SIO451: IUD Insertion Videos on TikTok - 0/10 Do Not Recommend

Transcript

This transcript was generated automatically and may contain errors — the audio is the record.

0:00:15 Thomas: Hello and welcome to serious inquiries only. This episode 452 and there's no, there's no tie-in to the book Fahrenheit 451 whatsoever. This unfortunate could have taken advantage of that. Have meant podcast millions. No, we'll just do a regular SIO, but not exactly because Lydia is joining us for this one. And so is Dr. Jenny Wu. Rather than do an intro here and then another intro in the episode, I'm just going to get right on over to the episode in which all will be explained. Right after this break, which you can avoid if you go to patreon.com/seriouspod to support the show, get rid of the ads, get the bonus stuff. Here's our interview with Dr. Jenny Wu. We're joined by Dr. Jenny Wu. And I said we because also Lydia is joining me today. I insisted upon it. I don't know. Apparently, we're planning on not doing that. Seems weird to me. So, yeah.

0:01:05 Lydia: I snuck in you don't have lived experience for this what do you mean

0:01:15 Thomas: But Jenny, how are you doing today?

0:01:17 Jenny: I'm doing well. Thanks so much for inviting me on this podcast. Listened to a bunch of podcasts, but I have never actually been invited to speak on one. So I'm really excited to be here. Yep,

0:01:28 Thomas: Absolutely. I To have you. Um, a there's a lot here, so I just wanted to start by saying when we first, uh, dating around when we first started dating, uh, you had already had an IUD in, right? It was like just before

0:01:40 Lydia: Yeah it was like right before we started dating yep

0:01:43 Thomas: And what's funny is like you told the story of getting it and it was Like so deeply disturbing that like it's genuinely stuck with me and and don't know when you first mentioned it but we talked about maybe doing an episode about it um uh I just really wanted to because it it was so crazy to me like how much women go through and doing it that no doesn't get really mainstream attention like it it's it's it wasn't just you obviously there's like other friends and people we know who have a similar story of like, oh yeah, this thing was like really painful. And yet, you talks about it or at least didn't at the time. And so that always struck me. And, so yeah, why don't you talk about how we got to doing this episode?

0:02:25 Lydia: Um, there was a feature in the New York Times regarding women and IUDs and how this experience that it's more painful than a lot of women are led to believe or it can be more painful rather. And what are the pain management options and like not really having the information at all or having the wrong information. And saw that, you you were quoted in that article, Jenny, and wanted wanted to invite you on after I saw, you a related study of yours and

0:02:55 Thomas: You just teach us what, and I, me, can you just teach me and the audience what an IUD exactly does and maybe like, you know, why it's such an effective form of birth control, some of the trade -offs, some of that stuff?

0:03:09 Jenny: So an IUD is short for an intrauterine device, it's essentially a small T -shaped plastic device that goes into the uterus. There's usually two forms that we talk about, the hormonal IUD, which has a hormone called progesterone, and then the non-hormonal IUD, which is of copper. And so the hormonal IUD works in that it prevents the uterus from having a lot of thick lining.

0:03:39 Jenny: And While the way that the copper IUD works is that it creates this like hostile barrier for sperm. And so it kind of creates this micro environment that is not like, guess it's hostile for sperm, I think is the best way that I can describe it.

0:03:52 Thomas: It's like really feminist and it's like, get the fuck out of here. No, I'm just kidding. I'm tolerating your shit.

0:04:02 Jenny: And both of them are, you know, over 99% effective in preventing contraception. The Paragard or the copper IUD is now approved as a form of emergency contraceptions. So you can put that in within five days of an intercourse. And there's now new data for the hormonal IUD as well as being an effective form of an emergency contraception. Um, so it does involve someone placing the IUD for you. So it is something that needs to be done in the Um, then generally, um, you know, you would have to go to the clinic to get it taken out. The copper IUD is good for 10 years. Um, if not 11, to my understanding, and then the hormonal IUDs good for eight years. So then Mirena IUDs good for eight. And then now they've made a couple of different ones called the Kyleena that's good for five years, the Skyla that's good for three years. And so there's different types of hormonal IUD, IUDs. And I think a lot of that has to do with marketing, you know, marketing the Kyleena and Skyla for women who haven't had a delivery So know, I think it lives within the world of what we call LARCs or long acting reversible contraception. It's

