More Than a “Little Pinch”: Medicine Finally Admits Women’s Pain Is Real
A PatientLead Health GuidePost
After decades of dismissal, new medical guidelines acknowledge what women have always known: routine gynecologic procedures can be excruciating when pain is treated as an inconvenience rather than a medical reality.
The scene plays out in examination rooms across the country: a woman lies on a table, gripping the edges as a healthcare provider inserts an intrauterine device or performs a cervical biopsy. “Just breathe deeply,” comes the familiar refrain, often followed by “This will only take a minute.” What happens next, the sharp, breath-stealing pain that can leave patients shaking, has been systematically minimized by a medical system that has long treated women’s pain as less valid, less urgent, and less deserving of intervention.
That narrative is finally beginning to change, thanks to new guidance that represents both a medical milestone and an overdue reckoning with healthcare’s gender bias.
ACOG’s Watershed Moment
In early 2025, the American College of Obstetricians and Gynecologists (ACOG) issued groundbreaking recommendations that fundamentally shifted how the medical community should approach pain management during intrauterine device insertion. For the first time, the organization explicitly urged clinicians to offer real analgesia and anxiolytics. A big improvement over breathing exercises and murmured reassurances.
The committee’s decision came after reviewing compelling evidence that up to seventy percent of patients experience moderate to severe pain during IUD placement. This isn’t the mild discomfort that medical textbooks have long described, but genuine, intense pain that can rival contractions or kidney stones. Yet for years, the standard protocol in many offices consisted of little more than ibuprofen taken an hour beforehand and the promise that “it’ll be over quickly.”
The new guidelines represent a seismic shift from the approach that dominated gynecology for generations. Instead of expecting women to endure what one patient advocacy group termed “medical torture,” clinicians are now encouraged to offer lidocaine injections, oral pain medications, or even conscious sedation when appropriate. The message is clear: women’s pain during medical procedures is not a character test to be endured, but a medical reality that deserves treatment.
The Ripple Effects of Unmanaged Pain
An IUD insertion may occupy only five minutes of a healthcare provider’s day, but for patients, unmanaged pain can reverberate for months or even years. The psychological impact extends far beyond the procedure room, creating what researchers now recognize as medical trauma, which is a form of post-traumatic stress that can fundamentally alter a person’s relationship with healthcare.
Studies show that patients who experience severe, unmanaged pain during gynecologic procedures are significantly more likely to delay or skip follow-up appointments, avoid preventive care, and report heightened anxiety about future medical encounters. For women already managing chronic conditions, this medical avoidance can have cascading health consequences.
The trauma manifests in various ways. Some patients report panic attacks when scheduling routine gynecologic visits. Others describe a phenomenon they call “white coat syndrome,” where merely entering a medical facility triggers physical symptoms like rapid heartbeat, sweating, and nausea. The most troubling cases involve women who forgo essential healthcare entirely, choosing to risk serious conditions rather than face the possibility of being dismissed or hurt again.
Beyond IUDs: The Broader Landscape of Dismissed Pain
While ACOG’s IUD guidance represents progress, it illuminates a much larger problem that extends throughout women’s healthcare. Colposcopy, the procedure used to examine abnormal cervical cells, routinely involves taking tissue biopsies, yet most patients receive minimal pain management beyond over-the-counter medications.
The contrast with other medical specialties is stark. A dermatologist performing a skin biopsy typically offers lidocaine injections as standard practice. A dentist wouldn’t dream of drilling a tooth without adequate numbing. Yet gynecologists have long performed cervical biopsies, cutting tissue from one of the body’s most sensitive areas, while offering little more than acetaminophen and the instruction for the patient to stay still.
The minimization extends to other common procedures. Endometrial biopsies, which involve inserting a thin tube through the cervix to sample uterine tissue, are often described to patients as causing “mild cramping.” This description bears little resemblance to the intense, stabbing pain many women actually report experiencing. Hysterosalpingograms, X-ray procedures that involve injecting dye through the cervix and into the fallopian tubes, are similarly downplayed despite causing pain that can be severe enough to cause fainting.
