An Intrauterine Device and the Uphill Battle to Understand Female Pain

By Bailey Hosfelt

Illustration: Nicola Hamilton

Illustration: Nicola Hamilton

I got an IUD last month.

The decision to do so was in the works for the better part of the spring and summer, and after many arduous calls to my insurance hold music, I got the formal go ahead.

As luck would have it, I was already on my cycle and my gynecologist had a last-minute opening and a ParaGuard with my name on it.

The appointment was soon after my 21st birthday, and I figured there was no better gift to give myself than a form of birth control whose lifeline is equal to three presidential election cycles.

With hormonal birth control pills having exacerbated my depression and anxiety to a point that rendered my behavior unrecognizable, I had decided that enough was enough.

The “ultra-low-dose” options weren’t living up to their potential advocated by doctors, and I no longer wanted to put one pill in my body only to take two others in a feeble attempt to stabilize its unsavory side effects.

A friend of mine who also experienced the exhausting intersection between contraceptive care and diminished mental health recommended I opt for the copper IUD. My gynecologist echoed the same concisely convincing sentiment (“no hormones”) and, after doing a cost-benefit analysis of my own body, I was on board.

Weeks later, I’m still on board. But in the short amount of time that has followed, I have become personally attuned to the distinct, often dismissed, ways in which females must experience and endure pain.

Broaching this topic is tricky, mostly because it’s inherently multifaceted and dependent upon the individual.

It reminds me of a particularly challenging college course where the subject matter is filled with contradictions and dead ends, nuance and non-answers.

Sure, you reach the end of the semester more knowledgeable than when you first started, but you also become hyper aware that, more times than not, opening one can of worms leads to a trail of ten more.

Constructive confusion is what past professors have coined this feeling, and, lately, I’ve found myself lending the term to the conversation surrounding female pain: the exacerbated outcries followed by periods of silence, the one size fits all standards offered to treat idiosyncratic symptoms.

Although my thoughts on the subject didn’t surface until I was personally doubled over in discomfort thanks to 32 millimeters of copper taking up shop in my uterus, I can corroborate them with countless stories of other women’s experiences, IRL or otherwise.

Through think pieces and academic journals, op-eds and medical research, the evidence is there and it’s uncomfortably apparent: as a society, we underestimate female pain.

According to “The Girl Who Cried Pain,” a study in the Journal of Law, Medicine & Ethics that analyzed gender-based bias in the treatment of pain, “women are more likely to be treated less aggressively in their initial encounters with the health-care system until they ‘prove that they are as sick as male patients.’”

Within the medical community, this phenomenon is known as “Yentl Syndrome.” In other words, until women can prove that they are in as much pain as men in similar situations, they will not receive the same treatment.

This means longer wait times for women in emergency rooms (even more so for minority populations) and a more difficult time convincing doctors of the legitimate nature of their pain.

Some diagnoses will have no male comparison, such as endometriosis or polycystic ovary syndrome, and it’s unacceptable to think that doctors will waste time trying to find a patriarchal link that doesn’t exist.  

When it comes to chronic pain, “The Girl Who Cried Pain” shows that men are more likely to receive a referral to specialty pain clinics from a general practitioner whereas women must see a specialist. Researchers have found that women in these situations are most often older and have been afflicted with their pain for a longer duration of time before receiving a referral.

In this regard, women were prescribed “more minor tranquilizers, antidepressants, and non-opioid analgesics” while their male counterparts received more opioids. This goes to show that women’s symptoms are still being treated as an emotional condition as opposed to a physical one.

Clearly we haven’t come a long way from diagnosing women with hysteria, giving them sedatives, and calling it a day.

Author Joe Fassler described the blatant sexism he witnessed in a Brooklyn emergency room in “How Doctors Take Women’s Pain Less Seriously.” His wife Rachel, who experienced excruciating pain due to an ovarian torsion, received a repeated diagnosis of kidney stones while being shoddily shuffled throughout the triage system.

