s Health Advisory Council. “Sometimes we just need to say, ‘This is very important, and we need to set aside more time to fix this problem. “”

There isn’t a large body of research measuring pain caused by invasive gynecologic procedures, but a UK study on hysteroscopies – a procedure where a provider looks inside the uterus using a flexible tube for diagnosing abnormal bleeding – found that patients ‘pain ratings did not match clinicians’ estimates. An advocacy group in the UK, Campaign Against Painful Hysteroscopy, works to provide information to women before their intervention about the different levels of pain they might experience and the pain relief options available before them, during and after their interventions.

Stacy Holmstedt, a 46-year-old software designer from Phoenix, had an experience similar to Sarah’s. After the growths in her uterus and ovaries continued to grow for five years, Holmstedt agreed to have an endometrial biopsy to rule out cancer. Her doctor never told her that anesthesia or sedation were options.

“We didn’t discuss the pain before the procedure, and to be honest I walked in thinking it wouldn’t be a big deal,” Holmstedt said.

While researching endometrial biopsies online before her procedure, Holmstedt read articles telling her that she should prepare for pain that looks like period cramps. She planned to take over-the-counter ibuprofen before the procedure and breathe deeply to get out of it.

“The pain was so much worse than I had prepared for,” said Holmstedt. “I tried to stay calm and quiet because I had never given birth and felt like a giant weakling, but every scratch literally made me see stars in front of my eyes. All I could do was moan against the wall next to my face.

The one-doctor approach

Dr Huma Farid, obstetrician / gynecologist at Beth Israel Deaconess Medical Center in Boston and professor of obstetrics and gynecology at Harvard Medical School, encourages patients to discuss pain management before invasive procedures.

“Patients are asking and should be asking questions about pain relief,” she said. “Sometimes the process of numbing the cervix can be more painful than the procedure, but I think it’s important to ask.”

Farid said that providing anesthesia often requires one or more painful injections, and that since procedures such as endometrial biopsies and IUD insertions are relatively quick, receiving multiple injections can actually be more painful than the procedure itself. . She tells patients to take 600 mg of ibuprofen before procedures and advises them on the extent of pain they might be feeling.

For office procedures such as IUD insertion and colposcopies, Farid offers heating pads, ibuprofen, and music to help patients cope. Hysteroscopies that involve the removal of a polyp or fibroid take place in the operating room, where anesthesia would be an option.

“However, for any procedure, even an IUD insertion or a biopsy, if the patient requests it be done under general anesthesia, I will do it in the operating room,” Farid said. “Patients can have a variety of reasons for this request, and I always try to honor their desire for more anesthesia. ”

Minkin, who herself had three endometrial biopsies, said she was ready to share her own experiences on the procedures to help patients decide how they want to manage pain and educate them on the level of pain. that they might feel. She noted that a recent endometrial biopsy patient – who had experienced significant pain in previous endometrial biopsies – was not even aware that the procedure had taken place because she had taken ibuprofen in her stomach. advance and had been given medication to help her cervix dilate before the procedure.

“I think part of the problem is that women experience the discomforts of these different procedures very differently,” Minkin said. “I encourage both providers and patients to speak up – for providers to describe what pain looks like as best they can and for patients to explain their anxieties and feelings about pain. , in particular during a previous procedure. “

Know your options

Holmstedt found another doctor – his third in a decade – after whoever performed the biopsy requested a second procedure.

Holmstedt told the new doctor she wanted a hysterectomy. When he said that a biopsy was also needed, she expressed concern about the pain. The doctor told her he would use twilight (also called conscious sedation) to make her feel nothing and give her a prescription for pain relievers after the procedure. She said the biopsy was almost painless and her results were negative. Her hysterectomy months later also went well.

Recently she shared part of her story on Twitter after a person has expressed outrage on the lack of pain management for invasive procedures.

“When I remembered all the emotions from my first biopsy, I just wanted to reveal it all through a tweet,” Holmstedt said. “Gynecologic procedures are always treated as something that women shouldn’t need anesthesia to manage. We are given less pain and anxiety management than dental care, and that is not true.

* Sarah’s last name has been withheld upon request


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