Research on exact pain scores for these procedures remains surprisingly limited, a gap that speaks to the medical community’s historical lack of interest in quantifying women’s pain experiences. Instead, much of what we know comes from patient reports shared in online forums and support groups, where women compare their experiences and share coping strategies in the absence of adequate medical guidance.
The Historical Roots of Medical Dismissal
The systematic dismissal of women’s pain in healthcare settings isn’t accidental. Deep-seated biases that have shaped medical education and practice for centuries. The roots trace back to historical beliefs about women’s pain tolerance, their supposed tendency toward hysteria, and the medicalization of normal female experiences.
Modern research has documented these biases with troubling clarity. A landmark 2001 study published in the Journal of Law, Medicine & Ethics found that women are significantly more likely than men to receive prescriptions for sedatives rather than pain medication when presenting with identical symptoms. More recent research has shown that women wait longer in emergency rooms, are less likely to receive adequate pain medication, and are more frequently told their symptoms are psychological in nature.
The bias becomes even more pronounced when women present with conditions that disproportionately affect them. Endometriosis, a condition that can cause excruciating pelvic pain and affects roughly 10% of reproductive-age women, takes an average of seven to eight years to diagnose. During those years, women are often told their pain is “normal menstrual discomfort” or advised to “try to relax” and reduce stress.
The consequences of this treatment extend beyond individual suffering. When half the population receives substandard pain management, it represents a massive public health failure that affects families, workplaces, and communities. Women who can’t access adequate pain care may be unable to work, care for children, or participate fully in society, outcomes that ripple far beyond the examination room.
The Invisible Illness Connection
For women already managing chronic conditions, inadequate pain management during medical procedures can trigger what researchers call a “symptom cascade.” This is a domino effect where acute trauma exacerbates existing health problems and creates new ones.
Consider the experience of someone living with fibromyalgia, a condition characterized by widespread pain and extreme fatigue. For these patients, undergoing a painful medical procedure without adequate anesthesia it can trigger a flare that lasts weeks or months. The central nervous system, already hypersensitive, becomes further dysregulated, leading to increased pain throughout the body, disrupted sleep, and cognitive difficulties often called “fibro fog.”
The same pattern occurs with other conditions that predominantly affect women. Patients with chronic fatigue syndrome may experience what they call “post-exertional malaise” after stressful medical encounters, leading to a crash in energy levels that can confine them to bed for days or weeks. Those with autoimmune conditions like lupus or rheumatoid arthritis may find that procedure-related stress triggers disease flares, causing joint pain, skin rashes, or organ involvement.
Perhaps most troubling is the impact on women with post-viral syndromes, including long COVID. These patients often describe living within carefully managed “energy budgets,” where any additional stressor, whether physical or emotional, can push them into prolonged periods of severe fatigue and neurological symptoms. A traumatic medical procedure can represent such a significant stressor that it fundamentally alters their functional capacity for months.
The interconnections between acute medical trauma and chronic illness highlight why adequate pain management can help prevent long-term disability and preserve quality of life. When medical providers fail to recognize these connections, they may inadvertently cause harm that extends far beyond the procedure itself.
Understanding Pain’s Complex Legacy
The neuroscience of pain helps explain why dismissive treatment during medical procedures can have such lasting effects. According to the 1965 gate control theory of pain, developed by researchers Ronald Melzack and Patrick Wall, the nervous system doesn’t simply transmit pain signals from body to brain like a telephone wire. Instead, it actively processes and modifies these signals, with the brain’s interpretation heavily influenced by context, emotions, and past experiences.
When someone undergoes a painful medical procedure while feeling dismissed, frightened, or helpless, the brain processes that pain differently than if the same procedure occurred in a supportive, well-managed environment. The emotional context becomes encoded along with the physical sensations, creating what pain researchers call “pain memories” that can be triggered by similar situations in the future.
