An IUD is a T-shaped device is inserted into the uterus to prevent pregnancy. Photo: PEAKSTOCK / Science Photo Library / AFP
When Checkpoint asked to hear from patients about their IUD experiences, we were inundated with hundreds of messages.
Patients said getting their intra-uterine device or IUD inserted was extremely painful and worse than childbirth.
The T-shaped device is inserted into the uterus to prevent pregnancy. Normally, a patient is told to take paracetamol or ibuprofen beforehand but that is mainly for potential pain afterwards.
Videos circulating on social media of women sharing their experiences going through IUD insertion has triggered new guidelines around advice and anaesthetic in the United States and there are calls here to do the same.
Brooke Jones tried to have an IUD fitted a few years ago but it got so painful, it had to stop.
"I had about, you know, about three or four doctors, and they were all kind of trying to have a go, it went on for about an hour and a half.
"It was beyond anything, it was worse than giving birth."
Jones said there was no prior discussion about the possible pain or discomfort she could experience.
Brooke Jones said she tried to have an IUD fitted a few years ago but the procedure was so painful the doctors had to stop. Photo: Supplied
She was not alone, many people who contacted Checkpoint about their experience said potential pain was not addressed.
Diana* had an IUD fitted this year - she was given laughing gas and squeezed the hand of a nurse.
"He didn't mention that I could be in excruciating pain like I was, when he had finished l had wriggled two feet up the bed.
"I was just so sore, the only other pain I've been in like that is childbirth."
If she had known it would be that painful, she would not have gone through with it.
"It should all be upfront and everyone should know how bad it can be for some people."
Diana said if she had known how painful it would be to have an IUD fitted, she would not have gone through with the procedure. Photo: Supplied
Another patient, Tracey, echoed this concern, after a similar experience left her in tears, feeling faint and vomiting.
"I think it's disgusting, to be honest it wasn't just a little bit of a pinch, I think I'm pretty tough I've gone through two caesareans without pain relief for afterwards.
"I can't have opioids, so they gave me panadol and I coped with that better than having this IUD put in, it was the most painful thing I've gone through."
She said stronger pain relief needed to be offered.
"I just don't think it's acceptable, there has to be pain relief given for this, it's just ... it's not okay."
Important to inform patients about potential pain, doctor says
Dr Beth Messenger is a medical director at Sexual Wellbeing Aotearoa, and has been inserting IUDs for the last 18 years.
When it came to pain relief, Messenger said every patient was different.
"So the majority of people don't get any additional pain relief at insertion.
"That's partly because the experience of people with IUD insertion is so varied but it's also because the evidence for what else we might offer them is not that great, we know that some local anaesthetic might help."
But the quality of evidence to support the use of local anaesthetic is limited, so it is not part of a routine IUD appointment which could mean waiting months longer for an appointment with an inserter who is trained to administer it.
In the last 12 months the number of IUDs inserted at Sexual Wellbeing Aotearoa with local anaesthetic was less than 5 percent.
The issue has gained attention in the US after videos did the rounds on social media showing women in agony while getting an IUD inserted.
That led to the Centre for Disease Control to update its guidelines this month - recommending doctors talk to patients about potential pain and about anaesthetic options.
Messenger is part of the contraceptive advisory group updating the guidelines on contraception in New Zealand.
She acknowledged informing patients about potential pain was important.
"To set some expectations, to expect that it might be painful and there are some people who have pelvic pain that are more likely to experience pain with an IUD."
But Messenger said it was harder to access pain relief in New Zealand as local anaesthetic injections were only partially funded so that cost was passed onto the patient.
Anaesthetic gel was less effective and an anaesthetic spray was not funded, she said.
For some patients being put to sleep under a general anaesthetic was required but it was not as accessible in the public system, she said.
"We do have an issue with equity again in that not everybody is able to go privately for a general anaesthetic in the private system without insurance it's thousands and the public system really doesn't have the capacity to routinely offer general anaesthetic."
IUD effective form of contraception - gynaecologist
Gynaecologist Dr Amelia Ryan said an IUD was one of the most effective forms of contraception available and it was important not to put people off getting one.
Dr Amelia Ryan Photo: Supplied / Samantha Donaldson Photography
Ryan said it was easily reversible and hormonal IUDs had loads of benefits like helping ease pelvic pain, heavy periods and could be part of treatment for perimenopause.
"The insertion itself can be painful because of the need to push the insertion device through the cervix which, particularly in women who haven't had a baby, can be quite tightly closed.
"The uterus can also spasm, which can cause cramping pain.
"It's important to remember that at least 50 percent of people who have an IUD inserted will have minimal or no pain at all."
Ryan said the most important issue was proper counsellling and consenting patients about what to expect and knowing the pain relief options available.
"If you do want additional pain relief you can speak to the clinician doing the insertion and there are likely referral pathways available but they might involve significant delays."
If an insertion became painful Ryan said "it's okay to stop and change the plan".
"Ultimately, I really think clinicians are doing the best by their patients and trying to balance the amount of discomfort with the desire and motivation of their patient who really just wants to get an IUD in place."
Te Whatu Ora is in the process of reviewing guidelines on contraception and said updated advice could be expected later this year. It said until then it could not answer questions from Checkpoint.
*Checkpoint agreed not to give Diana's surname.
