The Lack of Pain Management in Gynecological Procedures

The field of gynecology has a complex history regarding pain management. Dr. James Marion Sims, often referred to as the "father of modern gynecology," conducted experiments on enslaved Black women without providing any form of anesthesia. This troubling legacy continues to affect outcomes today, as Black individuals often report higher pain scores, receive fewer pain assessments, and have less pain management intervention compared to their white or Asian counterparts during gynecological procedures. Furthermore, disparities in pain management extend beyond race, highlighting a significant gap in the treatment of all individuals undergoing gynecological procedures.

There is a notable lack of pain management guidelines in gynecology. For example, the American College of Obstetricians and Gynecologists does not provide any guidelines regarding pain management for IUD placement. The level of pain associated with the procedure is one reason why providers may be hesitant to recommend it for adolescents or individuals who have never given birth. However, pain management is rarely, if ever, discussed or offered as part of the procedure. Additionally, providers often describe the experience as a "small pinch" or "mild discomfort," while many individuals clearly express that the pain they feel exceeds those descriptions.

There is a notable gender bias in how conditions typically associated with women are treated. However, it is crucial to recognize that trans, nonbinary, and intersex individuals of all genders also need gynecological care. When women report pain, they are often dismissed as overreacting or being hysterical. In truth, these individuals can experience moderate to severe pain during gynecological procedures, but their pain is frequently minimized because of prevailing gender biases.

Healthcare providers often overlook or fail to acknowledge their patients' pain. They may assume that patients do not want pain management for gynecological procedures. Even when patients ask about pain management, providers might lack knowledge of the available options for specific procedures. Many providers are not adequately trained to offer pain management for these procedures, leaving patients unaware that such options exist.

Time constraints contribute to inadequate pain management in gynecological procedures. Certain pain management options can be challenging to incorporate into a single appointment alongside a procedure. For instance, general anesthesia requires preparation time and a recovery period for the patient to wake up. Sometimes, appointments can be rushed, providing little time to discuss pain management options in detail.

Inadequate pain management in gynecology can result in a lower quality of care. If individuals anticipate a painful procedure, they may avoid seeking care altogether. Furthermore, when healthcare providers fail to acknowledge or validate their patients' pain, it can lead to misdiagnoses or undiagnosed conditions. Recognizing and addressing pain is essential for delivering high-quality healthcare.

Additional Sources: Center for Women’s Health: Oregon Health & Science University, Underdark.org, British Medical Journal, Black Perspectives: African American Intellectual History Society, UNC Department of Obstetrics and Gynecology: UNC School of Medicine, Journal of Contemporary Medical Education