This helps explain why women who have traumatic experiences during gynecologic procedures often report increased pain sensitivity during subsequent medical encounters. Their nervous systems, having learned to associate certain medical contexts with threat and pain, become hypervigilant and reactive. What might have been tolerable discomfort becomes amplified into severe pain, creating a cycle where each negative medical encounter makes the next one more difficult.
The phenomenon extends beyond medical settings. Research shows that people who experience medical trauma may develop increased sensitivity to pain in general, finding that everyday aches and pains feel more intense than they did before. For women already managing chronic pain conditions, this amplification can be devastating, essentially resetting their pain baseline to a higher, more debilitating level.
Understanding these mechanisms underscores why proper pain management during procedures is a medical necessity that can prevent the development of chronic pain and medical trauma. Every time a healthcare provider dismisses a patient’s pain or proceeds with a painful procedure without adequate anesthesia, they risk creating lasting harm that extends far beyond the immediate procedure.
Practical Advocacy in Action
Armed with new medical guidelines and a better understanding of pain’s complex effects, patients can take concrete steps to advocate for appropriate pain management during medical procedures. Success often depends on preparation, persistence, and strategic communication.
Pre-Appointment Preparation
The advocacy process should begin before you ever enter the examination room. When scheduling procedures like IUD insertion or colposcopy, explicitly ask about pain management options. Don’t accept vague reassurances that “it won’t be too bad” or “it’s over quickly.” Instead, request specific information about what pain relief options are available.
If the scheduling staff seems unprepared for these questions, ask to speak with a nurse or provider directly. Some patients find it helpful to send questions via patient portals in advance, creating a written record of their requests. Key questions might include: “What pain management options do you offer for this procedure?” “Can I receive lidocaine injections?” “Do you prescribe anxiety medication for patients who need it?” “What would you recommend for someone with a history of severe pain during medical procedures?”
Communicating Pain History
Healthcare providers often make assumptions about pain tolerance based on limited information. Counter this by providing specific, quantifiable details about your pain experiences. Instead of saying “I have a low pain threshold,” try “During my last Pap smear, I experienced pain that I would rate as 8 out of 10, and it lasted for several hours afterward.”
If you have chronic pain conditions, explain how medical procedures have affected you in the past. For example: “I have fibromyalgia, and my last gynecologic procedure triggered a flare that lasted three weeks. I’d like to discuss pain management options that might prevent this from happening again.”
Bringing Support
Having an advocate present during medical procedures can significantly improve outcomes. This person serves multiple functions: they can help you remember questions to ask, provide emotional support during stressful conversations, and serve as a witness to ensure your concerns are taken seriously.
Choose your advocate carefully. The most effective advocates are calm, assertive individuals who understand your medical history and treatment goals. Brief them beforehand about your concerns and what you hope to achieve during the appointment. Some patients create written summaries of their medical history and current symptoms to share with both their provider and their advocate.
Documentation and Follow-Up
Keep detailed records of your medical encounters, including what pain management was offered, what you experienced during procedures, and how you felt in the days and weeks afterward. This documentation serves several purposes: it helps you track patterns over time, provides concrete information for future providers, and creates a record that can be valuable if you need to seek care elsewhere.
Consider using smartphone apps designed for symptom tracking, or create a simple diary that includes pain levels, functional impact, and emotional responses. Photos of written instructions or discharge papers can help you remember details later when symptoms or medications may affect your memory.
Systemic Change Through Individual Action
While the new ACOG guidelines represent significant progress, transforming medical culture requires sustained effort from both patients and providers. Individual advocacy plays a crucial role in this transformation, as each person who speaks up helps normalize the expectation of adequate pain management.
Provider Education
Many healthcare providers genuinely want to help their patients but may lack training in modern pain management techniques or awareness of recent guideline changes. Sharing current research and guidelines can be an effective advocacy strategy. Consider printing copies of relevant studies or guideline summaries to bring to appointments.
