If you ask a random group of women on the street, chances are that they will all know a story of a sister or girlfriend who would describe the placing of the hormone or copper spiral as painful or even terribly terrible. Anecdotes are over, but how intense that pain is really, and for what percentage of spiral users actually applies, surprisingly, there was no real answer to that. Until this week.
Ava, a client organization for contraception and abortion, therefore left it to research By research agency Ipsos I&O. Half of all spiral users, according to that research, experienced “serious to unbearable pain” when placing. Four in ten women also suffered from nausea or dizziness during placement. Almost one in ten fainted. There was no difference between the copper and hormone spiral. It also didn’t matter whether the spiral was placed by the doctor or the gynecologist.
Fear of removing
Around 2,800 women participated in the study, just under 600 of them had a hormone or copper spiral installed in the last five years. The respondents with a spiral were asked to give their experienced pain a score of 0 (no pain) to (10 the worst pain that someone can imagine). Only 4 percent of women were not bothered at all when placing. Even in the first hours after placement, a third of the women had serious pain. One in five women also had such severe pain when removing the spiral, some five to eight years later. Moreover, almost one in ten women postponing the removal of the spiral, for fear. If you wait too long, the spiral will no longer protect against pregnancy.
“There have been worries about the falling number of women who use birth control for years,” says Alina Chakh, chairman of AVA. “Then it is also important to look at the thresholds to use contraception. The spiral is potentially a suitable contraceptive for many women, but the fear of pain keeps three out of ten women from taking a spiral, shows our research. It limits them in the freedom of choice for contraception. ”
According to Chakh, the results of the research stand for something bigger than just that spiral: the conversation about pain relief in all kinds of gynecological interventions is not sufficiently conducted. “It symbolizes how we look at women’s pain. At the dentist you can just get anesthesia if you want, with gynecological procedures that is suddenly complicated. We seem to think that the benefits of contraception always outweigh the disadvantages. The protection against pregnancy is always worth the pain, it is part of it. The fact that there was hardly any research on the pain experience of the spiral confirms that image. “
In April of last year published de Volkskrant An opinion piece Van Ava, in which the writers argued for more and better pain relief while placing the spiral. A local anesthesia with a puncture, for example, or a narcotic gel or spray. According to the current guidelines, doctors can advise you to take paracetamol or ibuprofen in advance. This also happens in many cases, according to this study, but AVA wants women to be able to claim other forms of pain relief than now that is currently the case. The Dutch GPs Genootschap (NHG) said it would again study the guidelines last year, but has not yet made a decision.
Doubts about anesthetize
Gynecologist and professor Annemiek NAP of the Radboudumc does not recognize the high pain scores from her own practice. “That does not alter the fact that you should always take experienced pain as a doctor seriously.” If women want that, Nap says, they can get a intoxication with her. “Then the sedation specialist must be used, and a new appointment must be made, but it is possible.”
She has her doubts about the local anesthesia. “You can give someone four punctures, but I estimate that more painful than putting a spiral.” Nap suspects that narcotic gels and sprays will not remedy the real pain. “The most painful moment of placing is pulling the peritoneum. But with a spray you don’t reach that peritoneum, that only numbs the cervix. So I wonder if that helps. “
Just offering the option for pain relief can help to reduce experienced pain, thinks Astrid Masters, pain psychologist and assistant professor at the Open University. “Pain is pre -eminently a subjective experience, on which many factors influence. What stories do you know from your area, have you had earlier nasty gynecological experiences? But also: how much control do you experience about the situation? ” Installing a spiral – with your legs wide in a gynecological chair, not knowing what you can expect and cannot see what exactly happens below – can be experienced as a lack of control. “By being offered at least the option of anesthesia, you have a choice. That can benefit the fear of pain, or the actual pain experience. “
According to Masters, it is important to take the results of this study seriously, “also because a nasty experience in placing or removing the spiral can make gynecological treatments extra exciting in the future. Fear of pain can enhance the actual pain. ”