0:05:09 Lydia: I can speak to my experience. I was on birth control pills ever since I was in high school. I had a really irregular period. Skipped my period for like eight months at one point. And I went on birth control pills and had a regular period because of the medication for a period of time. And then at a certain point when I was in grad school, I wanted to transition to a different form of birth control. I wanted something more like long, acting, you know, didn't need to remember to take a pill every day. And I was interested in an IUD because it was, you know, like, set it and forget it sort of approach for a long period of time. And so that was really really appealing to me. So I set up an appointment and I think this was like right right before they started doing like free IUDs with Obamacare. I think this was early on, health but my insurance was really good. So I still paid basically nothing. And I went in for my appointment. Didn't get any any information really about what to expect at all going in. I knew kind of, I guess, the general basics of how it would work because it was, you birth control method I was electing to get. So I had a conversation with my OBGYN. But the person who did the insertion was was not my OBGYN. It was a different doctor for whatever reason that day. And she came in and she was like, OK, you know, is what you can expect in general. Know, you might feel a little like pain, a little bit of spotting after the procedure. Feel free to take ibuprofen. And I had my friend with me because I I just didn't know what was happening. I think we were getting like lunch after or something. And I think I wasn't sure if I'd be able to drive after I like had no idea what to expect. So I go into the office. She gives me kind of this brief rundown and my friends in the office with me. Then what happened next was the horrible. It never been pregnant before. And there was no, like, like, okay, now I'm going to do this. It was more like spread, them. And here's a big pole that we're going

0:05:48 Thomas: Big poll.

0:07:26 Lydia: To shove up you. We have to get this little thing into, past your cervix rather. You know, we have to open up your cervix in, do that. It was horrible. You know went in my body and as she was pushing through to try and open up a space to get it through. I involuntarily like my butt left the the table. And I just like was like this involuntary seizing of all my muscles and stuff. And she was like, you can't do that. You need to relax. And I was like I don't know what to tell you. Like it hurts. I'm not, I'm doing this on purpose. And she was like, you just need to deal with it and figure it out. It was horrible. It was I think she was very dismissive of my experience like she seemed to think that it like couldn't possibly be that painful or that I should have known that it was going to be that painful and I chose this to experience myself so like what did I expect you know like that was sort of that situation for me and as she's continuing the procedure I'm like I'm just kind of pushing through and really trying to push through and trying to keep my butt on this stupid table so I stopped getting yelled at by the doctor and my friend is holding my hand and I like I can feel her looking at me as like the color like left my body and I just started sweating profusely my hands like so clammy and cold and I was was very very very thankful I had my friend there with me because she she and I talked afterwards and she was like yeah you just like looked like a ghost immediately like the way that your body was responding to this in the moment very clearly was incredibly painful and I got more sympathy from this you know non -medical person who was actually like watching me and caring for me as opposed to the doctor who was inside my body at the time. That was a lot. That was a lot, a lot, however, I will say, then it was fine. Like, then I

0:09:37 Lydia: Was like, a little sore, but I went to rehearsal later that night. I had like a little bit of cramping, but it wasn't bad. And then it truly was like a set it and forget it sort of approach. And then I just it for a long time thereafter. I kind of decided, like, don't know if I would do it again. You from know, that very first day, I was like, yeah, I Don't know, if, if that's an experience I'm gonna pursue for a second time, once this thing gets removed, I might be looking at different options, just because it wasn't, I didn't want to have to go through that again. Again. Was really bad. So that's kind of how my IUD journey began.

0:10:17 Jenny: No, no, it's so interesting to always hear from the patient perspective, because we usually don't get feedback from patients afterwards.

0:10:25 Lydia: Man.

0:10:25 Jenny: That's something I've been intentionally doing, is asking patients for feedback, which, you know, goes both ways sometimes.

0:10:33 Lydia: I can speak to you know, what I went through and stuff like that. But in terms of the medical experience, I I just call the thing a big pole. So yeah.

0:10:41 Thomas: Is there a more technical name for the big pole or what?

0:10:44 Jenny: Think the technical term for the poll is probably when the doctor placed the tenaculum on the cervix. And so the teniculum is a device that is totally not made by a person with a cervix, where it's just, it's sharp. And so it allows the provider, the physician who's placing the device to, we call it grasp and stabilize the cervix in a way that's able to straighten the uterus out and allows for a better way of replacing the IUD. And that's, you know, it kind of makes a little bit safer. So you're not poking the IUD through the uterus. But I mean, placed tenaculums quite often in my job, it does not look comfortable. As a person who's had an IUD, I totally get that the experience is, you different than anything you've ever felt before, before if you haven't had a baby.