It was not until 14 and a half hours later that Rachel received a correct diagnosis and was wheeled into surgery.

As Fassler wrote:

“The diagnosis of kidney stones—repeated by the nurses and confirmed by the attending physician’s prescribed course of treatment—was a denial of the specifically female nature of Rachel’s pain. A more careful examiner would have seen the need for a gynecological evaluation. But this particular ER, like many in the United States, had no attending OB-GYN. And every nurse’s shrug seemed to say, ‘Women cry—what do you do?’”

Leslie Jamison spoke candidly on the situation Rachel underwent in her book The Empathy Exams.

She explained that months after writing “Grand Unified Theory of Female Pain,” an essay that shed significant light on the different ways in which forms of female suffering are disparaged and ridiculed, “one of my best friends had an experience where she was in a serious amount of pain that wasn’t taken seriously at the ER.”

Jamison continued:

“That to me felt like this deeply personal and deeply unsettling embodiment of what was at stake. Not just on the side of the medical establishment…but on the side of the woman herself: My friend has been reckoning in a sustained way about her own fears about coming across as melodramatic.”

That last line reverberated in my brain. Trying not to interpreted as melodramatic is an unfortunate part of many women’s everyday existence, including my own.

We minimize our own pain, shrugging it off as “fine” or “not that bad” for fear that we will seem like too much, which brings me right back to where I started: my IUD insertion.

In the lead up to the procedure, the nurse asked me if I had the day off or if I intended to go back to work. I answered the latter, and she continued checking my blood pressure without so much as skipping a beat.

It wasn’t until an hour later when the overwhelming wooziness took over my whole body that I realized that wasn’t an option.

My hands were clammy, and my back was sweating profusely. My ears were ringing, and it felt like I was coming down with the flu and falling asleep all at once.

I got into a Lyft, and my eyelids fluttered open and shut along FDR Drive as my cramps continued to intensify.

As much as I was disappointed in myself for not being able to carry on with my day according to the original plan, I was also disappointed with the medical professionals who failed to mention the very real pain I could (and did) feel after the fact.

Maybe the nurse didn’t want to assume I couldn’t handle it, for fear she’d typecast me as another melodramatic female in pain. Maybe I wanted to believe I was above it all.

Luckily, I soon realized I wasn’t alone or over-exaggerating. According to a 2014 study, patients, on average rated their maximum pain during IUD insertion as 64.8 out of 100 while providers perceived it to be 35.3.

This significant discrepancy made me feel seen as I read the narratives of other women who went through the same thing.

Some passed out from the pain and compared it to getting pinned in the cervix with a staple gun.  Others recalled slight discomfort and the need for rest.

Many more vocalized their love-hate relationship with the device, deciding to suck up with the side effects for lack of a better option.

And this is where I fall.

On one hand, I’m discouraged that my hormone-less options for birth control boiled down to the copper IUD or barrier methods which are increasingly prone to human error.

On the other, I’m lucky to have access to healthcare and the right to make decisions for my own body. I’m lucky to have a safeguard that can outlast legislation overturned on Capitol Hill and carry me into another decade of life.

I keep telling myself that a crazy heavy flow and the constant consumption of Advil isn’t that bad. And in the grand scheme of things, it isn’t. But the fact that women simultaneously give up  control of their bodies to gain it back in another aspect demonstrates that there is more work to be done.

Just like Sindha Agha wrote in the article that accompanies her New York Times op-doc “Birth Control Your Own Adventure:” I am hesitant to criticize birth control while asserting my right to it in the next sentence.

But as she argued, “I deserve a health care system that doesn’t consider what’s unacceptable for men to be the gold standard for me.”

And in the uphill battle to understand female pain—to truly empathize with others and articulate it myself—I look back to Leslie Jamison’s words:  

“The wounded woman gets called a stereotype, and sometimes she is. But sometimes she’s just true.”