The Time Has Come: Why Every Woman Deserves Pain Control for Gynecologic Procedures

For too long, women have been told to "just breathe through it" during common gynecologic procedures. They've been dismissed when they describe excruciating pain during IUD insertions, told that endometrial biopsies cause "mild cramping," and advised to simply take an ibuprofen before a colposcopy. But a groundbreaking shift is happening in women's healthcare, led by new guidance from the American College of Obstetricians and Gynecologists (ACOG) that finally acknowledges what women have known all along: these procedures hurt, and pain control should be standard, not optional.

A Long-Overdue Recognition

In May 2025, ACOG released comprehensive new recommendations for pain management during in-office gynecologic procedures—guidance that represents a watershed moment for women's healthcare. The document importantly recommends that ob-gyns and clinicians discuss and offer pain management options to every patient seeking an in-office gynecologic procedure and ensure that pain management counseling is individualized, culturally competent, trauma-informed, and guided by shared decision-making.

This isn't just about comfort—it's about trust, dignity, and access to care. Pain and anxiety about pain can present barriers to patients accessing needed or beneficial health care. When women avoid necessary procedures like IUD insertions or cancer screenings because they fear the pain, we all lose.

The Reality of Current Practice

The statistics are sobering. Previous studies show that only 536 per 10,000 IUD placements (5.36%) were accompanied by either a pain or anxiety medication administration that was documented on the same day. This means that over 94% of women receive IUD insertions with minimal or no documented pain relief—a practice that would be unthinkable for comparable procedures in male patients.

Common in-office gynecologic procedures, such as IUD insertion, colposcopy, hysterosalpingography (HSG), and endometrial biopsy, are routinely performed with no or inadequate pain management. The consequences go beyond momentary discomfort: when healthcare providers minimize women's pain, it leads to patient dissatisfaction, distrust, and reluctance to seek future care.

The Evidence for Effective Pain Control

Research consistently shows that multiple effective pain management options exist for gynecologic procedures. Here's what the evidence tells us:

IUD Insertion

Multiple studies demonstrate that local anesthetic agents significantly reduce pain during IUD insertion. Overall, a series of systematic reviews supports the use of local anesthetic agents, specifically lidocaine (as paracervical block or by genital mucosa application), for management of pain associated with IUD insertion.

One particularly compelling study compared different approaches and found that lidocaine spray superior to lidocaine injection for IUD insertion–related pain. The difference in patient experience was dramatic—women who received proper pain management were significantly more likely to recommend IUDs to friends and family.

Endometrial Biopsy

For endometrial biopsies, the evidence supports a multimodal approach. Multiple studies have reported on the use of topical analgesics, specifically 10% lidocaine spray, for procedural pain and postprocedural pain for endometrial sampling. Studies consistently show that women who receive topical lidocaine experience significantly less pain during these procedures.

Colposcopy and LEEP Procedures

For cervical procedures, local anesthetics are efficacious, and studies have shown a reduction in pain using paracervical block or lidocaine spray. While there may be slight increases in procedure time, the dramatic reduction in patient suffering makes this a worthwhile tradeoff.

Hysteroscopy

The evidence is particularly strong for hysteroscopy procedures. There is sufficient high-quality evidence to recommend local injected anesthesia at the time of diagnostic and operative hysteroscopy and endometrial ablation.

Nitrous Oxide: A Game-Changing Option

Among the most promising developments in office-based pain management is the growing use of nitrous oxide (laughing gas) for gynecologic procedures. This isn't a new medication—nitrous oxide was discovered in 1772, first used as an analgesic in the 1800s, and has been incorporated into anesthetic practice for over 150 years.

Safety and Efficacy

The safety profile of nitrous oxide is exceptional. Nitrous oxide sedation is extremely safe and has been used for dental and medical procedures for approximately 100 years. It is well-tolerated, reversible, and non-allergenic. Unlike stronger sedatives, women remain fully conscious and can drive themselves home afterward.