0:11:37 Thomas: It sounds like hun for you is a lot of it might have been made better by just having fair warning you know like is that part of it I mean obviously it's still gonna suck but

0:11:47 Lydia: Yeah. I could see it going either way because I there's also potential for the anxiety of what to expect. Like if you're if you'RE told like some people experience, you know, some amounts of pain. I that I done well with that or I could have not done well with that. I always think like more information though heading into like a medical procedure is probably for the best because you if my anxiety was too much I could've had that conversation with my doctor too how to approach the anxiety I was feeling in advance of procedure but yeah pain medication piece of it too is just shocking to me Like based of how my body responded, like and the only thing that it could be was like you know, no pain management during the procedure, take an ibuprofen after as it were like the same thing as, you cramps or a headache or something like that. It was just unbelievable to me. So I think that would have helped a bit more, too.

0:12:48 Jenny: I think that's such valid points in so many ways. I think one is, you know, how do we talk about pain during procedures? Because having placed a bunch of these IUDs, you Know, the reaction is different. Like I have really young patients who do really well, or people you expect to not do really, well, do surprisingly really well. And some people who have had multiple before being like, Oh, my God, that was the worst thing I've ever experienced in my life. And it's so hard to predict who will do well. And I think part of that is related to everyone has just different cervical nerve sensations. People have different responses to pelvic exams. It's a very private, very invasive exam in so many ways. And so I've definitely thought about that question of, do we prime people and talk about this and say, you're going to experience a lot of pain with this procedure. And is that better for patients versus saying, you know, I think the common thing that has been done a is, you know, talking about it in euphemisms, right, talking about it as a pinch or as a poke. And that doesn't necessarily really describe the experience that

0:13:53 Jenny: People feel. And so I feel the that I practice, you know, I use more terms like this feels like a really deep cramp or some people describe it like this. And it can be a painful experience for some people. But, you know, as a provider on my end, it's so hard to predict, you Know, how well people tolerate a IUD procedure. But you know, I don't think it is in our realm to assume that people are all going to do fine, right. And I think that's where the pain management part of this is so important. I think a lot of that's it's really interesting because there's not a lot of good data out there on pain. Pain studies are the most easy to conduct. They're so varied on so many different ways. And so much different factors that play into people's pain. And I think anxiety in particular is one that really amplifies pain in the gynecological setting. And so I think the way that my and the study has really changed my practice is that I think what people people want is to be offered something for pain, right? I think people don't want to be gaslighted that they're not going to experience pain at all. Or how dare you even think that you're not going to have pain? Or, you dare You like, you bother me with your discomfort in that way. And just

0:15:08 Jenny: Be like, hey, some people experience pain with this. And these are different options. Here are the pros, here are the cons, it may It may mean that you need to come back for a second visit or it means that if you're like, I don't really want to come back or want to get it today, then we can try this other options. And reality is, is the data is not super strong out there for a lot of these different pain management options. And perhaps it's a reason why they just haven't been offered in the past.

0:15:32 Jenny: But I really do think that our generation of gynecologists feel differently about this topic. And I think social media is really playing a part in, you us to change our minds about this or forcing us to care about this topic. You know what I mean?

0:15:46 Thomas: So this is interesting because the on the way you presented it now, gosh, 13 years ago or whatever, I guess that's a while. Um, it really stuck with me because it felt like your, um... wasn't taken seriously or even really cared about. Like it felt... And this was just, again, my secondhand impression from your telling me the story, but that's what what stuck with me. And I, I guess when I saw this article, which the, the you title of which being getting an IUD hurts, why aren't more women offered relief? And was like, I guess what I wanted to maybe get your guys' thoughts on is like, do you think this is the kind of thing, I worried that this is something that it seems like happens a lot in, you know, healthcare, which is like women's pain, not being taken as seriously as men's.

