Latest news with #IUDs
India.com
14 hours ago
- Health
- India.com
Why U.S. Funded Contraceptives Worth $10 Million Are Being Burned In France While Poor Nations Plead For Help
France Contraceptive Burning: In a warehouse in Belgium, crates of unused birth control pills, intrauterine devices (IUDs) and contraceptive implants – funded by American taxpayers and meant for women in the world's poorest countries – are being prepared for destruction. The supplies, worth nearly $10 million, are not expiring anytime soon. Some carry shelf lives until 2031. But they are still being burned, in France, at a cost of over $160,000. This wastage is the result of a deliberate choice by the U.S. government. After President Donald Trump ordered a shutdown of foreign assistance programmes of the United States Agency for International Development (USAID) in January, thousands of boxes of reproductive health supplies were stranded. Aid groups rushed in. The United Nations Population Fund (UNFPA) and reproductive health NGOs offered to take the contraceptives and send them where they were needed most – in sub-Saharan Africa, for instance, where these supplies are often the only thing preventing unsafe abortions. But Washington said no. Over and over. Offers Turned Down, Rights Sidelined Sarah Shaw, who works with MSI Reproductive Choices, said her organisation was ready to repackage and ship the supplies at no cost to U.S. taxpayers. They were even willing to follow U.S. rules, but they were told something shocking: the supplies would only be sold at full market price. 'This is not about money It feels more like an ideological assault on reproductive rights,' Shaw told Reuters. Aid groups warned of the human consequences of women denied access to basic contraceptive care, of lives destabilised by unwanted pregnancies and of a surge in dangerous abortion attempts. But the U.S. government refused to budge. The boxes remained untouched. And then came the decision: incinerate everything. Pressure, Politics and Fears of Abortion Links A source close to the talks said the Trump administration feared the supplies might end up with organisations linked to abortion services, something that could technically violate his funding rules. Stamped with the USAID logo, the packaging became another sticking point. The government simply did not want the risk, even if that risk was remote. In Brussels, Belgian officials tried to negotiate. They asked if the supplies could be redirected or handed off. 'Despite these efforts, and with full respect for our partners, no viable alternative could be secured. Sexual and reproductive health must not be subject to ideological constraints,' Belgium's foreign ministry said. But their plea fell on deaf ears. Too Little, Too Late Even in Washington, lawmakers tried to intervene albeit late. A few introduced legislation this month in a last-ditch effort to stop the destruction. But insiders admit it may already be too late. Reuters also obtained an internal USAID memo from April. It clearly recommended that the supplies be immediately handed over to another agency to avoid waste and added costs. That advice was ignored. So now, $10 million in birth control will go up in smoke. Not because it was faulty. Not because it was old. But because politics triumphed over people and ideology outweighed empathy.
Vox
10-07-2025
- Health
- Vox
What if IUD insertion didn't have to be so painful?
