Scandal of the women left in screaming agony by ‘painless’ procedures

Lucy Cohen is no stranger to pain. As a former professional powerlifter, who represented Wales in international competitions, she knows how it feels when the human body is pushed to its absolute limits.

But nothing, says the 38-year-old from Swansea, prepared her for the excruciating agony she experienced during a recent medical procedure undergone by thousands of women every year in the UK.

This was to have a contraceptive intrauterine device (IUD) — commonly known as the coil — placed in her womb. 

It involves inserting the T-shaped implant into the womb via the cervix, the narrow opening at the base of the womb, using a speculum to hold it open.

The coil (so-called because original versions were coil shaped) is routinely fitted in GP surgeries and sexual health clinics across the country, and has become increasingly popular in recent years as it can provide effective contraception for up to ten years before it needs replacing.

What’s more, according to the NHS website, the process of implanting it gives women little or no major cause for concern. In gently reassuring terms, it states: ‘It can be uncomfortable when the IUD is put in — but you can take painkillers after, if you need to.’

Yet this description contrasts sharply with the experiences of women who, like Lucy, say it left them screaming in agony, traumatised and feeling violated.

‘It was utterly excruciating,’ says Lucy, who is married to Adam, 36, an engineer, and runs her own digital accounting firm. ‘The whole thing took about 25 minutes, and for much of that I was screaming and shouting in pain. It was so bad I almost fainted.

‘At one point, my GP asked me if I wanted her to stop but I was just desperate to get it over and done with and couldn’t face going through it again. By the end, I was in a state of shock.’

Lucy’s story echoes those of BBC TV presenter Naga Munchetty and author Caitlin Moran, who last month shared their own grim experiences.

Naga said she screamed so loudly her husband, who was waiting in a nearby corridor, tried to find which room she was in so he could halt proceedings.

‘I fainted twice and felt violated, weak and angry,’ she said. Like Lucy, she had been told to take a couple of paracetamol or ibuprofen before her appointment.

Their stories struck a chord with many women who responded on social media. One wrote: ‘I was only offered a local anaesthetic injection [known as a paracervical block] after I’d screamed the place down. I thought: ‘Why didn’t you just do that in the first place?’

Nor is this the only routine gynaecological procedure that women are told is virtually painless yet leaves thousands traumatised.

Good Health has revealed previously how hysteroscopies — checks that inspect the womb for causes of heavy or abnormal menstrual bleeding — are being performed without women being offered adequate pain relief.

Doctors tell women that the 30-minute procedure, performed in an outpatient clinic and undergone by more than 10,000 women a year on the NHS, will be no worse than a smear test and that, if they’re worried about experiencing pain, they should take paracetamol or ibuprofen beforehand.

This is despite guidance from the Royal College of Obstetricians and Gynaecologists that a general anaesthetic or sedation should be offered to at-risk women with a ‘closed’ or tight cervix, such as those who are child-free or post-menopausal.

The Campaign Against Painful Hysteroscopy says it knows of at least 100 women who’ve been diagnosed with post-traumatic stress disorder as a direct result of painful hysteroscopies.

Women meant to grin and bear it

Some women feel they’re the victims of an outdated notion that, as they already endure the discomfort of periods and childbirth, they are expected to put up with the pain of gynaecological examinations or procedures. But men are treated differently.

One woman tweeted in response to Naga’s story: ‘When my husband went for a vasectomy he was offered a general anaesthetic — yet we don’t give even local anaesthetic to women. There’s a perception that women have to grin and bear it and we are all hysterical.’

In a study published in the Journal of Pain in April, participants were asked to view videos of men and women with identical shoulder injuries and who had reported similar pain scores.

Asked to rate how much pain they thought patients were in, judged by their facial and vocal expressions, women’s pain was consistently judged to be less severe — by both sexes — even though they were in just as much agony.

Researcher Elizabeth Losin, a professor of psychology at Miami University, said one reason may be that women are stereotypically thought to be more expressive when it comes to pain, even though there is little evidence for this.

‘The tendency therefore is to discount women’s pain behaviours as overly expressive, while perceiving men to be stoic,’ she says. ‘So when a man makes an intense facial expression, you think, ‘Oh my, he must be dying’.’

As a result she says, studies show women are often prescribed less pain-relieving treatment, and wait longer to get it, than men.

