{"id":2432,"date":"2025-03-10T12:06:26","date_gmt":"2025-03-10T12:06:26","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmjsrh\/?p=2432"},"modified":"2025-03-10T12:06:26","modified_gmt":"2025-03-10T12:06:26","slug":"letting-patients-lead-improving-how-we-care-for-obgyn-patients-in-pain","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmjsrh\/2025\/03\/10\/letting-patients-lead-improving-how-we-care-for-obgyn-patients-in-pain\/","title":{"rendered":"Letting Patients Lead: Improving How We Care for OBGYN Patients in Pain"},"content":{"rendered":"

By India Rogers-Shepp & Deepti Divya Gopisetty MD<\/em><\/p>\n

Images of patients biting their lips, fists clenched, eyes squeezed shut while they fight gasps of\u00a0<\/span>pain, follow us into the exam room. As trainees in gynecology, we are taught to use \u201cverbi-caine\u201d \u2013 words as a form of anesthesia \u2013 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<\/span> new CDC guidelines<\/span><\/a> recommending that clinicians discuss pain management options for IUD insertions with patients, but they only scratch the surface. Our new paper, \u201c<\/span>Understanding patient experiences during gynaecological procedures: a qualitative exploratory study<\/span><\/a>,\u201d digs deeper and finds that multiple factors create a positive experience, including emphasizing patient-centered care and pre-procedural education and support.\u00a0<\/span><\/p>\n

\u00a0<\/span>We must abandon the outdated approach to pain “management” that lauds stoic endurance of pain as a woman’s strength.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<\/span> survey from 2023<\/span><\/a>, 80% of clinicians offer over-the-counter painkillers like ibuprofen for IUD insertions, yet only 4% of clinicians offer a lidocaine block despite<\/span> research that suggests it decreases pain<\/span><\/a>.\u00a0<\/span><\/p>\n

\u00a0<\/span>In our clinic, we are seeing patients prepared with questions based on what they\u2019ve 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, \u201cSedation would be great. I don\u2019t want you to go through what I did.\u201d <\/span>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<\/span>. 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<\/span> CDC guidelines update<\/span><\/a>, researchers are now studying the impact of sharing stories of<\/span> endometriosis pain<\/span><\/a> and<\/span> IUD insertion and removal pain<\/span><\/a> on TikTok.\u00a0<\/span><\/p>\n

\u00a0<\/span>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.\u00a0\u00a0<\/span><\/p>\n

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\u2019re in control,” or “We can pause anytime,” have a profound impact. Audre Lorde once said, \u201cYour silence will not protect you,\u201d and in the context of gynecology, this could not be more true. The phrase \u201cverbi-caine\u201d exemplifies the capacity of language to transcend communication and become a critical part of our healing methodology to validate and respond to a patient\u2019s pain.\u00a0\u00a0\u00a0<\/span><\/p>\n

\u00a0<\/span>Pain management disparities extend beyond IUDs to procedures like endometrial biopsies and colposcopies.<\/span> For instance, research shows that patients who have never given birth may experience more pain during procedures.<\/span><\/a> However, we must be careful not to generalize\u2014some<\/span> nulliparous patients report minimal discomfor<\/span><\/a>t, 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.\u00a0<\/span><\/p>\n

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<\/span> CDC guidelines update<\/span><\/a>, researchers are now studying the impact of sharing stories of<\/span> endometriosis pain<\/span><\/a> and<\/span> IUD insertion and removal pain<\/span><\/a> on TikTok. This past September\u2019s<\/span> New York Times<\/span><\/i> op-ed<\/span><\/a> aptly highlighted the limitations of current pain management strategies for IUD insertions, but we believe we must push this conversation further.\u00a0\u00a0<\/span><\/p>\n

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\u2019t just a clinical issue\u2014it\u2019s 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\u2014and must\u2014do better.<\/span><\/p>\n

\n

About the Author<\/p>\n

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\u2019s health, the intersection of housing and health, and health equity.\u00a0<\/span><\/p>\n

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.\u00a0<\/span><\/u><\/u><\/p>\n

Competing interests: None declared<\/p>\n","protected":false},"excerpt":{"rendered":"

By India Rogers-Shepp & Deepti Divya Gopisetty MD Images of patients biting their lips, fists clenched, eyes squeezed shut while they fight gasps of\u00a0pain, follow us into the exam room. As trainees in gynecology, we are taught to use \u201cverbi-caine\u201d \u2013 words as a form of anesthesia \u2013 to ease the anxiety that too often […]<\/p>\n

Read More…<\/a><\/p>\n","protected":false},"author":513,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[599,15153],"tags":[],"class_list":["post-2432","post","type-post","status-publish","format-standard","hentry","category-screening","category-sexual-health"],"yoast_head":"\nLetting Patients Lead: Improving How We Care for OBGYN Patients in Pain - BMJ Sexual & Reproductive Health blog<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blogs.bmj.com\/bmjsrh\/2025\/03\/10\/letting-patients-lead-improving-how-we-care-for-obgyn-patients-in-pain\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Letting Patients Lead: Improving How We Care for OBGYN Patients in Pain - BMJ Sexual & Reproductive Health blog\" \/>\n<meta property=\"og:description\" content=\"By India Rogers-Shepp & Deepti Divya Gopisetty MD Images of patients biting their lips, fists clenched, eyes squeezed shut while they fight gasps of\u00a0pain, follow us into the exam room. 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