The appointment before she got her first intrauterine device, or IUD, Ana Ni's doctor asked about her pain tolerance. Low, she said; medium, if she's being generous. The clinic had just begun offering nitrous oxide, or laughing gas, to patients to help manage pain during IUD placements and, given the alternative — to undergo the procedure sans anesthetics — she gladly accepted. Before the insertion late last year, Ni, a 26-year-old health care consultant, took deep breaths of the nitrous oxide. She started to feel woozy. 'Initially you just feel relaxed,' she says, 'and then suddenly you get a bit of a head high, similar to when you would hit a vape. That kind of feeling, but intensify it more.' During the procedure, she continued to breathe the gas through cramping. Without the laughing gas, she suspects the pain would have been more acute. 'I know it's a short procedure,' Ni says, 'but I honestly cannot imagine it without the laughing gas.' Vox Culture Culture reflects society. Get our best explainers on everything from money to entertainment to what everyone is talking about online. Email (required) Sign Up By submitting your email, you agree to our Terms and Privacy Notice . This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply. The reality is more complicated. Many patients felt they were lied to by their doctors whose only option for pain management was over-the-counter painkillers. Studies analyzing social media posts about IUD insertion found that almost all of them mentioned pain and discussed how this pain was minimized. Part warning, part public service announcement, these viral videos not only helped bring to light the real suffering patients were experiencing, but also shaped professional guidance regarding what pain management doctors should offer them. Within the past year, the Centers for Disease Control and Prevention and the American College of Obstetricians and Gynecologists (ACOG) released updated recommendations for pain management during IUD placement. Both suggest clinicians offer local anesthetics like lidocaine spray, lidocaine-prilocaine cream, and paracervical block — an injection of anesthetic around the cervix. Other providers are going further, offering anti-anxiety medications or general anesthesia. The most effective way to address pain is perhaps the most straightforward, and the most novel: talking to patients and hearing their concerns. While the ACOG guidance found insufficient evidence to support nitrous oxide use, Ni remembers her doctor telling her how it helped other patients. She had a similarly positive review; she says she'll request it again when she needs to replace her IUD. 'Unless there's some other medication then,' she says. 'But I feel like the laughing gas will suffice.' Over 6 million people in the United States currently use IUDs as contraception, and the evolving pain management standards around them show the medical establishment has moved to address women's pain — and how much more work is left to be done. Aside from having a slate of pain management options on offer, the most effective way to address pain is perhaps the most straightforward, and the most novel: talking to patients and hearing their concerns. The shifting standards around IUD procedures point to the ways doctors are only beginning to see patients as experts of their own bodies, and to take women's concerns seriously. 'This fits right into a movement that has really picked up steam, but I doubt is the norm across medical disciplines,' says Eve Espey, a professor and chair of the department of OB-GYN and family planning at the University of New Mexico. 'But if you approach patient care in that way — in thinking about what a patient might experience with a painful outpatient procedure — [it] would dovetail very nicely into that much more patient-centered approach.' A history of pain in gynecology Intrauterine devices are a form of long-acting birth control that have grown in popularity over the last 30 years, especially among those between the ages of 25 and 34. There are two categories of IUDs: copper and hormonal, both of which prevent sperm from fertilizing eggs. Part of the allure of IUDs is that, unlike the pill, which must be taken daily, an IUD is effective for anywhere from three to 10 years, depending on type. No upkeep, no prescription refills. Some users report less cramping and bleeding during periods and less endometrial pain; others stop getting their periods altogether. 'There's also some literature that says if you tell people that something's going to hurt, that it hurts more, which is true.' Although the insertion itself only takes a few minutes, there are multiple points of pain throughout the procedure. First, the medical professional inserts the speculum, an instrument that opens the vaginal walls, which can be painful for some patients. Then, using a device called the tenaculum, the provider will grasp the cervix to straighten and hold it in place. The depth of the uterus is then measured, which can cause cramping, and finally, the IUD itself is inserted. Espey has placed countless IUDs during her 37-year career as an OB-GYN. For a while, she'd outline the risks and benefits and answer any patient questions. But she wouldn't necessarily emphasize the potential for pain in order to avoid scaring patients. 