by Lisa Jarvis, Bloomberg Opinion

Credit: Unsplash/CC0 Public Domain

Anyone who watched Olympic bronze medalist Ilona Maher giving her rugby opponents the stiff arm knows she is tough as nails. Yet she recently posted a video on social media exhaling deeply, clutching her stomach and leaning into a tree with the caption, "Connecting with nature before getting my IUD replaced."

Yes, even a world-class athlete known for her beast mode winces at the thought of the brief but sometimes extremely painful procedure to insert long-acting birth control.

Thousands of women chimed in to commiserate. They're part of a groundswell of patients speaking up on social media about the too-often ignored or downplayed discomfort of routine gynecological visits, whether that's insertion or removal of an intrauterine device or anxiety around basic cancer screens.

The medical establishment is finally starting to listen to them.

But there is a lot of room for improvement, whether that's fostering better conversations between patients and doctors, finding ways to better manage women's mental and physical discomfort or making overdue investments to advance medicine for women's reproductive health.

In general, simply validating women's experiences could go a long way toward ensuring they are empowered to make the best choices for their health.

When patients are driven to social media for advice, there's a real risk they aren't getting the best or even accurate information—and reproductive health has been a particularly fraught topic on TikTok and Instagram. Women need balanced information so they can weigh the very real pain of an IUD insertion or removal against its long-term benefits, whether that's years of effective birth control, being spared painful periods or easing the symptoms of endometriosis.

A good first step in changing the conversation came last month, when the Centers for Disease Control and Prevention updated its guidelines for IUD insertions. The agency said that doctors should talk to patients about potential pain and for the first time suggested lidocaine, which numbs the nerves in the cervix and lower uterus, could help some.

The hope is that can offset the intense cramping and nausea that some experience during and even hours or days after the procedure (which itself typically takes under three minutes)—pain previously managed mainly through gritted teeth and at most a high dose of ibuprofen.

Lidocaine isn't a panacea. The drug is administered via an injection near the cervix, a process that might not appeal to all patients. And the data are mixed when it comes to its effectiveness in minimizing pain: Of the six studies reviewed by CDC, half found lidocaine could help and half did not.

But patients should get to decide what works best for them. "Every single patient needs a conversation about what they may experience and what your office provides to minimize discomfort—and that hasn't historically been done well enough," says Deborah Bartz, an obstetrician-gynecologist at Brigham and Women's Hospital in Boston.

That conversation should involve a realistic explanation of what the IUD insertion process involves and what it might feel like, and include options for how to manage the pain. Everyone's pain tolerance is different, and everyone is bringing different fears and experiences into the office.

For some, the anticipation of the experience itself is extreme—enough to cause some women to put off the procedure for years or forgo an IUD altogether—and pairing pain management with an anti-anxiety medication might help, Bartz says. In some rare cases, doctors might even consider sedation.

But the process for placing and removing long-acting birth control isn't the only discomfort during regular gynecological visits. More needs to be done to make it easier for women to stay up-to-date on the simple Pap test, which plays a vital role in screening for cervical cancer.

No one particularly enjoys getting a Pap smear, in which cells are scraped from the cervix to look for early signs of cancer and HPV, but the experience can be overwhelming for some—people who are sexual assault survivors, for example, or those who are afraid of what can feel like an extremely vulnerable moment.

A 2022 study found a significant rise in the number of women who weren't up-to-date on their screening in 2019 compared with 2005. Many women in the study said they didn't know they needed the screening, didn't have a provider or were uncomfortable with the test.

A few new options are emerging that could help, though it's important to ensure they are as accurate and affordable as the conventional method. In May, the Food and Drug Administration approved a self-collection HPV test developed by Roche. While the sample must be retrieved in a doctor's office before being sent away for processing, allowing women to do so privately might alleviate some anxiety. The eventual arrival of at-home tests, which are in development in the US, could be a bigger help.

In general, patients are more satisfied with their care—even if it involves some amount of pain—if they feel they've been given options, which in turn allows them to feel some agency over their experience, Bartz says.

And while some discomfort is unavoidable, finding small ways to make patients feel empowered during their visits to the gynecologist, whether that's through self-testing options or merely a more open dialogue with their doctor, can go a long way.

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