‘Scissors’ pierce through the tissue

An estimated 45,000 women a year in the UK are fitted with a coil, widely regarded as one of the most effective forms of female contraception, second only to surgical sterilisation. The devices, made of metal or plastic, come in two forms. Hormone-based IUDs gradually release progestin to thicken mucus around the entrance to the womb, stopping sperm entering.

Non-hormonal IUDs are made with copper, which acts as a spermicide.

To insert into the womb, a doctor or specially trained nurse first inserts a speculum to gain access to the cervix.

The thin lining of the cervix is then pierced using a tenaculum, an instrument that looks like a pair of scissors with a tiny hook on the end of each prong. This ‘anchors’ the tissue, securing the cervix in place while other tools are manoeuvred into the womb.

A probe called a sound (which resembles the dipstick used to check car engine oil levels) is then pushed up into the uterus to measure its length and angle, so the coil can be manoeuvred into position.

Lucy, who’d been taking the Pill, was advised to have a copper IUD in April after suddenly developing painful blood clots in her right leg.

As the Pill can increase clot risk, doctors recommended she stop taking it and have an IUD while they carried out investigations.

‘When I looked up the procedure online, it didn’t sound comfortable,’ says Lucy, who has no children. ‘So I asked my GP if I could have a stronger painkiller, such as codeine, which I’ve taken before. But my GP assured me that a couple of paracetamol an hour or so beforehand was all I needed.’

But soon after the procedure began, Lucy was in agony.

‘The speculum was uncomfortable but not painful,’ she says. ‘It was when the GP inserted the sound device that the pain really hit. I was screaming and shouting in pain and became faint.

‘It was so awful — it’s hard to describe — but it felt like my body was being invaded and violated.

‘At the end, I was really tearful. The GP was quite matter-of-fact and just said to take over-the-counter painkillers if I suffered any cramping over the next few days.

‘By the next morning, when the pain had finally subsided, the shock turned to anger that at no point had anybody warned me this procedure could be so traumatic. I had only ever heard it described as a mild discomfort.’

Lucy set up an online petition for better pain relief for women having an IUD inserted and 24,000 have already signed it.

The initial piercing of the cervix is one of the most common sources of pain. Doctors are taught to minimise this either by closing the scissors-like tenaculum on the cervix tissue very slowly, or by getting the patient to cough at the exact moment the cervix wall is punctured — as a form of distraction from any pain.

Research suggests both techniques can dampen down the pain, yet clearly these do not work for many. One important factor is that women who’ve not given birth vaginally appear more likely to experience pain. This is simply because their cervix has never been significantly dilated before. 

Pain relief is something of a postcode lottery 

The Faculty of Sexual and Reproductive Healthcare, which represents UK doctors and nurses performing such procedures, says it’s well known that women who’ve never given birth may need stronger pain relief. This may also apply to women with painful periods, who are prone to heavy uterine cramps during the procedure.

It says there are a variety of pain relief options available to doctors. These include local anaesthetic gels or sprays, which can be applied to the cervix. A paracervical block, where local anaesthetic is injected into the cervix itself, is also very effective.

But the organisation admits access to proper pain relief varies. Lucy insists she was not offered any of these options, despite falling into the high-risk category.

Mary-Ann Lumsden, a professor of medical education and gynaecology at the University of Glasgow and former senior vice-president of the Royal College of Obstetricians and Gynaecologists, says: ‘GPs do not routinely assess patients for risk factors, such as whether they had a caesarean. There is a tendency to say there might be a bit of discomfort when, actually, for many women, it’s going to be really quite bad. It seems to be a bit of a postcode lottery.’ 

For example, under a recent Freedom of Information request, the Campaign Against Painful Hysteroscopy has established that patients attending the Royal Free Hospital in Hampstead, North London, are routinely given the option of a general anaesthetic from the outset, while those at Barnet Hospital are offered it only if they cannot bear the pain the first time it is performed.

The two hospitals are not only just five miles apart but they’re run by the same body — the Royal Free London NHS Foundation Trust.

For women undergoing hysteroscopy, the Campaign Against Painful Hysteroscopy says some leading experts appear to be actively resisting the wider use of pain control for women.

It points to a keynote lecture given earlier this year during an online seminar run by the British Society of Gynaecological Endoscopy (which represents doctors involved in performing hysteroscopies).

The prominent Italian gynaecologist Attilio di Spiezio Sardo, who’d been asked to address UK doctors on best practice, said it was vital women were kept awake so doctors could monitor progress by the level of suffering. ‘The pain of the lady is your friend — not your enemy,’ he said.