'We just assumed that if somebody came in for an IUD, that they wanted it,' Espey says. 'It's not that we wouldn't describe the fact that it was painful — I did — but it's also a little tough, because there's also some literature out there that says if you tell people that something's going to hurt, that it hurts more, which is true.' The concern was IUDs would be too difficult and painful to place for anyone else. 'On average,' Epsey says, 'women who have had vaginal births, particularly recent vaginal births, have far less pain with IUD placement than women who have not or who have only had C-sections.' Birth control pills were the go-to contraceptive method for decades, Espey says. But as more evidence emerged about the safety and efficacy of IUDs for people of all ages with uteruses, guidance about who should get an IUD began to change in the 2010s. But even as more people — particularly those who had never given birth — began to get them, the perception that the procedure was only mildly uncomfortable persisted. Indeed, medical providers often rated their patients' pain during IUD placement as significantly lower than what the patients experienced. Women and gender-nonconforming people's experiences in medical settings have long been dismissed. In a 2018 review of scientific literature about gender biases in health care, men were seen as 'stoic' when it came to pain, while women were perceived as being more sensitive to pain and 'hysterical.' Hysteria was a popular medical diagnosis for centuries, almost exclusively used to refer to women. The diagnosis was used to classify women as having a mental disorder associated with sexual and social repression and weak character. Women and gender nonconforming people's experiences in medical settings have long been dismissed. The field of gynecology has similarly nefarious origins. The 'father of modern gynecology,' James Marion Sims, developed gynecological practices by experimenting on enslaved women without anesthesia based on the false stereotype that Black people have higher pain thresholds. Amid the eugenics movement of the 1900s, those with low incomes, people of color, and people with disabilities underwent forced sterilizations. Even as late as the 1990s, contraceptive implants were marketed toward low-income Black communities as a means of controlling reproduction of those deemed unfit or unworthy of parenthood. 'I'm an OB-GYN,' says Ashley Jeanlus, a board-certified OB-GYN in Washington, DC, 'but I'm also not very naive that historically and to modern times, how we take care of patients isn't always patient-centered.' The recent CDC and ACOG pain management guidelines are a welcome change, Jeanlus says. 'We're showing that there is improvement, that we're taking important steps to making sure that we are standardizing care, ensuring that patients are receiving these procedures with compassion and dignity, and we're not telling them to just tough it out anymore,' she says. Better evidence ACOG's pain recommendations, released in May, were almost two years in the making. Between the uproar on social media and a greater availability of research showing the efficacy of local anesthetic during IUD placement and other in-office procedures, clinicians felt it appropriate to make a statement, says Kristin Riley, an OB-GYN and minimally invasive gynecologic surgeon at Penn State Health and one of the co-authors of the ACOG committee opinion on pain management. 'There's a lot more studies about this overall topic,' she says, 'and we wanted to pull it all together in one place where clinicians and potentially patients could see it all together and really give people options.' Both the ACOG and CDC guidelines are just that: recommendations for practitioners. They urge doctors to better understand what pain management options are available and supported by research, and to inform their patients of these options, risks, and benefits. CDC guidelines simply mention topical lidocaine 'might be useful for reducing patient pain.' ACOG goes a step further, saying pain management options 'should be discussed with and offered to all patients seeking in-office gynecologic procedures.' But whether doctors follow the guidelines is completely voluntary. Getting an IUD? Here's how to advocate for yourself. Learn about the different options for pain management. What might be best for you? Discuss your concerns, fears, and preferences with your doctor ahead of time. Don't wait until the day of your appointment to ask about anesthetics or anti-anxiety medication. Ask as many questions as you want until you feel comfortable. Make sure your doctor explains all of your options, which may include referring you to another clinic with more resources. Develop a plan. What medications will you take pre-appointment? What form of anesthetic will your provider use during the procedure? If your doctor isn't taking your concerns seriously or doesn't offer pain management that you want, find a new one. Ask if your doctor has a referral list. Or you could reach out to a hospital affiliated with a university. There might be a higher chance of finding a provider that offers additional pain management there, Jeanlus