Get out the Guillotine for Medical Patriarchy
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I’m so angry
I’m writing this from France on Bastille day and I’m ready to pull out the guillotine. Just a heads up that Angry Gabrielle is here today. I’m so furious, I’m shaking. But I know it’s Friday, so if you need something lighter, try this post about birthday oddities.
A few days ago I shared a humorous Reel about IUD insertion. Since then, I have received hundreds of messages from women who have had their pain ignored, denied and discounted during gynecology procedures. I’ve shared a wide variety of those messages on Instagram — be warned, many are harrowing and left me in tears, feeling nauseous, and so damn angry.
I’m angry at the deeply patriarchal medical system that is devoted to the idea that women can’t make decisions for their own bodies. I’m angry that doctor’s are stuck in a system where they can’t get insurance companies to cover pain medication for gynecology procedures. I’m angry at insurance companies — how do insurance companies justify denying pain management for gynecological procedures? How is that even legal? Are there procedures for men’s bodies that are routinely denied pain management coverage?
I’m angry that we as a society treat women’s pain inconsistently or not at all, while we treat men’s pain thoroughly and consistently. It’s not that I want men’s pain to be ignored, it’s that we can all see very clearly that our society knows how to take pain seriously, so when we don’t take gynecology pain seriously, that’s a choice. We are choosing to ignore, deny, and discount women’s pain. We could easily treat and address the pain; we have lots of tools, techniques, and resources to do so. But we choose not to.
Mixed in with the messages I received about pain, were messages of fear. Women wrote that they didn’t want me to publicly share information about the pain of IUD insertion, because they feared that would fuel the fire of anti-contraception groups. That brought on more anger. I’m angry that our country is having fights about birth control options at all. I’m angry that the fight against contraception is so intense and harmful, that women are worried about even discussing their experiences, and the sometimes negative realities of contraceptive options.
And I’m also angry there are people who think if women just behave “correctly” and don’t complain, and don’t talk about our pain, that the anti-women groups will stop trying to take away our rights.
They won’t! They definitely won’t! Even if we only speak glowingly about contraception, they will still try to take it away, because they don’t actually care about contraception, or about what women want and need. They just hate women. That’s all. They hate women. They hate women so much, they will do anything they can think of to control and subjugate half the world’s population. (And remember, lots of women hate women too! Women hate other women, because the men they love and fear hate women.)
We can want both
Yes, we’re grateful for IUDs and we’re grateful for having contraceptive options. And yes, we want the norm to be effective pain management options for all gynecology procedures. It’s not asking a lot!
It’s so weird that I even need to write that. Of course it’s okay to want both effective birth control and effective pain management for gynecology procedures! It’s very very normal to want both things.
What other intense, invasive medical procedure do we across-the-board assume won’t cause pain, so we don’t even need to discuss pain management?
The medical community’s pain management standard for IUD insertion is currently nothing. At most, the standard is: take an Advil. And yet, we know there are women who experience severe pain during IUD insertion. This isn’t anecdotal. It’s a fact. Any doctor or gynecologist who performs IUD insertions knows there are women who experience great pain during the procedure.
We don’t think women’s pain is worth studying
But do we know what percentage of women experience severe pain during IUD insertion or extraction? Not really. I did a quick search and the first article said: “The pain level during the insertion of an intrauterine device (IUD) is between 2/10 and 4/10 on the pain scale.” But how can that be accurate when some women are literally passing out from the procedure?! Perhaps it’s a weird average?
The second article said: “Some people may have other kinds of reactions during insertion. These can vary from feeling lightheaded and nauseous to passing out. It’s not entirely clear how common these reactions are. Some research suggests they are rare, but estimates vary widely.”
We don’t know how many people experience severe pain during IUD insertion, because we don’t think women’s pain is worth studying.
Is there an insertion technique that hurts less than others that we can could require as the medical standard? No idea! Because we don’t think women’s pain is worth studying.
Are there factors that can determine ahead of time if a women is likely to experience pain at insertion? Probably! But we don’t know what those factors are, because we don’t think women’s pain is worth studying.
The second article I referenced also says: “A different study of people who have not given birth found that 77% of participants reported moderate to severe pain at insertion. Even so, 75% of participants in the study said the procedure went “very well.” Fascinating! Horrific! Women are so used to expecting their pain to be ignored or downplayed, that even when experiencing moderate to severe pain (totally unnecessarily because pain management options exist!), they still report the procedure went “very well.”
What if we applied the same thinking to vasectomies
Imagine if we applied this thinking to vasectomies. What if we started from a baseline of assuming all vasectomies were experienced as a pinch of pain for a short time. And because of this assumption, what if the standard medical care was not offering or even mentioning pain management for vasectomies.
