Recent recommendations from the American College of Obstetricians and Gynecologists (ACOG) urge healthcare providers to improve pain management during in-office gynecological procedures, such as IUD insertions and cervical biopsies, NPR reports.
The guidance highlights the need for clinicians to discuss potential pain upfront with patients and offer effective options to reduce discomfort.
Many patients have endured procedures with minimal pain relief, relying on ibuprofen or sheer endurance. However, pain experiences vary widely: while some feel little discomfort, others describe the pain as intense. Despite this variability, some clinicians have traditionally considered pain management unnecessary and thus have not offered it.
ACOG’s new guidelines, released last week, call for “upfront and thorough” conversations between doctors and patients about the likelihood of pain and available treatments. Among the recommended options is the paracervical block, which involves injecting a local anesthetic—commonly lidocaine—around the cervix to numb the area. Lidocaine creams and sprays are alternatives for patients who prefer to avoid injections, though research on their effectiveness is more limited.
Dr. Danielle Tsevat, an OB/GYN and gynecological pain researcher at the University of North Carolina, notes that some physicians combine topical anesthetics with paracervical blocks to maximize pain relief. The new recommendations also mention sedation and anti-anxiety medications as possible aids, particularly for adolescents or survivors of sexual trauma.
ACOG’s call for enhanced pain management aligns with growing patient advocacy and reports of painful experiences during gynecological procedures. For example, Memphis attorney Melissa Stewart shared that her IUD insertion was unexpectedly painful and that she had not been warned about the discomfort beforehand. Research suggests that lack of preparation can increase patient anxiety and worsen pain perception.
These updated guidelines follow similar moves by the Centers for Disease Control and Prevention (CDC), which last year emphasized shared decision-making and acknowledged that local anesthetics can reduce pain during IUD insertions. ACOG’s recommendations go a step further by explicitly encouraging clinicians to offer anesthetic options routinely.
Dr. Karen Meckstroth, a clinician and educator at San Francisco General Hospital, welcomes the change. She has long advocated for local anesthetic use during gynecological procedures and trains residents accordingly.
“I can’t think of any other procedures with a significant chance of severe pain where we don’t recommend at least local anesthetic,” she said.
Meckstroth also observes that some doctors who were previously hesitant are now adopting these pain management techniques.
The evolving norms coincide with increased visibility of patient experiences on social media platforms like TikTok, where people have shared videos and stories of painful or distressing visits to OBGYN clinics. While much of the attention has focused on contraception, ACOG’s guidance covers a broader range of procedures, including endometrial biopsies often performed on older patients, who also deserve attention to pain management.
The timing of these recommendations also carries historical and social significance. Historian Deirdre Cooper Owens of the University of Connecticut points out that gynecology has a troubled past, including unethical experimentation on enslaved Black women. The new guidelines explicitly acknowledge that systemic racism and inequities have influenced how pain treatment is administered, with Black patients and women historically receiving less pain relief than others.
“Given the current climate of legislation limiting women’s bodily autonomy, these recommendations emphasizing transparency, choice, and equitable care are especially important,” Cooper Owens noted.