notes. You can also try searching for a provider who is fellowship trained in complex family planning , which means they have received additional training in abortion and contraceptive care. Pain is complex and subjective, which makes studying it difficult. Patients who have a history of sexual abuse and trauma or prior negative gynecological experiences can also experience greater pain during IUD placement. The number of different pain medicines — injected lidocaine, sprays and gel-based lidocaine anesthetics, over-the-counter painkillers — and the various combinations in which researchers use them in studies make it difficult to reach conclusive results, Riley says. Danielle Tsevat, an OB-GYN at the University of North Carolina at Chapel Hill who studies gynecological pain, says the most conclusive evidence for pain relief during IUD insertion points to a lidocaine paracervical block, especially among patients who have never given birth. During her medical residency a few years ago, Tsevat had a mentor who utilized the anesthetic during IUD placements. She'd seen it used for other procedures, like abortion or miscarriage evacuations, but the shot wasn't commonly used for IUD placements. Other studies have found topical lidocaine gel or creams to be effective at minimizing pain from the tenaculum (the device that holds the cervix in place during the procedure), Tsevat says. Other methods aren't as definitive. Ibuprofen hasn't been shown to help during the insertion, but can ease cramping afterward. Some clinicians will offer anti-anxiety medications since anxiety can put a patient at higher risk for pain, Tsevat says. 'They report improved outcomes after that too,' she says. 'That one also doesn't really have much evidence behind it yet…but it's something that we've seen offered.' Nitrous oxide, what Ana Ni used during her procedure, has also shown promise in studies, Espey says. Meanwhile, misoprostol, one of the pills used in medical abortions, was found by ACOG to cause more abdominal pain during IUD placement. No one option provides a panacea because there is no one source of pain during IUD placement, and the pain itself is relatively short-lived, lasting all but a few seconds. Additionally, a shot itself can be uncomfortable. Perhaps the paracervical block — administered after the speculum is inserted — would be more effective if clinicians waited a few minutes after giving the shot. 'But that also prolongs the procedure too,' Tsevat says. 'A lot of patients just say, 'I want to get this over with and done,' and not be in the speculum for that long.' Related How to get the sexual health care you deserve During her medical training, Fran Haydanek, a board-certified OB-GYN in Rochester, New York, says she was never taught about pain management during IUD placement. After hearing from her patients, and others' horror stories on social media, she began counseling patients on pain management options and offering paracervical blocks in 2021. She estimates 80 percent of her patients opt for the injection, and her practice eats the cost because insurance won't reimburse for the medication, she says. 'There's clear guidelines from medical organizations that are saying this [medication] should be offered,' Haydanek says. 'Doctors should be reimbursed for that.' However, across the board, few providers seem to be offering these medications. In a small recent study, only 28 percent of clinics offered lidocaine, including paracervical blocks, for pain management; 85 percent recommended ibuprofen. Another study that looked at pain medications for IUD placement within the Veterans Affairs Health Care System found that lidocaine was used only 0.2 percent of the time, while nonsteroidal anti-inflammatory drugs were used during 8 percent of IUD placements. Whose pain matters? Perhaps the most effective pain management option is IV sedation or general anesthesia, which ACOG notes requires additional research to determine risks, benefits, cost, and accessibility. It's an even more resource-intensive option. 'I would bet a million dollars that if we studied IV sedation and IUD pain that we would find that it significantly reduces pain,' Espey says. But clinics would need a pharmacy, nursing staff, advanced monitoring equipment, a recovery room — all of which could drive up costs for patients. The many years that passed before women's pain was taken seriously for IUD insertions, as well as the continued lack of research into the cost and accessibility of general anaesthesia, lead to a logical question: Whose pain does the medical establishment take seriously? Men have long been offered pain medication for below the belt treatments. Aside from medications, innovations to the devices used during IUD placement could make the procedure more comfortable. The tenaculum, for instance, the tool that grasps the cervix and is a major source of pain, dates back to the 1800s. A Swiss company, Aspivix, has developed an alternative tool, called Carevix, that uses suction to secure the cervix. The device is FDA-cleared in the US and is used in 21 health care centers worldwide, including at the Indiana University School of Medicine and Columbia University, according to the company's chief marketing officer, Ikram Guerd. Given the absence of a silver-bullet solution, the most consequential change when it comes to addressing pain is far more understated. 