- Stephanie O’Donohue, content material and engagement supervisor
I had combined emotions watching Davina McCall’s latest documentary Tablet Revolution.1 The programme did properly to boost consciousness of typically unknown uncomfortable side effects of hormonal contraceptive drugs, systematic cuts to sexual well being companies, and the hazards of misinformation influencing youthful generations. However the section on intrauterine gadgets (IUDs) left me mystified.
Davina tells how the Mirena coil has suited her properly, each as a type of contraception and as a part of her hormone substitute remedy. Optimistic accounts about IUDs are widespread. Many ladies select them as their most well-liked technique of contraception or to alleviate well being points similar to heavy durations. Latest knowledge inform us that IUDs are the principle technique of contraception for 11% of girls and women accessing sexual and reproductive well being companies.2
Davina was filmed having her IUD changed by Lesley Regan, the UK’s first girls’s well being ambassador. The digicam remained on Davina’s face, as we noticed her smile and barely flinch on the process, with the worst ache being a short second which she described as “very sore” and a sense of period-like cramps. This was counterbalanced with optimistic suggestions and her abstract that, for her, 10 minutes of “discomfort” was a small value to pay for the advantages.
Afterwards she raised considerations round systemic boundaries and a postcode lottery for entry, with some sufferers ready months to have an IUD fitted. Lesley Regan defined that there’s a scarcity of educated workers and lack of funding for coaching and that workers additionally must have “a little bit of follow.” She went on to say that there are lots of ache aid choices for girls having an IUD fitted.
Nevertheless, the section did little to acknowledge much less optimistic experiences and the considerations raised by hundreds of sufferers who’ve undergone extraordinarily painful IUD procedures.3 I’m certainly one of these girls and have written concerning the impression that extraordinarily painful gynaecological experiences can have bodily and psychologically.4 To not point out the violation of belief felt by many who weren’t forewarned of the danger of ache or supplied acceptable help throughout and after the process. The impression of this may be lengthy lasting, deterring some from accessing vital well being checks sooner or later.
Girls need to be seen by properly educated, skilled healthcare workers for invasive procedures similar to IUD insertions and removals. For years, many organisations have been calling for increased requirements in gynaecological coaching and highlighting the hurt that persists when that is absent.5678 We should push for complete scientific coaching on this space, co-designed with sufferers who’ve lived expertise to share. Acceptable prioritisation and funding can guarantee this doesn’t create additional delays to girls’s means to entry IUDs.
The section within the documentary additionally missed a chance to advertise knowledgeable consent in healthcare. All sufferers, significantly younger women who’re more and more having IUDs fitted, ought to be supported and empowered to make the proper alternative for them, after discussing the choices, dangers, and being properly knowledgeable.
We all know from girls who’ve shared their IUD experiences that details about the danger of considerable ache, and the care given if this does occur, is patchy at greatest and leaves lengthy lasting psychological and/or bodily trauma at worst.
In my opinion, the context of Davina’s IUD substitute process was unreflective of actuality. She was handled in a personal hospital by an skilled gynaecologist and had numbing gel utilized and anaesthetic injected. We all know from sufferers’ accounts that ache aid isn’t all the time supplied or given, regardless of steering, and when used it doesn’t all the time stop excessive ranges of ache.9 Many people stay unaware that different ache aid choices can be found—that is itself a breach of knowledgeable consent. We don’t know who’s being supplied ache aid as a result of no knowledge is out there round requirements of care on this space.
If girls’s lived experiences had been valued as integral to bettering follow there could be extra funding directed at tackling gaps in analysis and fixing unanswered questions.
We’d like an unbiased audit of affected person reported experiences and outcomes of IUD procedures, co-designed with sufferers to seize significant knowledge. This could embody the tools and ache aid used, data supplied beforehand, and knowledge on protected traits in order that inequalities usually are not missed. Solely then can the size of the issue be understood, areas for enchancment recognized, and motion taken. Importantly, this will additionally reveal areas of fine follow that may be shared amongst clinicians to enhance affected person experiences.
It’s clear extra analysis is required to grasp girls’s various experiences of ache throughout gynaecological procedures. All girls ought to be capable to entry reproductive healthcare promptly with out the danger of great ache or trauma.
Conflicts of curiosity: None to declare
Provenance: not commissioned, not externally peer reviewed.