White IUD against a blue background

“Just a Pinch:” Pain, IUDs, and Consciousness-Raising

“I’m still pretty traumatized from my first [intrauterine device (IUD)] insertion experience,” TikTok user @redaces93 recounted. “Yes, they fed me the whole ‘just a pinch’ bullshit lie . . . when I screamed from the pain, the nurse put her hand over my mouth and told me to shut up.” Another TikTok user, @theperiodpositiveplace, called the day of her insertion “one of the worst days of my life.” Yet another, @helllokittypiss, described how she experienced little pain during multiple piercings and tattoos, but used the sound of Cristina Yang from Grey’s Anatomy screaming “someone sedate me” to describe the pain of her IUD insertion. Indeed, a quick search of #iudinsertion on TikTok shows thousands of videos, many from IUD users, describing the intense pain of IUD insertion.

Many medical procedures can cause pain, so it is not surprising that the insertion of an IUD, which must be pushed through a dilated cervix and into the uterus, would be painful. However, many of the horror stories on TikTok tell of physicians downplaying the pain before the procedure and refusing to offer any kind of anesthesia or pain relief other than over-the-counter medications, such as ibuprofen or acetaminophen. While pain relief is an important theme in these insertion videos, the majority of TikTok patients seem most upset by the lack of clear descriptions of the pain many, if not most, experience. As @tw1nk_0r_twunk posted, when techs told her she would feel “a little pinch,” she experienced excruciating pain. “That’s got to be medical gaslighting,” she insisted. “There’s got to be a better way . . . to do this.”

When I first came across these stories on TikTok, I immediately thought of my research into the Women’s Health Movement of the 1960s and ‘70s and its many critiques of women’s treatment within the medical field. Within this movement, feminist activists criticized the patriarchal and paternalistic medical system, which denied women knowledge of and over their own bodies and glorified the physician (who was, at the time, usually male) as an absolute expert over the human body. A major goal of the movement was to “take our bodies back from the institutions of medicine and reframe our knowledge and experiences of our bodies in ways not configured by sexism.”[1] As many women’s health activists argued, the medical system regularly individualizes experiences of pain, writing off women in particular as weak or hysterical when they express pain beyond what physicians expect. Physicians too often wrote off women’s complaints, particularly of pain, as “psychosomatic and therefore ‘unreal’.”[2] By suggesting that women’s experiences were not real and, in essence, all in their heads, physicians engaged in what activists now call medical gaslighting.

Women in a crowd hold up a sign that says WOMEN UNITE, and Our Bodies, Ourselves is written in red across the bottom.
A 1973 copy of Our Bodies, Ourselves from the Boston Women’s Health Collective. (Courtesy Our Bodies Ourselves)

While this was a term unknown to activists at that time, gaslighting is the “undermining” of a person’s “reality by denying facts, the environment around them, or their feelings.” Although it is most often discussed in terms of friendships or romantic relationships, modern health activists use medical gaslighting to describe the process by which doctors write off patients’ symptoms as “emotional” or “psychogenic”, leading to the underuse of painkillers and delayed diagnosis and treatment. In order to combat this form of manipulation, and to reassure women that they did understand their bodies, health activists turned to consciousness-raising. It was through this process that women were able to recognize that their personal experiences are in fact political experiences – that patients could recognize the similarities between them and their treatment by the medical establishment. Women could come together to discuss their stories “of humiliation, of bullying, callousness, or outright carelessness on the doctor’s part.”[3] This was an important element of the Women’s Health Movement, which allowed patients to begin acting collectively to make changes both in women’s experiences within physicians’ offices and in larger health policy.

Although these kinds of consciousness-raising groups – where women come together, in person, to discuss their experiences – may be less popular today, consciousness-raising still occurs. Indeed, by sharing their experiences online, TikTok users are engaged in a form of social media consciousness-raising. While these videos do not act as a formal movement, they play an important role in helping patients push back against medical gaslighting and trust their own experiences. These videos allow IUD users to share their experiences of painful insertion, unsympathetic doctors, and a medical system that under-acknowledges reproductive pain. Women who would have never met or interacted without social media are able to connect with others dealing with similar discomfort and anger. And, often for the first time, patients interested in IUDs could view the faces of those undergoing insertion to decide whether the contraceptive was best for them. The popularity of the videos has also forced physicians to respond to women’s criticisms, sometimes continuing to undermine women’s claims of pain and other times calling for changes in pain relief for the procedure.