Dr Anne Connolly, of the Royal College of GPs, said ‘We understand some women have had difficult exper-iences … but patients should be reassured that these instances are exceptionally rare.’

It was so awful I had to give up halfway through

By Nadine Dorries, Minister of State for Mental Health , Suicide Prevention and Patient Safety

The name Naga Munchetty is one many of us know, so when I read the broadcaster’s account of the extreme pain she experienced having a coil (an intra-uterine device or IUD) fitted, I took note.

She spoke of having fainted twice — and her screams were so loud, she said, that her husband, hearing them from the waiting room, came searching for her.

Other high-profile women have recounted similar stories.

I had a flashback of my own vivid experience as I tried to have an IUD fitted six weeks after the birth of my first chid.

Unlike Naga, I did not have a small cervix and had recently given birth to a baby the size of a large bag of spuds. Having a coil fitted would surely be a breeze by comparison, I thought.

I willingly lay on that couch, seriously deluded, until the procedure began and the reality kicked in.

At the best of times (are there any, in these circumstances?) the process of someone you may never have met before asking you to remove your knickers, fixing your feet into stirrups, spreading your legs wide so you cannot escape (exposing your most private parts to the elements), then inserting a metal speculum the size of a BBQ steak-flipper into your vagina (ratcheting the device open against muscles tense and constricted with fear) is degrading. And that is the easy part.

To hear from those with more recent experience, I spoke to several women who had endured the process and highlighted this alone as a source of real distress. ‘It makes you feel vulnerable and violated — like you can’t run even if you wanted to,’ said one.

The second part is where the pain kicks in. The doctor or nurse will attach metal clamps to the cervix with one hand to dilate it, tilting it forward while, with the other hand, they insert the IUD.

At this point, the walls of the uterus clamp down, just as they do in labour because the neck of the cervix has been forced open.

The pain has been described as being of the same intensity as a fracture — only if you had a fracture, someone would give you Entonox (gas and air) or morphine.

But if you have a steak-flipper in your vagina and metal clamps on your cervix, you are offered the hand of a poor nurse to squeeze until the knuckles crack.

I, too, screamed — and although I did not faint, I was in so much distress that I abandoned the process halfway through.

On feet that felt as if they were made of fresh dough, grasping door handles, chair-backs and even a nurse’s apron, I staggered out of the clinic, minus birth control.

The Royal College of Gynaecologists and Obstetricians, in response to women’s accounts of their IUD experiences, acknowledged the concerns around pain and indignity being raised.

Dr Diana Mansour, vice president of the Faculty of Sexual and Reproductive Healthcare, commented that while ‘for many women the pain associated with an IUD fitting is similar to experiencing period cramps and no pain relief is required . . . for some, particularly those who have had no children or delivered their children by Caesarean section, additional pain relief may be needed’.

Sadly, not one of the women I spoke to could tell me their pain had been anything but severe. And having already had a child certainly did not reduce my pain.

I was stunned to discover that for women wanting an IUD fitted, almost nothing has changed in the 36 years since my experience. Is this because we women go through the pain of childbirth, so the belief that pain is our lot has crept into society’s subconscious?

Whether it is undergoing a diagnostic hysteroscopy without pain relief, suffering for years with endometriosis before receiving a diagnosis, having our breasts squashed between metal plates for a mammogram or smears that nick, at all stages of adult life, women suffer.

How do we solve this? It is clear that in government we must do better to listen to women’s voices — and recently, in response to a call for evidence, 112,000 women told us about their experiences of a health service designed by men, for men, where male is the default.

IUDs are one of the most effective contraceptive methods available, with not even one woman in 100 having an unplanned pregnancy (compared with nine out of 100 who take the Pill).

We must support women to access IUDs if that is their choice. And the best way to do that is to find a way to make the procedure pain-free.

This really isn’t brain surgery. Thousands of pain-free, minimally invasive procedures take place across our NHS every day. If a dentist can offer you twilight sedation for a filling, it is beyond time to look at how we deliver services to women that include effective pain relief.

Change does happen. Despite the listed contraindications and side-effects, it didn’t take very long before prescription-only Viagra was made available over-the-counter for men to buy — yet perimenopausal women have to fight to be prescribed the correct HRT.

I’m sure the nurse cradling crushed knuckles would rather be trained in operating the flow valve of an Entonox canister. It is time for change.