Health workers at Planned Parenthood’s Fairview Heights clinic this week began offering patients sedation before they undergo procedures to insert intrauterine devices, which are placed in the uterus to prevent pregnancy.
The devices have been used for decades, but many patients describe waves of pain when a nurse or doctor inserts them. Patients have long endured the uncomfortable procedure, but providers are now considering offering women the option of sedation to make the insertion less unpleasant.
Clinic officials say they decided to offer optional sedation after some patients said they were scared to use the birth control method because they anticipated pain.
“Folks really want this super-effective, great form of birth control but also are having such negative experiences with its insertion," said Colleen McNicholas, chief medical officer of Planned Parenthood of the St. Louis Region and Southwest Missouri. “At the end of the day, we want people to feel empowered to choose the method that's going to work the best for them. But we also feel like they don't need to be traumatized in the process of getting that method.”
Starting this week, the clinic will offer patients the option to undergo intravenous sedation for IUD insertion and removal, as well as for uterine biopsies and other procedures.
McNicholas believes the clinic is the first in the St. Louis region to offer sedation for IUD insertion.
Intrauterine devices are a form of birth control shaped like a capital T. They’re made of metal or plastic, and some emit hormones that prevent pregnancy. They’re about as effective as tubal ligation in preventing pregnancy, according to the Mayo Clinic, and many people choose an IUD because they don’t want to worry about taking daily pills.
According to the federal Centers for Disease Control and Prevention, about 20% of women who have had sex have used an IUD.
But many patients, both in clinic settings and on TikTok and other social media platforms, have said it's painful to have one inserted, McNicholas said.
Patients most often experience pain when the IUD is inserted through the cervix with a straw-like tool, she said. Once inserted, the device isn’t usually embedded in any tissue — it typically sits suspended in the uterus, an organ that’s shaped like an upside-down pear.
McNicholas said not all people will opt for sedation, but the organization wanted to give patients multiple options.
“You know, I think that for most providers, offering sedation has been historically an option that is thought of only if and only when a patient can't tolerate the initial procedure,” McNicholas said. “So rather than making patients come and endure the process and then decide they can't tolerate it, we were sort of flipping the script and saying, ‘You know your body best.’”
IUD insertions are often done at primary care offices or clinics, said Michael Belmonte, an OB-GYN and fellow at the American College of Obstetricians and Gynecologists who serves as an in-house expert on family planning.
Belmonte said providers are better serving patients by giving them options to deal with the sometimes-painful procedure, but many providers don’t have the infrastructure or staffing to provide full sedation.
“Because something like full IV sedation … or general anesthesia does require a lot of time, money and expertise, it's not going to be available in all settings,” Belmonte said. “There are specialized clinics across the country, particularly family planning clinics, that do offer those sorts of things. But I would say that the vast majority of clinics don't have the space requirements or the personnel availability to actually make that happen.”
However, Belmonte said that since pain is a subjective experience, it makes sense to offer different safe options for patients to feel comfortable. Not all patients who get an IUD experience a large amount of pain, he said.
“For certain specific patients, it's an excellent option,” he said. “And having those available in certain areas can help patients experience IUD insertion with a lot less pain and discomfort.”
The American College of Obstetrics and Gynecology doesn’t provide any specific guidance on what should be done for an IUD insertion, he said. Depending on the patient, the provider and the practice, a patient could receive numbing with a gel or injection, oral medications to relieve anxiety or even general anesthesia in an operating room.
Because Planned Parenthood already had the ability to sedate patients, offering it for IUD insertion didn’t require many changes, Planned Parenthood officials said.
Patients should discuss options with their doctor before the procedure, Belmonte said. A good provider will be able to walk patients through what a clinic can provide.
It’s also wise to check if insurance providers will cover some of the cost of sedation or anesthesia, since some may not consider it necessary for the procedure, he said.