Recent research demonstrates impressive results for gynecologic procedures. In a rigorous randomized controlled trial of women undergoing hysteroscopic procedures, mean maximum procedure pain scores were 22.8±27.6 mm and 54.5±32.7 mm for intervention and control groups, respectively (p<.001). Even more telling: most study participants (97%) stated N2O/O2 should be offered for gynecologic office procedures and 86% would pay for it if not a covered benefit.

Practical Benefits

What makes nitrous oxide particularly appealing is its practicality. Nitronox™ isn't general or local anesthesia; it's a relaxant that helps you stay calm during your procedure... you remain awake during your procedure and are able to respond to your doctor and follow any instructions given to you.

The system offers women control over their experience. Because the system features on-demand delivery, you only receive a dose of nitrous oxide when you breathe in through the mask or mouthpiece. Many people enjoy this self-administration feature because it allows them to control exactly how much pain medication they receive.

Comparing Options

When directly compared to traditional intravenous sedation, nitrous oxide holds its own. A recent study found that effectiveness of nitrous oxide and pethidine/midazolam is comparable for pain relief in minor gynecologic procedures. However, nitrous oxide had significant advantages: side effects of nitrous oxide is significantly lower when compared to those in pethidine/midazolam group and patients in nitrous oxide group had significantly faster recovery time.

Breaking Down Barriers

The path forward isn't just about medical evidence—it's about addressing the systemic barriers that have prevented adequate pain management for women. These barriers include:

Provider Education: Many healthcare providers simply aren't aware of all available options or underestimate women's pain levels.

Time and Cost Concerns: Some providers worry that pain management will extend appointment times or create additional costs.

Institutional Policies: Many clinics lack protocols for routine pain management during office procedures.

Insurance Coverage: While basic local anesthetics are typically covered, newer options like nitrous oxide may require out-of-pocket payment.

The Broader Impact

This isn't just about individual comfort—it's about healthcare equity and access. When procedures are more tolerable, women are more likely to:

• Complete preventive care screenings

• Choose highly effective contraceptive methods like IUDs

• Seek timely treatment for gynecologic conditions

• Trust their healthcare providers

• Recommend care to friends and family
  

Moving Forward: What Patients Can Do

The new ACOG guidelines represent a crucial first step, but change requires action from both providers and patients. Here's what women can do:

Ask About Options: Don't assume pain management isn't available. Ask your provider what options they offer for procedural pain control.

Do Your Research: Learn about procedures beforehand and come prepared to discuss pain management preferences.

Advocate for Yourself: If your provider dismisses your concerns about pain, seek a second opinion or ask to speak with another provider.

Share Your Experience: Whether positive or negative, sharing your experiences helps other women make informed decisions about their care.

The Road Ahead

The release of ACOG's comprehensive pain management guidance marks a turning point, but implementation will take time. As a women's health nurse practitioner, I treat patients every day who express anxiety about pain related to common procedures like IUD placement. Unfortunately, many patients feel their pain has been diminished or dismissed by their clinicians, which data shows can lead to patient dissatisfaction and distrust.

Change is coming, driven by mounting evidence, updated guidelines, and most importantly, women's voices. The question isn't whether we can provide better pain management for gynecologic procedures—the evidence clearly shows we can. The question is when we'll make it standard practice.

Conclusion

For generations, women have endured unnecessary pain during routine gynecologic procedures, often being told it's "just part of being a woman." But medicine has evolved, and so should our expectations. With safe, effective options like local anesthetics and nitrous oxide readily available, there's no excuse for continuing to subject women to avoidable suffering.

The new ACOG guidelines represent more than just medical recommendations—they're a recognition that women's pain matters, that their comfort and dignity deserve respect, and that quality healthcare means more than just getting through a procedure. As these guidelines are implemented across the country, we move closer to a future where no woman has to choose between necessary medical care and unbearable pain.

The tools exist. The evidence is clear. The guidelines are published. Now it's time for healthcare providers to step up and give women the pain-free care they deserve—and for women to demand nothing less.

This article was originally published in Port Washington Living Magazine