'The most important thing that we've done, ironically, is stressed how important it is to talk to your patient,' Espey says. Trauma-informed care — in which doctors take a patient's past into account — puts the patient at the center of treatment. When patients feel safe to discuss prior challenging IUD placements or past sexual assault, the provider can better individualize pain control. Giving survivors of sexual assault control over their medical appointments can help avoid retraumatizing them. But how much control, how much information, is appropriate to share with patients? Doctors walk the fine line between disclosing how much discomfort to expect from a procedure (and potentially causing increased anxiety) and downplaying their concerns. Research shows that the more people expect pain, the more painful the experience actually is. But to say IUD insertion is entirely pain-free might come across as gaslighting. 'Do you minimize pain to reduce that anticipatory anxiety at the expense of potentially looking like you're lying to your patient about something quite painful?' Espey says. For Espey, the sweet spot is offering patients plenty of options, from prescribing anti-anxiety medications prior to the procedure or rescheduling them at a clinic with more resources. 'Just giving patients options really helps people feel like they can make a decision,' she says. In a current study, Tsevat, the UNC OB-GYN, is surveying patients post-IUD placement. The feedback has been interesting, she says. Some patients report low pain, while others have compared the experience to razor blades in their uterus. Some were offered pain management, others were not. One participant, who was getting her IUD replaced after eight years, was delighted when her doctor explained the pain management options available. 'She said it was still painful,' Tsevat says, 'but she was just happy that she had gotten something and [it] helped her experience a little bit.' Most notably, patients hardly ever discussed their experience with their doctors afterward; it wasn't something they thought was appropriate to mention. When patients don't feel seen or taken seriously, it can have lasting impacts and may result in their avoiding future health care. While one aspect of women's pain in medicine is finally being discussed, others with painful periods or endometriosis may still feel dismissed. There's still room for more conversations, more transparency.
Scoop
09-07-2025
- Health
- Scoop
Cutting Red Tape To Improve Medicines Access
Associate Minister of Health Associate Health Minister David Seymour welcomes Pharmac's decision to improve access to asthma inhalers and long-acting contraceptives from 1 August 2025. 'For the first time, Pharmac has its own Minister. Last year I outlined in my letter of expectations that Pharmac should have appropriate processes for ensuring that people, along with their carers and family, can participate in and provide input into decision-making processes around medicines – this is committed to in the Act-National Coalition Agreement,' Mr Seymour says. 'Since then, the culture shift at Pharmac has been positive. It has moved towards a more adaptable and people-centered approach to funding medicines. My expectation is that this will continue.' Following a consultation period Pharmac has made decisions to: · Improve access to some strengths of budesonide with eformoterol inhalers. · Remove some of the barriers to Mirena and Jaydess intra-uterine devices (IUDs). 'From 1 August 2025 people will be able to get three-months supply of some budesonide with eformoterol inhalers all at once. Pharmac will also fund some budesonide with eformoterol inhalers on a Practitioners Supply Order (PSO), meaning doctors and nurses can keep some in their clinic for emergency use, teaching, and demonstrations,' Mr Seymour says. 'For the over 120,000 Kiwis using this type of inhaler the changes mean less visits to the pharmacy for resupply, better asthma management, and an extra option for supply in emergencies. 'Doctors and nurses will also be able to keep Mirena and Jaydess IUDs in their clinic and will be able to place them in the same appointment. Pharmac will fund these on a PSO to enable this. 'Current settings mean women need to get a prescription from their doctor or nurse, pick their IUD up from a pharmacy, and then bring it back to the clinic to be placed. Pharmac estimates over 21,000 women to benefit from these changes in just the first year of funding. 'People told Pharmac that these changes will make a real difference. They will make it easier for people with asthma to get the inhalers they need and improve access to long-acting contraceptives like Mirena and Jaydess. They make sense for people. 'People should have the opportunity to share what the impact of changes would be for them. 'The Government is doing its part. Last year we allocated Pharmac its largest ever budget of $6.294 billion over four years, and a $604 million uplift to give Pharmac the financial support it needs to carry out its functions - negotiating the best medical deals for New Zealanders.'
