There’s been a large anti-OB/Gyn social media presence for a while now. If you spend any time on Instagram or TikTok looking at pregnancy or reproductive health information, it will find you quickly. As an OB/Gyn, I, of course, become somewhat defensive when viewing this content, but I also find it very important not to ignore it so I can best understand what patients are seeing and the kinds of viewpoints they have. My perceptions as a physician are shaped largely by my training and the textbook information and guidelines we follow, and that doesn’t always necessarily match up with reality.
A big topic that often arises is pain – stories of pain the was not managed appropriately, that was ignored, or that people were gaslit into thinking wasn’t real. Pain is obviously a difficult topic because no one but the person experiencing it truly knows its severity. We can use all the frowny to smiley face or number rating systems we want, but we don’t have the discrete objective measures that we have for other vital signs. We simply have to believe someone, and that’s surprisingly hard for a lot of people to do.
Women’s pain has historically been underestimated, especially for Black women. Medical training teaches that certain procedures simply don’t cause much or any pain, or that women handle the pain well, regardless of what patients themselves express as their true experiences. Physicians and other care providers then end up with pre-conceived notions of what *should* happen, worsening the experience for some patients and making it outright dangerous for others.
I have my own minor personal experience with this. There’s a procedure called an HSG during which dye is put into the uterus while we watch with X-ray for evaluation of the uterine cavity and patency of fallopian tubes. I always told patients that this was crampy, but I didn’t understand just how crampy it was until I went through it myself. Although the pain was brief, it was intense. Now my typical counseling spiel includes, “I almost kicked the doctor in the face when it was done to me.”
I recently listened to the podcast “The Retrievals”, which centers around how women’s pain is perceived and managed in the context of a scandal at an IVF clinic. I highly recommend taking a listen yourself – with the warning that you are sure to walk away from it with new or heightened anger toward the world of medicine. It was shocking to hear how many red flags were blown past throughout the story and how people after the fact communicated to patients that despite their descriptions of severe, traumatic, life-changing pain that *no harm was done* to them or that they should simply not care about it because they ended up with a baby in the end.
A few days ago I shared the image below from Reductress that had the headline, “’You may feel a little pinch,’ says gynecologist revving industrial chainsaw.” I shared that not to minimize anyone’s pain experiences but to highlight that some of us are simply way off base with the expectations we give to patients. If we can’t paint a realistic picture, it can actually worsen pain, and psychologically it makes patients feel like they must be doing or feeling something wrong to not meet the expectations put forth. Often, then, they don’t speak up, and feel a need to simply “grin and bear it”.
Because everyone has such different experiences with pain, however, there’s not a one-size-fits-all answer to managing pain appropriately. If we scheduled every single procedure we do (like IUD insertions or biopsies of the lining of the uterus, for instance) in a setting where sedation or full anesthesia could be provided, that would be overkill for many, and a huge barrier to care for others.
Personally, I’ve been trying to do a more thorough job discussing just how painful a procedure may or may not be, using each patient’s unique history and circumstances to try to make the plan that makes most sense for them, and offering additional pain management strategies broadly. I often say something along the lines of, “I don’t want to torture you, and there’s no reason for you to suffer.” I’m not perfect, and as much as I hate to say it, I’m sure there are patients who have walked away from an exam or procedure with me feeling that their pain was not appropriately addressed or managed. I strive to always be better.
For any patient, my best recommendation would be to be as honest as possible with your care providers about previous experiences with mental and physical pain (“I passed out from pain the last time I had this done”, “I didn’t need anything beyond ibuprofen and Tylenol after my C-section”, “pelvic exams are really traumatic for me and I avoid seeing the doctor because of that”) and advocate for yourself as much as possible. If you envision a particular pain management plan and your provider can’t offer that for you, explore why and if they’re open to a change. Speak up if something doesn’t feel right, or bring someone along who can help do that for you – we can’t know what you’re experiencing if you don’t tell us. And if a provider doesn't listen to your truth, it's time to walk away and find someone new.
Women have too often suffered needlessly with pain, and I want everyone to know that they deserve better than that.