If you’ve ever lain on an exam table, been told something would be “a quick pinch,” and then felt something that was not a quick pinch — and then apologized for flinching — this is for you.
You didn’t overreact. The estimate was off. And that isn’t a feeling; it’s been measured.
What everyone was told
Most of us were raised to trust the person holding the instrument. They’ve done the procedure hundreds of times. They know what it usually feels like. If they say it’ll be mild, it’s reasonable to expect mild, and reasonable to assume that if it isn’t, the problem is you.
That trust isn’t foolish. Experience does make clinicians better at many things. But there’s one thing experience doesn’t automatically improve, and it turns out to matter a lot: knowing how much something hurts someone else.
The inversion
In a study published in Contraception, researchers asked 200 women having an IUD inserted to rate the pain at its worst point on a 100-millimeter scale. Then they asked the clinicians performing the procedure to estimate the same thing.
Patients rated it 64. Clinicians estimated 35.
Same procedure, same room, same minute. Nearly half the pain disappeared between the patient’s experience and the provider’s estimate. The pattern held across the study: providers consistently judged the procedure as less painful than the women having it said it was, and often misjudged which moment hurt most.
It isn’t only IUDs. In a study of 981 emergency department patients with acute abdominal pain, women and men reported similar pain scores. Women waited longer for pain medication — a median of 65 minutes compared with 49 — and were less likely to receive opioid analgesia, 45% compared with 56%.
Here’s the mechanism, and it’s less about malice than about calibration. Think of a kitchen scale that reads light by nearly half. Every individual measurement looks plausible. Nobody notices until someone weighs the same thing on a different scale. Pain is invisible; clinicians infer it from expression, history and expectation. If the expectation is “this is minor” or “women tend to exaggerate,” every reading comes in light — and the treatment is sized to the reading.
Sources: Maguire et al., Contraception, 2014 · Chen et al., Academic Emergency Medicine, 2008. Full references below.
What this means in real life
It means the advice you were given before a procedure may have been based on a number that was wrong by half.
It also means the quiet conclusion so many women draw — I must have a low pain threshold — rests on a comparison that was never fair. You weren’t being measured against other women. You were being measured against a guess.
And it compounds. Pain that’s underestimated gets undertreated. Pain that’s undertreated makes the next appointment harder: more bracing, more dread, sometimes avoided care. One study can’t tell you about your specific doctor. It can tell you that if your experience didn’t match what you were told, the mismatch has a documented direction.
There’s a practical cost here that rarely gets named. The IUD is one of the most effective forms of contraception available, and fear of insertion pain is one of the reasons some people avoid it. When a clinician says “quick pinch” and the patient experiences something closer to 64 out of 100, the patient doesn’t just have a bad afternoon. She tells her friends. She delays the replacement. The underestimate travels.
It also shapes what gets researched. If clinicians believe a procedure is mildly uncomfortable, there’s little pressure to study better pain control for it. Women had been describing IUD insertion pain for decades before national guidance asked clinicians to counsel every patient about it. The guidance followed the testimony; it didn’t lead it.
None of this requires bad intent. It requires a measuring system that nobody recalibrated. That’s a more hopeful diagnosis than malice, because calibration can be fixed — and it starts with patients reporting the real number and clinicians writing it down.
What actually helps
In August 2024 the CDC updated its U.S. Selected Practice Recommendations for Contraceptive Use. Before IUD placement, all patients should be counseled on potential pain and on the risks, benefits and alternatives of pain-management options. The guidance notes that lidocaine — as a paracervical block or applied topically — might be useful for reducing pain, while acknowledging that the trial evidence is mixed.
That shifts the default. Asking about pain relief isn’t a special request anymore. It’s part of the standard. A few questions worth bringing:
- What pain relief do you offer for this procedure, and what does the evidence say about each option?
- Can I take something beforehand, and when?
- Can we pause if I need to?
- What should I expect afterward, and what’s not normal?
If you have a history of painful exams, trauma, or a previous difficult insertion, say so at the start. It isn’t oversharing. It’s clinical information.
The same goes for dread. Anticipation changes how pain is experienced: a body that expects to be hurt braces, and bracing makes many procedures harder and more painful. Clinicians who know that can plan for it — more time, more explanation, a different approach to positioning, a plan for stopping. Telling them gives them the information they need to do the procedure well.
Your pain was measured. The measurement was low, and the care was sized to the measurement.
Report the real number. It belongs in the chart.
Next in On the record:. And if you’d rather start closer to home, the quiz asks what your body actually needs.
References
- Maguire K, Morrell K, Westhoff C, Davis A. Accuracy of providers’ assessment of pain during intrauterine device insertion. Contraception. 2014;89(1):22–24. Link
- Chen EH, Shofer FS, Dean AJ, et al. Gender disparity in analgesic treatment of emergency department patients with acute abdominal pain. Academic Emergency Medicine. 2008;15(5):414–418. doi:10.1111/j.1553-2712.2008.00100.x
- Curtis KM, Nguyen AT, Tepper NK, et al. U.S. Selected Practice Recommendations for Contraceptive Use, 2024. MMWR Recommendations and Reports. 2024;73(3):1–77. Link