0:16:33 Thomas: And it from your story like is that a component of it or or on what you're saying is it is it more just a problem of like data and lydia's an outlier or I don't know I'm just curious trying to get that that picture yeah

0:16:45 Jenny: Don't think Lydia, you're an outlier at all. I think that your experience is really, really common. And I want to make sure that I validate that, like, I think that IUDs can are be really painful. And they can be really painful for a lot of people, especially people who've never had a vaginal delivery before. I And think that, you know, there's so much data to suggest that, you as physicians and providers don't take women's pain as seriously. And I think we're finally coming to a reckoning about that, and I think it's something that's gained a lot of traction on social media. It's getting a lot of attraction in kind of like our cultural discourse, right? Like the podcast that I love is the cereals, the retrievals podcast. I I think that is such a great podcast about pain and not, taking you pain seriously in the setting of, you egg know, retrievals. I saw the movie Barbie and I thought it was so fun at the end when she goes to the gynecologist. You know, I think that's such a funny joke because it's a shared shameful experience about being a woman is like going to the gynaecologist, right? And I get so many people saying like, to the gynecologist, like my least favorite thing to do, like I'd rather go to the dentist. And I think that the in our specialty are changing, you know. Almost all OBGYNs, at least in my class and, among you the trainees are women now. And, I think, that there is a change in, kind of, the of the the specialty, as well as the way that we are thinking about these issues. Yes, I totally think that Lydia, like your experience is not out of the, normal. And I think it's totally experience that we see a lot of as well. But then we also see people who say, I'm so surprised that was not nearly as bad as I thought it was going to be. And so

0:18:29 Thomas: Like yeah my friend lydia just told me it was gonna be fucking horrible it was fine I don'T know what her deal was yeah is

0:18:32 Jenny: I all those experiences, right? And to recognize that there is a huge range in how people will experience this thing. But at the same time, you want to avoid potentially causing a traumatic experience for someone who then will say, like to you, Lydia, perhaps I'm not going to use this form of contraception anymore because it was so traumatic. And we know that IUDs are highly highly effective for contraception they have so many other benefits besides just providing birth control so

0:18:57 Lydia: Think the other interesting thing, and maybe this is an opportunity for future studies regarding pain, is that the demographics of women getting IUDs has been shifting from my understanding, too. Like, it really used to be women who gave birth and then an IUD was inserted, you know, after the baby was born, essentially, as part of, you're here anyway, kind of thing. Thing. I know, the demographics, from my understanding, have been shifting to a lot of women who aren't mothers already, some of whom don't intend to ever be mothers, but still are seeking this as their contraceptive option. Because to your point, Jenny, that it's, you know, quite effective in preventing unwanted pregnancies for, you goal, I guess, for that IUD.

0:19:48 Jenny: And it's also really effective in you know a lot of women will no longer get periods with an IUD so I think about 50 % of women will not get a period and who wants a period so

0:19:55 Lydia: Mine went away. Yeah.

0:19:59 Thomas: That good okay how how does any of that work? I don't know. Please do educate me. How is that just fine?

0:20:00 Lydia: It was great.

0:20:07 Jenny: So um periods are you know you don't have have to have a period if you're on birth control. I think that's such a core tenet that we don't talk enough about that. If in some form of contraception, you don't need to have a period. Actually, what I think is a funny story is that the inventor of birth control is deeply Catholic, and so he invented the pill with this placebo week so that it would be accepted by the church.

0:20:32 Lydia: That's crazy.

0:20:33 Jenny: You don't need to have a period. And for some of our patients who say that they have mood symptoms, or they have breakthrough bleeding, we just tell them to skip the placebo week of their birth control pills, because you don't need to take them and just keep going.

0:20:33 Lydia: I did not expect that at all. Just keep going. Yeah? Yeah.

0:20:47 Thomas: It's one thing for some, you guy to do that for religious reasons. Why is that still today? What is done? Isn't it like, isn't that typically how it's prescribed?

0:20:56 Jenny: Think some people like to have periods because they like to know that they're not pregnant if they're taking birth control bills as a form of contraception. You know, I often tell my patients, you don'T need to HAVE a period if you DON'T want to and like tampons and pads are really really expensive. An IUD, you know, I think over 50 % of women will be amenorrheic or won't have a period or will have a much lighter period. And so it has a lot of other benefits. You know, we use IUDs even in the cancer setting. So it can be a treatment for early stage uterine cancer for patients who are not surgical candidates. It's a treatment for fibroids, it's treatment for endometriosis. It has a a lot of other benefits besides providing contraception. But I think the basis for our study was really that our young patients don't want an IUD. They're seeing stuff on TikTok, they're seeing something on social media that is moving them away from this really effective form of contraceptive, but also has all these other benefits.

