IUD insertions can be extremely painful, and in Yukon there's no standard to deal with it

Brenna Symanski vividly remembers the pain of having her intrauterine device (IUD) changed. 

"For a split second, it felt like every cell in my body was on fire," she recalled.

An IUD insertion is a procedure involving a tiny T-shaped device being inserted through the vagina and cervix and into the uterus to provide years of highly effective contraception.

But the experience of the procedure, and how painful it is, can vary widely between women — highlighting the fact that there is no standard approach to pain management when it comes to IUD insertions. 

Symanski grew up in the Yukon and lives in Whitehorse. The first time she had an IUD inserted she was 16. She says that time the experience was fine. She was given lidocaine, a topical gel anesthesia used to numb the uterus. She assumed getting the IUD changed would be a similar experience. It wasn't. 

"I screamed so loud," recalled Symanski. 

She says the nurse did not seem sympathetic, and told her "to imagine how much worse having a baby would be."

"And meanwhile, I'm trying not to pass out," Symanski said. 

After the procedure, she says she couldn't walk on her own and her partner had to help her to her car.

She feels that there was a dismissive approach to her pain during the procedure.

"It's just really sad that women's pain is just written off… I felt like I was annoying the nurses, by being in pain." 

Megan Manion, also in Whitehorse, says she was nervous about getting her IUD because she'd had painful experiences in the past. She asked at the clinic if there was anything they could give her ahead of time for the pain and says the nurse told her it would only be a little pinch. She says that was not her experience. 

"Like, I have a pretty high pain tolerance, but I was in tears I was in so much pain," said Manion. 

She says the female doctor told her not to be such a baby about it.

Experiences can vary based on provider

There are several places in Whitehorse that provide IUD insertions, and experiences can vary depending where people go. 

Only one place — the Yukon Sexual Health Clinic — offers Penthrox, an inhaled anesthetic that patients breath in and out during insertion. Michelle McCulloch, a nurse practitioner who helps run the clinic, says Penthrox "essentially blocks the sensation of pain."

Penthrox has only been available at the clinic since November, and patients who opt to have it are charged around $100. The clinic has been donated some funds to cover the cost for people who can't afford it.

CBC News spoke to several other women in Yukon who had IUDs inserted at other clinics. They said they were offered lidocaine, or were told to take ibuprofen or acetaminophen before or after. Some felt their pain and anxiety were not taken seriously. 

Justine Fair is a Yukon-based physician who specializes in women's health. She was instrumental in bringing Penthrox to Whitehorse. 

"I've thought for a long time there's no other procedure that we do as family physicians that has this amount of pain without putting people to sleep," said Fair.

"I've been inserting IUDs for more than a decade, and I know that it causes pain, and it's always been frustrating that we didn't have anything better."

Fair argues that women's experience of pain is "probably underappreciated and/or underreported."  

At the Yukon Sexual Health Clinic, patients seeking an IUD have a consultation so the health care provider can understand their past experiences with IUD insertions. 

"Whether or not they've had pregnancies and deliveries, past traumas, anxiety levels, and whether or not they've been sexually active," said McCulloch. 

Those conversations help determine what pain or anxiety medications are recommended for the patient. In rare cases, women are offered the option of being sedated at the hospital.

Alethea Stobbe, is the territory's director of integrated health which oversees the Whitehorse walk-in clinic, the Dawson City Medical Clinic, and the Yukon midwifery program. She says there is no policy dictating a pain-management regiment for IUD insertions, but says it's standard to consult with the patient before a procedure about the options. She cites ibuprofen, acetaminophen, and lidocaine as options.

"I think the majority of us are working to provide evidence-based care. But I also know there is some variation depending on where you're accessing," said Stobbe. 

Research indicates mixed results

According to Fair, part of the issue is that there is no proven best option for managing women's pain. She says some studies indicate success with certain medications, while others recommend alternatives.

"In my experience, different physicians use what they either research themselves or what they have found works the best for the patient population that they're serving," said Fair. 

According to the Society of Obstetricians and Gynaecologists of Canada, the research into what works best is so far inconclusive. A 2022 statement on the society's website lists medication recommendations for IUD procedures, including lidocaine, ketoprofen, ketorolac, naproxen (Aleve), and tramadol. The society also says Penthrox, or methoxyflurane, may be an effective option though there is no data specifically on using it during IUD insertions.

There is also no national standard for pain management with IUDs. Health Canada says provinces and territories are better suited to mandate any such guidelines.

The Society of Obstetricians and Gynaecologists of Canada's statement recommends that health-care provider and patient should work together to develop an appropriate pain management plan. 

That can leave people who are looking to access an IUD in the somewhat vulnerable position of having to advocate for themselves. 

McCulloch says it's important for people to know what their options are.

"If they are talking to a provider and they don't feel like they're being offered pain control, or management of anxiety, they should advocate for themselves to look for other options," said McCulloch.

McCulloch also says she's been getting good feedback recently from patients at the Yukon Sexual Health Clinic, who are reporting "the best experience they've had with a painful procedure."

"[That's] because of the knowledge they have and the medications that are offered," she said.