As noted above, videos abound of patients (mostly cisgender women) filming themselves undergoing an insertion or discussing their experiences afterwards. A major theme, of course, is the pain these women experience. However, the lack of informed consent is perhaps even more significant. Many women, both in videos and as comments on those videos, expressed horror when one medical practitioner showed how physicians hold the cervix during sounding, which is the measuring of the uterine cavity. Practitioners use a tenaculum, a long set of forceps with hooked, pointed ends. Although it is not supposed to puncture the cervix, it does happen and cause pain regardless. Unfortunately, clear information on how IUDs are inserted is surprisingly difficult to locate, and often written in a way that lay people may find difficult to understand. TikTok user @lissajostewart described how she “asked my doctor every conceivable question” before the procedure, “and I got the same answer over and over and over again. It’s some discomfort, you’re going to feel some cramping like menstrual cramps or maybe a bit more intense than menstrual cramps. Nowhere did I find anything that told me it was going to be so painful I would pass out and then projectile vomit.” After referring to descriptions of the procedure online, she angrily says, “When I asked [my doctor] why she didn’t warn me about how painful it was going to be she said if I had told you, you wouldn’t have wanted to do it.” Almost every video I watched had women expressing dismay over the lack of information surrounding the pain of the procedure.

And doctors have been quick to respond, often criticizing patients for instilling fear and preventing other women from undergoing the procedure. Dr. Karen Tang, for example, posted a video asking why people don’t get anesthesia for other painful experiences, such as tongue or nipple piercings. Dr. Tang then pulled out a paracervical block needle, a common form of anesthetic for certain procedures, and discussed how large and scary the needle might be for patients. Another, Dr. Jennifer Lincoln, argued that the data conflicts about whether IUD insertion or a paracervical block is more painful. She indicated that women rated the pain of a paracervical block as an eight out of ten, somewhat equal to that of an insertion. After thousands of comments from patients pushing back against these two physicians, both eventually removed the videos.

While some physicians responded negatively to women sharing these experiences, others did not, using TikTok to discuss pain management options and encouraging practitioners to be open and honest with their patients. Dr. Kunal Sood, an anesthesiologist, has posted numerous videos discussing the various forms of pain management available for women, including paracervical blocks, anesthetic gas (such as nitrous oxide), and IV sedation (often known as twilight sedation), and encouraged them to find a doctor willing to use them. Dr. Shannon Clark, an obstetrician, counters Dr. Lincoln by suggesting that research shows that anesthesia made IUD insertion easier for both patient and physician, and that nonpharmacological interventions for pain were also effective. For example, Dr. Clark suggests that patients use breathing techniques, meditation, or even hypnosis to help control pain. Gynecologist Dr. Mary Claire argues that “we need to change gynecological care, now.” The many patients sharing their stories, she says, are “starting a movement. The millions of views and tens of thousands of comments are not going unheard. This has to start with how we train and educate health care providers . . . the goal is to change the standard of care.”

Although the standard of care has not yet changed, women’s videos on TikTok have acted as a form of consciousness-raising, encouraging patients to ask their doctors about pain management and reigniting a conversation around women’s pain and medical gaslighting. Like the women before them in the Women’s Health Movement, they refuse to be told their experiences of pain are uncommon or that pain is necessary for access to safe, effective birth control. TikTok videos undoubtedly have led to a sense of empowerment among those asking for pain control and a shift in care among individual doctors. Without the kind of collective action used during the Women’s Health Movement, however, it is difficult to imagine large-scale shifts in standards of care. It is likely too early for us to know if these kinds of social media consciousness-raising actions will end up leading to real change in a system that has long been reluctant to do so. But, as activist and academic Gena Corea wrote in 1977, the first step toward systemic change in health care is for women to “take command” of their own health care, demanding better treatment and refusing to accept forms of medical oppression.[4]

Notes

  1. Nancy Tuana, “The Speculum of Ignorance: The Women’s Health Movement and Epistemological Ignorance,” Hypatia 21 (Summer, 2006): 2
  2. Gena Corea, The Hidden Malpractice: How American Medicine Mistreats Women (Jove/HBJ Books, 1978), 16.
  3. Sheryl Ruzek, The Women’s Health Movement: Feminist Alternatives to Medical Control (Praeger Publishers, 1978), 65.
  4. Corea, The Hidden Malpractice,21.

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One Comment

larafreidenfelds

Great piece! I agree strongly. The first time I had an IUD inserted, the (male) doctor told me it could hurt a lot, but I had better not move at all or I could get hurt. The nurse asked if I’d like to hold her hand. I thanked her and said yes. The doctor scoffed, “didn’t you just have a natural childbirth?” and rolled his eyes. What an asshole. Having the nurse’s hand to hold was really helpful, and got me through a painful procedure. That’s another important lesson from the women’s movement: women helping women through their reproductive experiences. Sometimes pain is hard to avoid, but you can at least provide support and care, and that actually means a lot.

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