Scoop
09-07-2025
- Health
- Scoop
Pharmac To Improve Access To Asthma Inhalers And IUDs From 1 August 2025
Pharmac is making changes to improve access to some asthma inhalers and long-acting contraceptives from 1 August 2025. 'We're making it easier for people to get the medicines they need, when and where they need them,' says Pharmac's Acting Director Pharmaceuticals, Adrienne Martin. 'These changes will help over 140,000 New Zealanders in the first year alone.' From 1 August 2025, people using some strengths of budesonide with eformoterol inhalers will be able to receive three-months supply all at once, reducing the need for multiple pharmacy visits. Some budesonide with eformoterol inhalers will also be available on a Practitioners Supply Order (PSO). This means doctors and nurses will be able to keep it in their clinic for emergency use, teaching and demonstrations. They will also be able to give it to people if accessing a pharmacy isn't practical. 'These changes mean people can keep inhalers where they need them most – at home, work, or school – and learn how to use them correctly with support from their health care provider. 'People have told us these changes will make a real difference,' says Martin. 'That they support better asthma management and align with updated clinical guidelines.' Pharmac is also changing how IUDs and contraceptive implants are supplied. From Friday 1 August 2025, Mirena and Jaydess IUDs will be available on a Practitioners Supply Order (PSO), allowing doctors and nurses to provide them directly during appointments. Pharmac is also increasing the number of Jadelle contraceptive implants available on PSO, reducing the number of stock orders clinics need to make, helping to save time - especially those with high patient volumes. 'These changes will improve access for over 21,000 people in the first year and align IUD access with other long-acting contraceptives,' says Martin. 'People have told us that it will remove barriers, reduce delays, and allow for timelier and efficient care.'
Yahoo
17-06-2025
- Health
- Yahoo
Too many women 'grin and bear it' when getting an IUD. I helped write new pain management guidelines to change that.
Millions of American women have had an IUD (a tiny T-shaped contraceptive device) inserted into their uterus. Many of them likely walked into their doctor's office with a bit of anxiety, not knowing what exactly the procedure would feel like: Would it be just a pinch or would it be incredibly painful? (There is no shortage of viral horror stories.) Also, would your doctor take your pain seriously? Up until recently, there wasn't a standard of care for IUD pain management. Women are often told to pop over-the-counter pain relievers before coming in for the procedure, even though they don't always control the pain. Any pain relief beyond that has been up to the woman's doctor or hospital, and depended on what options they had available. That's changing thanks to new guidelines on pain management for IUD placement issued by the American College of Obstetricians and Gynecologists last month, which follows the Centers for Disease Control and Prevention's updated guidelines in 2024. ACOG called out the 'urgent need' for doctors to acknowledge and treat patient pain and added that patients should 'have more autonomy over pain control options for their health care.' Genevieve Hofmann is a nurse practitioner who coauthored the new ACOG guidelines. In this interview with Yahoo Life's Rachel Grumman Bender, Hofmann explains why IUDs can be painful for some, why any fears shouldn't scare people off from getting this highly effective contraceptive and how these pain management guidelines are an important step in the right direction. IUDs are really one of the most effective birth control methods out there. We call them LARCs, or long-acting reversible contraceptives. Hormonal IUDs are over 99% effective at preventing pregnancy, and nonhormonal IUDs are equally effective. What's nice about hormonal IUDs is that we also use them to manage a lot of gynecologic conditions, such as heavy menstrual bleeding and painful periods. However, patients are coming to us and saying, 'I do not want to have this horrible experience with getting an IUD. How can we manage this?' I've been in practice for a little over 20 years and [when I started out], we would tell people to take some ibuprofen beforehand and try to do some distraction techniques while we're putting it in. There's a lot of grin and bear it in gynecology and in women's health. It's really challenging for us as providers to give people an accurate assessment of what they're going to experience with IUD placement. I've seen people who have had IUDs placed where it was like, That was not terrible, and then all the way to That was the worst pain that I've