Getting an IUD can hurt. B.C. doctors say it doesn't have to

Dr. Ana Armas Enriquez remembers the agony of getting an intrauterine device (IUD) as a teen.

“It was a horrible pain,” she said. “It’s excruciating.”

Decades later, the Nanaimo-based women’s health physician strives to alleviate that pain for her patients.

There are several pain-management tools to choose from, including oral painkillers, numbing gel, a cervical anaesthetic, and in extreme cases, sedation. Those options aren’t always offered to patients, Armas Enriquez said.

“It’s like going to a dentist and getting a root canal or a tooth extraction and not being offered freezing,” said Armas Enriquez, owner of Women’s Vita Medical Clinic.

Kaitlynn Hoffman has had several IUDs, which are inserted into the uterus through the cervix.

“It was quite painful and I was not offered any… pain management aside from being told Tylenol would work,” she said.

“It just feels like somebody is stabbing you with… some sort of sharp object in your uterus.”

She underwent the procedure for the third time in October. That time, Hoffman said she was offered cervical numbing and an Ativan.

“That was the best experience that I’ve had,” Hoffman said.

'WOMEN'S PAIN DOESN'T MATTER'

Last year, the Society of Obstetricians and Gynaecologists of Canada released a statement outlining pain management options. Still, a family planning physician said there aren’t any firm rules that explain how to make a patient more comfortable.

“Pain management is individual and it involves combining multiple methods. That’s very hard to study and so that’s why we don’t have clear guidelines and a lot of people assume that means to use nothing,” said Dr. Renée Hall, co-medical director at Willow Clinic.

Hall trains other physicians on IUD insertion. She said medical schools need to provide more robust training for the procedure.

“We have a lot of people who would never even consider one of the most effective options for birth control that has one of the lowest doses of hormones… because of all that they’ve heard from their friends about how painful and traumatic it was,” she said.

Asking women to grit their teeth through the procedure sends the message, "That women’s pain doesn’t matter or that we can tolerate more,” Hall said.

MEDICATION COMES AT A COST

Hall and Armas Enriquez said doctors need to be paid more for IUD insertions.

Their practices focus largely on women’s health, which means they aren’t compensated under B.C.’s family physician payment schedule. The province introduced the payment model in 2022 to address the doctor shortage through increased pay.

“I cannot participate in such a program because then I have to redefine my practice,” Armas Enriquez said.

As a result, she and Hall are compensated under the old fee-for-service model. That means they make $46.79 per IUD insertion.

That fee does not cover the cost of a cervical anaesthetic, an injection that numbs the cervix.

“How many people… with a debt of three quarters of a million dollars from going to med school in family practice can afford to do all of this?” Armas Enriquez said.

The health ministry said work is underway to improve compensation for IUD insertions.

Going forward, Hoffman is optimistic more patients will have a positive experience like she had in October.

“Hopefully we can learn from the doctors that are doing the work and taking the time just to make the experience a little bit better,” she said.