"I would say it's just a pinch, but that's not true. You'll feel a prick when I insert the needle, and then a burning sensation. It'll last for about thirty seconds and it will be unpleasant, but then it'll be over."
I am not used to having my pain acknowledged in clinical settings when it is not a symptom of a more complex issue. This is particularly true when it comes to experiences with reproductive healthcare. Several years ago, a doctor described IUD insertion to me as "mildly uncomfortable, but nothing like a real surgery." Years later I became aware that such statements are incredibly common despite contradictory testimony from those undergoing the procedure. After three painful, failed attempts, including two trips to gynecologists supposedly specializing in the procedure, I was labelled by the doctor as an anomaly and told that the problem lay in my anatomy. I was not offered any painkillers or sedatives for any of the three appointments, and due to inexperience navigating such encounters I felt too ashamed to request any for what was supposed to be mild discomfort. When I expressed to the doctor during the first appointment that the pain was severe, I was told that it was normal and only temporary. I stopped vocalizing my discomfort after that. I left the clinic after the third attempt in tears, angry at myself for not being able to handle a minor procedure and for not having a "normal" body.
Because of this, I was taken aback when the doctor who inserted my contraceptive implant acknowledged and accurately described the pain I would shortly feel when the local anesthetic was injected to numb my arm. Her statement affirmed not only that my pain was notable, but also that such pain is too often downplayed. Her words, I discovered, were informed by personal experience: she shared with me that she switched her description after undergoing contraceptive implant insertion herself and recognizing that such statements were misrepresentative and dismissive. Even though the anesthetic was only a minor part of the entire encounter, representing about 30 seconds out of a 15-minute appointment, that moment of validation stuck with me long after the appointment ended. Whether intentionally or not, the doctor's statement helped to soothe a psychic pain I had not realized I was carrying over the years.
Pain is notoriously difficult to measure and categorize. What counts as a normal or bearable amount of pain to one person could be experienced as vastly different by another. Pain is further not often experienced by patients as an isolated phenomenon in the way that diagnostic schemas typically require for accurate diagnosis and treatment. As S. Scott Graham writes when discussing the rise of the biopsychosocial model of pain, "there is no biological pain without psychosocial impacts, and no psychosocial pain without biological consequences" (5). Certain kinds of pain will further never be experienced by some. The doctor who was so blasé about the pain of IUD insertion was a cisgender man, and as such could not speak from personal experience or necessarily even fully comprehend what I felt in that moment. Pain experienced in relation to reproductive and sexual health is particularly likely to be disregarded in many settings. In a study released in 2021 by The Alliance for Endometriosis, 90% of the 1,817 respondents surveyed reported frequent dismissal of their pain as "a normal part of being a woman." If pain is not seen as abnormal, diagnosable, and treatable, it is often written off entirely.
This simple interaction felt much more meaningful and valuable in light of recent attacks on reproductive freedom in the United States. In the weeks preceding my appointment, I stumbled upon articles specifically about individuals unable to find doctors to remove their IUDs. Ironically, in Fran Hoepfner's article for Gawker about her inability to find a doctor willing to remove her IUD, the writer reveals that she had initially chosen this method of birth control to combat severe period pain only to find that the IUD caused a whole host of new, painful symptoms. For Fran and others who have had negative experiences with the IUD, being denied the choice of when to remove it represents a fundamental denial of their reproductive rights. This has, in turn, caused a citizen science of sorts to spawn on online platforms like Tiktok to provide advice on home removal.
Such movements have a long history in the realm of reproductive and sexual health. Nancy Tuana's 2006 article "The Speculum of Ignorance" provides a compelling argument for the epistemological nature of the women's health movement of the 1970s and 1980s. In response to the androcentrism of medicine, feminists employed such measures as the genital self-exam to combat ignorance around topics like the structure of the clitoris (8). As Tuana reports, both in the 1970s and to this day birth control methods for those with uteri have proliferated while options targeted at men have remained stagnant. The primary methods offered and advertised to this day are condoms and vasectomies, with the latter often being regarded as a more extreme choice. As such, the pain that is a supposedly just "part of being a woman" is further normalized and expected, requiring individuals with a uterus to endure often great deals of pain with the expectation that this is not remarkable or deserving of acknowledgement in clinical settings.
The pain I experienced during my contraceptive implant appointment provided no specific knowledge that could be used in the course of treatment. It could not be translated into a sign and mined for causality. The pain was the (brief, but notable) result of the medical intervention I sought, a necessary discomfort used to prevent and mitigate various kinds of further pain: the pain of the implant insertion, but also the potential pain that could be caused by an unintended pregnancy. It realistically required no acknowledgement for the treatment to be provided, but in choosing to recognize that pain my doctor provided a form of care more holistic than I had received in the past. Accurate descriptions of pain associated with reproductive and sexual health can do little often to eliminate the physical discomfort or to entirely combat the gendered nature of expectations around birth control. In my personal experience, however, they can do much to combat the attendant psychological pain that comes from repeated dismissal of one's experiences, in turn resulting in more positive experiences of health care for many whose pain has been historically disregarded.
Works Cited
Graham, S. Scott. The Politics of Pain Medicine. University of Chicago Press, 2015.
Tuana, Nancy. "The Speculum of Ignorance: The Women's Health Movement and Epistemologies of Ignorance." Feminist Epistemologies of Ignorance, 21(3), 2006, pp. 1-19.
Header image: Dr. Pauline Neveu, Implant contraceptif et allumette contraceptive matches, 2022. Wikimedia Commons.(https://upload.wikimedia.org/wikipedia/commons/thumb/4/4a/05_Implant_contraceptif_et_allumette_contraceptive_matches.svg/640px-05_Implant_contraceptif_et_allumette_contraceptive_matches.svg.png)
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