0:21:57 Lydia: Know, we've been talking a little bit about social media and its influence on people making medical decisions. I think that's the case probably across the entire medical industry. Specifically, there

0:22:10 Thomas: Well, as a doctor you must love that right like just super big fan of that

0:22:15 Jenny: A very interesting place to practice I think correct

0:22:19 Thomas: Wait

0:22:19 Lydia: Was sort of this, I don't know that it was a trend necessarily, but kind of a slew of videos on TikTok of women, young women filming themselves during their IUD insertions and posting it for other folks to see. And you decided to look into that a little bit more empirically, right?

0:22:41 Jenny: Yeah, and so, um, guess a little backstory is that I'm a millennial, so I'm not a Gen Z. Um, I got on TikTok kind of around the same time everyone else did during the start of the pandemic

0:22:52 Thomas: Can gen z be doctors already jesus what year is it how old are we shit okay

0:22:56 Jenny: I think my I think my medical students are Gen Z now. So yes, I think Gen Zs are becoming doctors. But I'm just a little bit older than a Gen Z, so I don't really always understand But, you know, I got on TikTok the same time I think most of us did, you Know, during COVID as a form of distraction. So the that the, I guess the algorithm works is that it starts, you you know, more and more showing you videos related to who you are. Terms So of your interests. So mine tend to be like cooking videos or interior design. And then more about your demographics. So being a young reproductive age woman. And I remember I'm a resident. So I'm in my third year of my OBGYN residency at Duke. A And trainee. And so I started watching these videos when was an intern of people recording themselves getting an IUD placed. And it's interesting because when I would see this, I'd be like, oh my God, I don't want an Iud if I watch this video.

0:23:01 Thomas: Where

0:23:57 Jenny: Like they look horrible. These And people are, you in pain. They're talking about in the comments, you Know, how their doctor or never talked about pain options. You can hear in the background, the provider saying it's just a pinch or you'll feel some pressure. And that being so discongruent with like the person's facial expression. And I thought that was just such an interesting difference than how I was talking about IUDs in clinic, you know, saying it is a great form of birth control. It is going to solve all of your problems. It is amazing. It's amazing. Really feeling like like my younger patients, the Zers that we would see would be like, no, I'm not really that into it. I don't want an IUD. And I would, sometimes I would ask them, I'd be like is it because of something you saw on TikTok? And they'd be, like, yeah, yeah it is. And I was, like okay, cool. And, so seeing that there is such a disconnect between how I as a provider talk about IUDs and recommend IUD versus how patients, you know, just aren't interested in it. And you you know, we think a lot about reproductive autonomy and autonomy and contraceptive choice. So, you know I never push an IUD on someone who doesn't want it, but it's always nice to understand the reasons why people are not choosing this form of birth control. So we just decided to study it. I was talking to my mentor, Dr. Jonah Swartz, about it on labor and delivery. And he's like, why don't you study it? And I was like, okay. So essentially it's a very simple design. We looked at the top 100 videos tagged IUD and we used a web scraper so we were able to scrape the data. And we had two medical students that we worked with kind the data along a standard coding. And then I kind of looked at all the discrepancies and we did some really pretty simple statistics and came out with, you know, within this one snapshot of time that a lot of videos had a negative tone about IUDs. So about 40 % of videos had an negative tone of IUD as compared to 20%. And that 30 % really talked about how much distrust they had of their healthcare provider. And videos that really just talked about, you know, a personal experience with getting an IUD, the vast majority of them had a negative tone or an ambiguous tone. And I think over 97% talked about pain and side effects related to an IUD. Also found that a lot of these videos, you now, we scored them along these standardized standardized forms of health information and quality. And while these are not the best scales to use, they do provide a little bit of data that perhaps these videos didn't have a lot of health information, but they were really understandable. So a lot, these videos were really approachable and understandable for patients, but didn't include a lot health information or health information quality. Really published this in the Green Journal or the Obstetrics and Gynecology, which is a journal that gets mailed to every OBGYN who isn't a member of the American College of Obstetric Gynecology. And it's a very, you know, it's a short study, it is a research letter, but really we wanted to talk to other providers that this is an issue that people care about and are talking about on the internet. And while you may not be on TikTok yourself, like our young patients are, and there's

0:27:08 Jenny: A lot coming out that say that Gen Z search on TikTok before they search on Google. It's where they're getting their information. And it's also importantly where they are getting their health information. And so there's a really interesting, a lot of really new research coming out about contraception, misinformation and disinformation on TikTok and the impact that has, especially as abortion access in our country changes. So, you know, this was kind of a study that came out of my own interest risk in the topic. I think highlights something that is part of our cultural discourse now of how are we talking about pain and why are we not talking about pain in gynecology?

