With the rapidly changing landscape around women’s reproductive health in the United States, securing safe and effective birth control has become an imperative for American women. There are a handful of options available to them, including, but not limited to, birth control pills, hormonal patches, and femidoms. However, intra-uterine devices (IUDs) are thought to be the most effective long-term birth control option, as they last for three to five years. IUDs can only be inserted or removed by a healthcare practitioner. The IUD insertion procedure causes moderate to severe discomfort and can be especially painful for women who suffer from endometriosis. Even though an IUD insertion is an invasive procedure, there are no standard pain reduction measures in place. The fear of procedural pain could discourage women from using this birth control method, which would prevent them from benefitting from this otherwise safe birth control method.

Currently, the most common form of pain relief offered to women undergoing IUD insertions is ibuprofen, which is administered pre-procedure. However, another approach that has begun to gain traction is the use of parenthetical blocks, which are nerve blocks used during obstetric and gynecologic procedures. In this procedure, the analgesic lidocaine is administered locally, as an alternative to full anesthesia. However, some clinicians fail to raise the use of parenthetical blocks as an option to reduce pain of IUD insertion. Different women experience pain differently, and this may be due to cultural differences, personal experiences, or prior gynecologic conditions, such as endometriosis. As a result, the pain can often be downplayed by clinicians, exacerbating patients’ fear of pain and reducing their trust in their physician.  Complications can arise if a patient is not informed about the level of pain to expect during the procedure, especially if the patient moves during the insertion. If the patient opts for the use of a parenthetical block during their procedure, they must wait for at least seven minutes for it to be effective. The added time can help to reduce a patient’s anxiety levels, making them less likely to move around during the insertion. While other pain management procedures for IUD insertion are yet to be explored, the use of parenthetical blocks like lidocaine suggests that it is promising.

Pain management in birth control has large social implications in the twenty-first century. Research has shown that Black, Hispanic, and Asian communities face more unplanned pregnancies because they either do not use contraceptives at all, or use less effective methods. A 2008 study out of California found that women with public insurance or no insurance were unlikely to use high-efficacy birth control methods like IUDs or birth control pills. The study pointed to another problem which does not appear in statistics: provider-level knowledge about contraception. When comparing anticipated pain on a visual analog scale against different racial groups, African Americans had a median anticipated pain score of 68 compared to White participants, who had a median score of 51. The study suggested that anxiety surrounding the procedure could be reduced if the clinician advocating for and performing the procedure was able to assure patients and speak to its benefits.

With modern medical advances, it is concerning that a standard pain management protocol does not exist across the country for IUD insertion. While parenthetical blocks are a step in the right direction, most studies suggest that counseling in local clinics will help reduce the barriers to IUD use. A good way to do so would be to incorporate conversations about different forms of birth control in school curriculums at the high school level. Furthermore, making patients aware of all their options regarding pain management should be mandatory for clinicians. Physicians should also clearly communicate the extent of pain a patient should anticipate during the procedure. The hope is that like for other gynecological procedures, a standard protocol for IUD insertion will be implemented soon.