By India Rogers-Shepp & Deepti Divya Gopisetty MD

Images of patients biting their lips, fists clenched, eyes squeezed shut while they fight gasps of pain, follow us into the exam room. As trainees in gynecology, we are taught to use “verbi-caine” – words as a form of anesthesia – to ease the anxiety that too often accompanies routine procedures, such as IUD insertions or endometrial biopsies. Words are a powerful part of our healing toolkit, but just like any other medication, they must be given with intention and thoughtfulness. We were thrilled to see the new CDC guidelines recommending that clinicians discuss pain management options for IUD insertions with patients, but they only scratch the surface. Our new paper, “Understanding patient experiences during gynaecological procedures: a qualitative exploratory study,” digs deeper and finds that multiple factors create a positive experience, including emphasizing patient-centered care and pre-procedural education and support. 

 We must abandon the outdated approach to pain “management” that lauds stoic endurance of pain as a woman’s strength. As clinicians and patients ourselves, we reject that this pain is untreatable and that ibuprofen is all we have to offer. According to a survey from 2023, 80% of clinicians offer over-the-counter painkillers like ibuprofen for IUD insertions, yet only 4% of clinicians offer a lidocaine block despite research that suggests it decreases pain. 

 In our clinic, we are seeing patients prepared with questions based on what they’ve heard. One patient, an adolescent nervous about their upcoming IUD insertion, brought their mother along for support. As we discussed pain management options, the mother interjected with, “Sedation would be great. I don’t want you to go through what I did.” We are encouraged to see patients advocating for themselves and each other through shared experiences, and it is critical that clinicians take an active role in advocating for their patients as well. Thanks to the amplification of patient voices and advocates, we are starting to see clinicians and politicians responding and demanding better patient care. In addition to the CDC guidelines update, researchers are now studying the impact of sharing stories of endometriosis pain and IUD insertion and removal pain on TikTok. 

 Recently, we had a patient whose IUD removal was particularly challenging. The clinician we worked with was remarkable in consistently checking in with the patient at every step, ensuring they remained in control of the process. We gave her control by informing her of each step and allowed her to guide us through pauses and breaks. This transformed a potentially traumatic experience into one where she said she felt supported, heard, and in control of her body.  

When we learn about trauma-informed care, we learn that the words we use with our patients lay the foundation for building restorative relationships. Simple phrases like, “You’re in control,” or “We can pause anytime,” have a profound impact. Audre Lorde once said, “Your silence will not protect you,” and in the context of gynecology, this could not be more true. The phrase “verbi-caine” exemplifies the capacity of language to transcend communication and become a critical part of our healing methodology to validate and respond to a patient’s pain.   

 Pain management disparities extend beyond IUDs to procedures like endometrial biopsies and colposcopies. For instance, research shows that patients who have never given birth may experience more pain during procedures. However, we must be careful not to generalize—some nulliparous patients report minimal discomfort, while others who have given birth experience significant pain. These are some of the nuances that providers must communicate openly and honestly, rather than assuming an approach works based on statistical averages. 

Thanks to the amplification of patient voices and advocates, clinicians and politicians are starting to respond and demand better care for patients. In addition to the CDC guidelines update, researchers are now studying the impact of sharing stories of endometriosis pain and IUD insertion and removal pain on TikTok. This past September’s New York Times op-ed aptly highlighted the limitations of current pain management strategies for IUD insertions, but we believe we must push this conversation further.  

A real issue is that we, as clinicians, sometimes fail to admit the limits of our knowledge about pain. We must be upfront with patients about the uncertainties and complexities of pain, and focus on partnering with them to develop a care plan that aligns with their preferences and needs. Pain isn’t just a clinical issue—it’s deeply personal, and our role is to empower patients through shared decision-making. As physicians, we have a duty to uphold reproductive justice by truly listening to our patients and honoring their choices. Patients everywhere deserve more than a one-size-fits-all solution like ibuprofen. By partnering with our patients, we can—and must—do better.

About the Author

India Rogers-Shepp is an MD student at Stanford University whose research interests include under-treated pain in gynecological procedures, the intersection of climate change and women’s health, the intersection of housing and health, and health equity. 

Deepti Divya Gopisetty MD is a resident OB-GYN at Stanford Hospital committed to improving patient experiences in reproductive healthcare and promoting patient-centered care and health equity in medical education. 

Competing interests: None declared