0:27:33 Thomas: Good point. I

0:27:51 Lydia: Think also, you know, one of the other elements that is you have to keep in mind as a consumer of things online is that, you always talked about this with things like Yelp. People are not going to be leaving positive reviews. Like if you're taking to the internet, yeah, you have something that you want to complain about or something that was unsatisfactory.

0:28:06 Thomas: Was thinking the same thing. Yeah, yeah. You're way more motivated.

0:28:14 Lydia: Yeah, Yeah, you're certainly more motivated. But now the question is, OK, but how do we make sure that people are applying that perspective when they're consuming that, that is speaking to health information, that it's not necessarily going to be, you whatever percent of people that didn't experience pain and had a perfectly fine IUD insertion experience versus the folks that, And this is coming from me when I just went on my little spiel about how terrible it was.

0:28:42 Thomas: Know, you started the campaign online. Actually, we

0:28:44 Lydia: Yeah, exactly.

0:28:44 Thomas: Should say that.

0:28:45 Lydia: I was rallying everybody. But I think that's an important piece. And I don't know how to help spread that message or to, I don' know, appropriately impact Gen Z or other folks who are getting that kind of material from TikTok as they enter into the healthcare industry. -making space, you know, which, to your point, Jenny, is becoming far more limited and, I constricted depending on where you live.

0:29:18 Jenny: You know, I live in North Carolina and the abortion access in this state has changed dramatically in the last six or seven years that I've lived in this state. So it's definitely creating challenges while really trying to balance patient autonomy and contraceptive autonomy reproductive justice. And so there's a lot of, I think, interesting issues that come up to play here. And I agree with you that I think social media tends to amplify more negative videos because that's more interesting to watch, right?

0:29:51 Jenny: Like, it's not interesting to be like, I had a great experience. It was totally fine. Versus like someone else who, you really share something. And I think what I really got from that is there are a lot of people out there who have really negative experiences with an IUD, you know, and in my limited scope, I see a range here, but it's also possible that my patients aren't telling me that they had such a horrible experience with this. And, you think a lot of patients unfortunately feel like they have to put on a brave face for their doctor when they go through something as, you potentially traumatic and potentially painful like this. Um I also

0:29:50 Lydia: Mm -hmm.

0:30:29 Jenny: Think that

0:30:29 Thomas: As a doctor, how judgy are you of your if patients they're not toughing it out enough? Is that?

0:30:34 Lydia: He's asking because of how I tend to be at the doctor's office. This.

0:30:38 Thomas: Poor Lydia always has to be the best, like, you know, patient or student or whatever, and think I'm just wondering, this is my intuition, I'm not a doctor, but you probably aren't keeping a personal report card of each of your patients in terms of how they handle things in your office. Or are you? Maybe you are. Maybe we can blow the lid right off this one.

0:30:59 Jenny: You think our generation of gynecologists I think just approach this you like I think we've all grown up with a different understanding of trauma -informed care not not to say that there aren't great phys who are not millennials who don't provide this as well but I think like as millennials like we've grown up with that language as part of our like discourse, right? Like that is on our social medias. Like we understand that language and it's more familiar to us. And so, I you think something that I do in my routine practice is I always talk to people like, how are pelvic exams for you? You know, getting a sense of, you Know, just or how much discomfort is is this going to be? And then I, use language a lot. Like, you if know, you feel pain, let me know how, like, I tend to check in quite often with my patients. And I always say, you're in control. If you want me to stop, I stop. And then, you tell me to start them, you, you stop. Right. And so it's, you trying to create some amount of patient autonomy in a situation that feels

0:32:01 Jenny: Feel so vulnerable and not, I think patients, you know, having recently had my IUD exchange, I recognized I was like, Oh, my God, I can't believe I do this to people all the time. Know, like had a past there was like, wow, like this is, you know, and, I think I like had a fairly positive experience, because I do this. So I actually know what to expect, right? I know, like, this is when they're placing the tenaculum.