As we know, all bodies are different and experience pain differently. In the messages I received from women about IUDs, there were several who said they experienced minimal or no discomfort at insertion, while others said the pain was worse than childbirth. So we know that due to differing bodies we can say with 100% confidence that there are men who could experience a vasectomy with no pain management and report the procedure went “very well.” Based on that 100% confidence, let’s pretend we teach doctors in medical school that that’s how most men experience it — just a quick pinch.
Can you imagine? If a man complained about the pain, we would say: “Dude, you’re being a wimp. There was a man in here yesterday and he didn’t even flinch. This is well-known as a basically a painless procedure. And besides, there are risks to pain management. Are you sure you want to take those risks for a procedure that men routinely get without pain management?”
It’s so bizarre to even think about. We would never do this!!!
Since we know at least some men experience pain during a vasectomy, the standard of care for all vasectomies includes local anesthetic.
Since we know at least some women experience pain during an IUD insertion, shouldn’t the standard of care for all IUD insertions include pain medication?
It’s always been done that way, so it’s fine
Now I understand that many doctors have been taught that pain treatment is unnecessary for IUD insertion. But it’s one thing to have been taught that it’s a painless procedure, it’s quite another thing to see women under your care experiencing severe pain to the point they freak out or pass out, and then continuing to pretend this isn’t a procedure that should have pain management as a standard.
If you’ve seen women experiencing severe pain during this procedure, and you continue to only offer Tylenol as a standard of care, how is that not some form of medical malpractice? Thinking that “it’s always been done that way, so it’s fine,” is not a sound argument for continuing a harmful practice.
The ONLY reason this isn’t happening, the only reason pain treatment is not a standard part of IUD insertion, is because our world fucking hates women!!
Consider that any time you are in a dentist’s chair, and require any kind of procedure, pain management is offered. Why in the world wouldn’t the same be true for gynecology procedures? (And notice, I wrote “offered.” If you’re someone who doesn’t experience pain during gynecology procedures, that’s great for you. You can say no thank you when the options are offered.)
And why do we act like the options for IUD insertion are general anesthesia or nothing. There is a huge spectrum of options between those two. Maybe, perhaps, possibly, we should fucking study the issue, so we know what the safest pain management option, is the most effective, for the most people. What a basic idea. Why in the world do I even have to type it?’
It’s not just IUDs
While we’re here, let’s also be clear, it’s not just IUDs! Many of the messages I received were about other types of gynecology procedures. Performing gynecology procedures on women without offering or even mentioning pain care seems to be standard for too many doctors.
The whole situation is barbaric and so disturbing, especially when remembering that the “father of modern gynecology” learned what he learned by experimenting on enslaved women while using no anesthetic!! The history of gynecology was written in the blood and torture of enslaved black women. And current day gynecology seems to have embraced its own brutal roots.
It’s so important to talk about our gynecology experiences plainly and openly. Even now, when the anti-contraception atmosphere is thick and ugly. A woman choosing to hide her pain or her experience, will not actually do anything to help fight against birth control restrictions. But a woman sharing her pain, sharing her experience, will very likely help the people around her demand and expect better care at their next gynecology appointment.
The conclusion shouldn’t be: Well I guess women should stop getting IUDs, it’s too painful. OF COURSE THAT SHOULDN’T BE THE CONCLUSION. Millions of women have loudly proclaimed the benefits of IUD use. The conclusion also shouldn’t be: I don’t want to get an IUD because I may not be able to access pain medication.
The conclusion should be: If I choose to get an IUD — which is a wise choice for so many women! — I will confidently, knowing I can request serious pain management for the procedure, and that I deserve pain management. I will know that I don’t just have to simply endure the pain, or try not to mention it, or pretend it didn’t happen.
Women need to know know they don’t have to report that a procedure that caused them severe pain “went very well.”
That’s all for now. I hope you have a beautiful weekend. Feel free to comment on anything I mentioned above, or whatever’s on your mind.
kisses,
Gabrielle
I feel the hatred for women in the US more than ever, it's exhausting. My daughter has endometriosis - a chronic, debilitating and terribly painful condition - and of course it doesn't get the research funding bc it's a woman's problem. Thanks for speaking out, motivates me to be more vocal about women's rights.
Thanks for writing this! I'm a NP in sexual health and place IUDs all the time. While most patients do great, it is totally an expectation that they will have some level of discomfort and I have very few options to manage it due to a variety of systemic issues. This article is reminding me that I need to be more liberal with my use of local anesthesia (lidocaine) which can be helpful for pain but isn't routinely offered.
Meanwhile, they invented a new needle-free method of local anesthesia for vasectomies because men won't get them because they are scared of the needle used for the local anesthesia!!!!!! It's sometimes called "gentle touch vasectomy." God forbid men experience any level of discomfort. [Abstract here: https://pubmed.ncbi.nlm.nih.gov/15821547/]