ever had in my entire life and I had a natural childbirth. There's a very large range of how people experience pain as well as anxiety. So I think as a provider, the guidelines really put the onus on us to help people anticipate the pain and have that conversation about what they can expect. Sometimes they won't know until they're in the throes of it, and so it's about being prepared with some pain options in anticipation that it could be a really painful and uncomfortable procedure for them. IUD insertion requires the placement of a speculum, which sort of holds open the vagina in a way that's not normal. So having a speculum in the vagina is not really comfortable. Then there's the procedure itself. A lot of times, we have to manipulate the position of the uterus, and we do that sometimes by putting a clamp on the cervix. It's this sort of sharp instrument that takes a little 'bite' out of the cervix to hold it in place. So that tenaculum placement can be very painful. IUDs are placed in the uterus, which is a muscular organ. To do that, you have to go through the cervix, which is the opening to the uterus. The cervix can be very tight, especially if someone has not had a vaginal birth. And so getting through that cervical opening can be really painful for some. The uterine body itself has some nerves, so something going into the uterus is just crampy and painful — it's a very deep, visceral pain that is hard to explain to people if they've never had any kind of instrumentation in the uterus before. We also have a really large nerve called the vagus nerve that goes through the cervix; so people can also have this kind of vasovagal-type response when we manipulate the cervix, which makes people feel really terrible too. It makes you feel like you're going to pass out and you get hot and you feel like you're going to throw up. And sometimes people feel like they have to poop and that is a really uncomfortable feeling as well. So there are many different aspects that cause pain. But not everyone's going to feel that way. As a provider, I don't want to scare people out of getting this really effective birth control method or way to manage heavy menstrual bleeding. So [it's about] finding that balance between giving people the information they need so they can feel, OK, I'm going into this with my eyes open, but also not terrifying and scaring people away that they say, Yeah, I'm never ever gonna do that. I always say it's like going to a restaurant. You're going to tell 25 people when you have a terrible restaurant experience. But if you have a great restaurant experience or a mediocre restaurant experience, you don't really tell anybody. So, I think there's a lot of people who do great with their IUD insertion and really manage it well, but they're not as vocal about it as somebody who's had a really awful experience. What the evidence for the guidelines really demonstrated was that using some sort of topical lidocaine, which is a numbing agent, on the cervix was beneficial compared to a placebo or compared to other distracting techniques or ibuprofen and other pain medications. Many of us have been offering better pain management options in the last several years compared to maybe what was happening 10 or 25 years ago. We know from the evidence that anxiety tends to worsen pain. I think providers will give anxiolytics [medications to treat anxiety], so telling patients to take a little bit of Xanax or some Ativan to help with the anxiety. And I do think people are using localized lidocaine, whether that's in a gel or a spray or putting in an injectable lidocaine through a paracervical (nerve) block. I think that is becoming much more typical. There's also IV sedation. The other big thing that comes out of these guidelines is that we as providers owe it to our patients to have a discussion about some options that are available to them. So, it's really having the conversation, guiding patients to make the best decisions for themselves and then hopefully being able to find some interventions that you can do in your clinic safely and effectively to give people some options. I hope that these guidelines get the conversation started in a way that we're meeting people where their needs are ... that they feel heard and can access things like IUDs that are really highly effective ... and that we believe patients when they say, 'This was really painful.' Or, 'I had a really terrible experience last time I did this.' [We should] trust them to know their bodies and say, 'OK, here are the things we're going to do to hopefully try to improve that experience this time.' So I hope that's what comes out of it. Patients need to feel like they're in a space where they can advocate for themselves and be heard. This interview has been edited for length and clarity.
