Women still face agonising coil fittings despite pain relief guidance

Women still face agonising pain during NHS coil fitting appointments despite official guidance to offer pain relief.

While many GPs and sexual health clinics now offer a range of pain relief options making the procedure much more manageable, many women say guidance from the Faculty of Sexual & Reproductive Healthcare (FSRH) has not filtered down across the board.

Patients have described recent coil fitting appointments on the NHS as “the worst pain ever” and said they were not offered pain relief beyond paracetamol or ibuprofen.

In July 2021, the FSRH and the Royal College of Obstetricians and Gynaecologists (RCOG) released a statement acknowledging the painful experiences of women who have received an IUD fitting and advising healthcare professionals to “offer appropriate analgesia”.

In March 2023, the FSRH updated its guidelines to say everyone should be offered adequate pain relief during coil insertions, such as a paracervical block, an intracervical local anaesthetic injection, or a numbing spray or gel.

It comes as TV presenter and menopause campaigner Davina McCall has launched a fresh campaign delving into the state of contraception in the UK, fronting the new documentary, Davina McCall’s Pill Revolution, which aired last week.

The presenter was filmed getting her coil changed on camera by Dame Lesley Regan, an experienced practitioner and one of the country’s leading gynaecologists. The procedure was at a private clinic and McCall was given a local anaesthetic injection and numbing gel.

McCall described the procedure as “uncomfortable” but said: “It is not too bad and with this gel, I can barely feel a thing.”

However, viewers have responded saying they have not been offered the same pain relief options at recent appointments, meaning they had a much more painful experience.

‘Pain relief wasn’t a discussion’

Becca, 25, from West Norfolk, got a coil fitted in February 2023 after deciding she wanted to come off the pill, having been on it since the age of 12 to alleviate heavy periods.

She had a phone consultation and was told to take ibuprofen and paracetamol before the appointment – but said: “Pain relief wasn’t a discussion.”

On the day of the appointment, she took the painkillers and drove 20 minutes to her local sexual health clinic as no one had told her she might not be able to drive home.

As the procedure began, she said the pain was “immediate”.

“I’ve truly never known anything like it,” she told i. “It made me jolt. I’ve had tattoos and that was nothing in comparison to getting the coil.”

Becca said she left the treatment room “in shock”. She continued: “I drove home and I remember crying out in pain in my car while I was driving because it felt like the only thing that would make it go away.

“I took paracetamol and ibuprofen painkillers all day and they didn’t even touch the sides of the cramps I was having. I felt sick; I was doubled over in bed with a hot water bottle.”

She said it made her feel “angry” to know she could have been “spared that pain” with adequate pain relief. “It wasn’t presented as an option at all,” she added.

Mia Dakin, 25, from London, was expecting to have local anaesthetic during her appointment to have a hysteroscopy and a coil fitting at Homerton University Hospital in London.

However, when it came to the appointment in February 2023 she was not given any pain relief at all.

She told i: “They did the procedure and there was no numbing gel, no local anaesthetic nothing.

“Afterwards, they said, ‘Make sure you pick up some painkillers on your way home’.

“I had really severe cramps to the point of feeling nauseous. My vision was blurring – it was honestly the worst pain I’ve ever had.

“The whole thing was awful. They were talking me through what they were doing but it was so painful and then they basically just said, ‘Okay off you go’.

“I went out and almost immediately felt like I was going to pass out.

The hospital has been contacted for comment.

Emma, 26, from South East London, had a vastly different experience with her coil fitting at her local sexual health clinic in January 2023.

She took painkillers beforehand and was given numbing gel on her cervix during the procedure.

“I was expecting the worst but in the end, actually, it really wasn’t so bad,” she told i.

She continued: “I was warned that I might find parts of the process uncomfortable and actually, I found the insertion of the speculum the worst part.

“I felt like I was taken care of and that my experience of pain – to the extent that I had it – was taken seriously.”

Dr Janet Barter, president of the FSRH, said that “women aren’t always getting the care that we would like them to get” due to pressure on the healthcare system.

Despite the guidance, she said some women are getting coils fitted without “proper conversation about pain relief” and not every clinical setting has every pain relief option available.

She told i: “It’s all about personalised care. So different women need different levels of pain relief and clinical settings can provide different levels of pain relief.

“We would advise that anyone who is going to fit an IUD should have a conversation with the patient about what pain relief options are available in general, and what pain relief options are available in that setting on that day.

“And then to have a discussion with the patient about whether they want to go ahead that day or whether they would like to be referred somewhere else.”

Dr Barter said medical professionals are doing the best they can, but the system is “very, very pushed” and not everyone has been trained to administer all methods of pain relief.

“It’s not that every woman everywhere will be able to access all methods of pain relief,” she said.

Simphiwe Sesane – a contraception and sexual health nurse consultant at MSI Reproductive Choices who was featured in the documentary – said she ensures adequate pain relief is given to her patients but this is not always the case elsewhere.

She told i: “With any guidelines, there can be a delay in people being trained up, especially with things like the injection.

“Guidelines can change, but there can be a bit of a time lag before it’s actually implemented within services.”

She said GPs do not necessarily have a medical professional who is qualified to train the members of staff and they may not have enough funding to offer certain services.

She advised people to ask questions about what pain relief is being offered as “there are settings that do not offer the whole array of local anaesthetics”.

“There is such a postcode lottery in terms of access,” she said, adding: “There are areas where pain relief is just not available, you have to travel which is not very fair on those women.”

Alice Pelton, founder of contraception comparison and information website The Lowdown, said she has noticed increasingly positive reviews of the coil since the FSRH guidance came out – but it is yet to filter down fully.

“We’re hoping in the next few years that will filter down properly and that women will get the numbing cream and injection – exactly like Davina had,” she told i.

She wants to empower women to ask what pain relief is available at their local clinic to make sure they feel happy with their upcoming appointment.

“I don’t really think women should have to ask but at least we’re starting a conversation,” she added.

Professor Kamila Hawthorne, chair of the Royal College of General Practitioners said: “GPs take sexual and reproductive health extremely seriously and are highly trained to have open, sensitive and confidential conversations with patients about contraception.

“But responsibility for delivering sexual and reproductive care is split between the NHS and local authorities, meaning that it is often fragmented and complicated to access. It is also significantly underfunded, for example, the funding a GP practice may receive to run a LARC-fitting service, may not always cover its costs.

“GPs and our teams are highly-qualified to help patients decide what type of contraception will suit them, and the potential side effects associated with each – but LARC-fitting itself is an enhanced skill, for which some GPs will receive specific training, and part of this will be around pain management.

“Many patients manage the discomfort associated with coil fitting with over-the-counter medication, but analgesia or anaesthetic interventions are also options, which do come with their own potential side effects to consider. No healthcare professional wants to see their patient in pain, so if they are concerned about experiencing pain ahead of a procedure – or if they experience pain during it – we would urge them to say something, so that this can be addressed.

“To improve the experience for the millions of patients currently using contraception, we need to see greater funding into primary care sexual and reproductive health services, to make sure patient care is well coordinated and accessible in the community.”