Kate*, a 40-year-old media executive, was about to get a coil fitted. She’d never been pregnant and, after seeing media reports, she was anxious that it might be painful. So she chose an NHS sexual health clinic, knowing they specialised in reproductive health and were experienced in fitting coils.
The clinic advised her to take painkillers beforehand and explained that she might experience ‘mild discomfort’ and ‘period-like pain’. The reality turned out to be very different.
“The pain from just opening my cervix was so intense that I nearly passed out before the coil was even inserted.” Kate had been assured this was unlikely and was shocked when she was tipped backwards to prevent fainting. After the fitting, she experienced the most severe cramps she’d ever had. “It went on for hours. The pain made me feel sick and dizzy, and I was getting more and more worried. When I phoned the clinic, they said my uterus had gone into spasm, and I was experiencing cramps similar to labour contractions.”
Kate’s experience is unfortunately not unique, and such stories can understandably make women anxious about having a coil fitted. Here, we look at why some people experience significant pain during the procedure and what should happen during a fitting, so that you are comfortable and fully prepared if you decide that the coil is the right option for you.
There have been multiple high-profile stories in recent years about extreme pain during coil fittings, harrowing accounts in magazines and newspapers, and thousands of women sharing their stories across social media.
The subject made headline news in 2021 when the BBC presenter Naga Munchetty described it as one of the most traumatic experiences she’s ever had and fainted twice when having her coil inserted. Times columnist Caitlin Moran’s article about her own painful coil fitting triggered hundreds of social media posts, sharing similar distressing experiences. The BBC, Vogue , and Glamour have all carried subsequent reports, with one woman saying: “It was horrific. My body went into shock; I was hot, cold, shaking, basically about to faint.”
A coil (also known as an intrauterine device or IUD) is a small T-shaped device that’s implanted in the uterus and protects against pregnancy, either by releasing a small amount of hormone or copper into the area. It can also be used to treat hormonal imbalances.
Experts agree that it is one of the most effective and safe ways to prevent a pregnancy. Many women like the fact that they release very low or no amounts of hormone into the body, and once they are fitted you can forget about them. No more remembering to take the pill or pregnancy scares, as they are more than 99% effective.
Although so many women have had negative experiences during a coil insertion, Senior Consultant Gynaecologist, Mr Pandelis Athanasias, says this should be the exception, rather than the rule. “I have fitted hundreds of coils and 99% of my patients experience minimal discomfort. It’s about careful preparation and carefully discussing your needs and concerns beforehand, so that we can provide appropriate pain relief throughout all stages of the procedure, including after the fitting.”
According to Mr Athanasias, pain “should not be a normal part of the procedure, but the reality is that thousands of women experience discomfort that they shouldn’t have to.” Kate found that she was given very little warning about the level of pain she may experience and was offered just an external numbing spray throughout the whole procedure. Mr Athanasias explains: “This is not enough, it mainly acts as a lubricant – it’s not an anaesthetic – and would have done very little to prevent the subsequent pain and discomfort.”
NHS guidelines state that women can ask for pain relief, including a local anaesthetic, and it’s important that you feel able to discuss this with your GP or clinic beforehand. The guidelines also advise that you should let your doctor know if you feel any pain during the fitting and you can request for them to stop at any time.
Kate’s experience of extreme pain and near fainting when the speculum and clamp were inserted into her vagina is a relatively uncommon but a recognised phenomenon. Mr Athanasias explains: “It occurs in some women when the vagus nerve is stimulated during procedures involving the cervix. It’s known as a vasovagal response – it’s a physical reflex (not a sign of anxiety) and can lead to that characteristic dizziness, drop in blood pressure, nausea or a loss of consciousness.”
Other issues at this point in the fitting can include:
Some women may also find coil fittings more painful if, like Kate, they haven’t previously given birth. As Mr Athanasias explains: “For women who’ve not had children, the diameter of the cervical opening is around 2mm while for those who have given birth, it’s around 3mm. The average coil is around 3 mm so this can sometimes cause problems when we insert it.”
Luckily there is a lot that can be done to try and make sure the coil fitting is not painful and that women are fully prepared beforehand. “It’s important”, explains Mr Athanasias, “that as doctors and clinicians we listen carefully to your concerns and needs, and discuss the pain relief options that are available to you. There’s a lot we can do to make sure you are at ease and experience minimal discomfort. The preparation for the procedure is as important as the actual insertion of the coil.”
The following options can help reduce pain:
Before
During
Mr Athanasias explains, “I always perform an ultrasound scan before and after the procedure. Knowledge of the uterine size and shape and confirmation of the coil location are extremely important.”
Afterwards:
Mild to moderate cramping for a few days after the procedure is to be expected, according to Mr Athanasias, as your uterus adapts to the coil. He recommends taking your painkillers a couple of hours before the fitting to help minimise any post-fitting cramping and to always make sure you’ve eaten and drunk plenty beforehand.
“It’s important”, Mr Athanasias says, “to look after yourself. It might be a good idea to take the rest of the day off, and have your painkillers and a hot water bottle to hand. It’s also a good idea to avoid strenuous exercise, swimming, and sex for 24-48 hours.”
He adds, however: “Many of my patients are pleasantly surprised, and find they can go about their day as normal. Some are back at their desk within a couple of hours or are fine to go and do the school pick-up. It really depends on the individual.”
Over the next few days and weeks, it’s normal for some people to experience the following:
However, if you experience severe or worsening pain, as Kate did, it’s important to contact your clinic or doctor for advice. Although complications are uncommon, severe pain can sometimes be a sign that the coil is not positioned correctly, there’s an infection, or the device has been partially expelled.
You should seek urgent help if:
Even if no underlying problems are found, if you feel something is wrong, it’s important to have it checked by a doctor.
Here at The Medical Chambers Kensington, our Consultant Gynaecologists are highly skilled at inserting and removing coils with little or no discomfort. They understand that this is an intimate procedure and that you should feel as relaxed and comfortable as possible.
Unlike standard GP practices, we always use guided ultrasound to assess the size, position and tilt of your uterus. This enables us to plan the procedure, gently position the coil accurately, helping to lessen any discomfort and reduce the risk of complications.
Together, we can decide on the most appropriate form of pain relief for you, including local anaesthetic injections or gels. After the fitting, we perform a further scan to ensure the coil is correctly positioned, as most problems usually arise from a device being placed incorrectly. Our specialists are also available over the subsequent weeks should you have any further concerns and questions.
Despite the distressing experiences reported by some women, experts say severe pain is relatively uncommon, particularly when appropriate care and pain management are provided. Gynaecologists also report that satisfaction rates with the coil are very high, with many women finding it a convenient and highly effective form of contraception once it has been fitted and any initial side effects have settled.
It’s not surprising, as the coil offers several advantages, including:
As Mr Athanasias explains: “The coil is one of the most effective and safest forms of contraception available, and I’d hate to see women being put off using it. Women should feel that they are informed and able to ask for the full range of pain relief options, and should expect dedicated, empathetic care throughout their treatment, including careful monitoring after the procedure.”
If you’d like to discuss your options with one of our Consultant Gynaecologists, including which type of coil may be right for you and what pain relief to expect, please call 020 7244 4200 or make an appointment online.
*name has been changed