When providers seem resistant to offering pain management, ask them to explain their reasoning. Sometimes the resistance stems from outdated training, insurance concerns, or unfamiliarity with newer techniques. Understanding their perspective can help you address specific barriers and find mutually acceptable solutions.
Institutional Accountability
Healthcare institutions respond to patient feedback, particularly when it affects their reputation or financial performance. If you receive inadequate pain management during a procedure, consider leaving detailed, constructive reviews on hospital or clinic websites. Focus on specific failures in pain management and their impact on your recovery and subsequent healthcare experiences.
Many healthcare systems also have patient advocacy departments or patient experience teams that investigate complaints and work to improve care. Filing formal complaints about inadequate pain management helps create institutional awareness of the problem and may lead to policy changes that benefit future patients.
Community Building
Connect with other patients who share similar experiences. Online support groups, condition-specific forums, and social media communities can provide valuable information about which providers and facilities offer better pain management. They can also serve as sources of emotional support and practical advice.
Consider sharing your positive experiences as well as negative ones. When you find providers who offer excellent pain management, recommend them to others and thank them publicly. Positive reinforcement helps encourage providers to maintain high standards and can influence their colleagues’ practices.
The Path Forward
The release of ACOG’s new pain management guidelines is an acknowledgment of a fundamental truth that women have been asserting for generations. Their pain is real, valid, and deserving of appropriate medical attention. This recognition opens the door to broader changes in how healthcare approaches women’s pain across all specialties and conditions.
However, guidelines alone cannot eliminate decades of ingrained bias and dismissive attitudes. Real change will require sustained effort from patients, providers, and healthcare institutions. It will mean training medical students to take women’s pain reports seriously, updating protocols to include adequate pain management as standard practice, and creating accountability systems that ensure guidelines are actually implemented.
The stakes extend beyond individual comfort during medical procedures. When healthcare systems fail to manage women’s pain appropriately, they perpetuate cycles of medical trauma, chronic pain, and healthcare avoidance that can last lifetimes. They contribute to the broader marginalization of women’s health concerns and reinforce harmful stereotypes about female pain tolerance and emotional stability.
Conversely, when healthcare providers offer compassionate, evidence-based pain management, they do more than prevent immediate suffering. They build trust, encourage continued engagement with healthcare, and help break cycles of medical trauma that can span generations. They model a different way of practicing medicine that sees women as reliable reporters of their own experiences and deserving of the same pain management that would be offered to any other patient.
Your Voice as Catalyst
Every woman who refuses to minimize her pain contributes to this larger transformation. When you ask for appropriate pain management during medical procedures, you’re challenging a system that has long treated female suffering as acceptable collateral damage.
The path may not always be easy. You may encounter providers who dismiss your concerns, offices that claim they “don’t do” pain management for routine procedures, or insurance systems that create barriers to appropriate care. But each time you persist, each time you insist that your pain matters, you help create a new normal where women’s pain is taken seriously.
Whether you’re preparing for an IUD insertion, recovering from a colposcopy, managing daily chronic fatigue, or supporting someone else through their medical journey, remember that your experience and your voice have power. The women who came before you fought to be heard despite dismissal and disbelief. Now, armed with new guidelines and growing awareness, you have tools they didn’t have and opportunities they created.
The transformation of women’s healthcare won’t happen overnight, but it will happen one appointment, one conversation, one refusal to accept “just breathe through it” at a time. Your pain matters. Your experience is valid. And your voice can help ensure that future generations receive the compassionate, evidence-based care that should be the standard for everyone.
Medical Disclaimer: This article is for informational and educational purposes only and does not constitute medical advice. Individual medical experiences vary significantly, and treatment decisions should always be made in consultation with qualified healthcare providers who can assess your specific situation, medical history, and needs. If you are experiencing severe or persistent pain, seek immediate medical attention. Always discuss pain management options with your healthcare provider before undergoing medical procedures.