0:32:21 Thomas: Brought your own pole. Yeah.

0:32:24 Jenny: I know know when they're putting the pole on because, you know, I know the steps of it. And so I that we are talking a lot more about trauma -informed care and that it obviously breaks my heart that there are so many people like you, Lydia, who have had that experience. And I'm just really hopeful that our generation of gynecologists feel differently about this topic.

0:32:45 Thomas: So I'm actually curious, and sorry to make make it specific to Lydia's story, I guess. But if you were Lydia's doctor, what steps are in a situation hypothetically like that? Is it the case that some people, just for whatever reason, it's going to be too painful? Or are there ways to manage it? Or is it like, hey, find a different form of birth control that doesn't involve a large pole? Or Is it like no, there's things we can do and ways that you this can go better I'm just curious hmm

0:33:13 Jenny: Yeah. So I think from this study, it's really changed my practice in that it made me realize that people just want to talk more about the pain and the experience of getting the IUD. And so what I do, and I think what a lot of my colleagues are starting to do now is that I preemptively talk about pain management. So when I have a patient that comes in, they want an IUD, I usually say something along the lines of, you know, for some people, this procedure goes really well. And for some People, this this procedure really hurts and I really believe in offering you something for pain. Here are the different options. And I will admit that, you know, there is not a lot of good data to say this option is better than the other, but I am willing to try whatever you want to make this as least traumatic as possible. And so the things that we hear a lot about and that was offered to you, Lydia, is ibuprofen, right? I think that people should be taking taking ibupropan, like a big dose, like ibuprofen, 800, four of those tablets, you an hour know, before the procedure starts.

0:34:14 Jenny: Just so it kicks in when you get it. Then to continue to take it, you know, every eight hours after your IUD for a day. Data to suggest that something called a paracervical block has benefit in reducing pain for people who haven't had a vaginal delivery before. But a paracervical block is essentially a needle full of lidocaine injected into the cervix at two different places. And so when you describe that to people, people are like, yeah, no, thank you.

0:34:12 Thomas: That makes sense yeah that doesn't sound amazing uh

0:34:42 Lydia: I'll tell you, I had to get lidocaine. I had unmedicated delivery had to change my mind.

0:34:47 Jenny: Good for you.

0:34:51 Lydia: I changed my mind with the second baby.

0:34:50 Thomas: No bad for her that was the first kid and then I was taking a hands -off approach obviously it's your body and then I didn't realize that lydia was just trying to prove something to nobody but herself and so I was like yeah get get the drugs as fast as possible. Get immediately as many drugs as you want.

0:35:08 Lydia: But I ended up having to get an episiotomy for the first baby. So because I didn't have an epidural, I had to get lidocaine before they stitched me up. And that was horrible. That was probably worse than anything I've ever experienced. So the epidural made that a lot easier with the second baby.

0:35:27 Jenny: I'm sorry. I'm so sorry. As someone who has to to do that occasionally it is I hurts mean to watch you know um

0:35:34 Lydia: It's intense. Yeah. Yeah, I don't know if I would would have done the paracervical block, I guess is my point.

0:35:38 Jenny: For sure um I think the data suggests that yeah the paracervical block may be a little bit painful for us to inject but then the overall experience tends to cause less pain so it's kind of like when you go to the dentist and you get like the numbing injection in your in your mouth then and everything else is a little bit better. Is, I think, one of the only thing that has really good, like, randomized control study data to suggest superiority. Other things that I offer, because why not, and they don't cause don't causing much issues is like a lidocaine spray, because I think you know, spray or like lidocain gel, because that doesn't hurt and you spray it and it may provide some benefit. I really do think that anxiety plays a big role in people's experience of the pain. And like, I think having a lot of anxiety because maybe you watch four hours of TikTok about it really amplifies a pain experience. And so for the patient who I think experienced a lot anxiety, like I would offer for an anti -anxiolytic like Sanex or Ativan, you know, a one -time dose, as long as they have someone who can drive them home, because obviously they can't drive if they're taking SaneX. So

0:36:47 Jenny: Those are some options that I offer from a pharmacological perspective. And then from a non -pharmacological perspective, you Know, I think a lot of it is, we call it vocal -local, like, you know your provider really talking you through it. I think, you, know, breathing exercises, exercises,

0:37:00 Lydia: That would have helped me so much.

0:37:03 Jenny: Music therapy. Like there's, so much other things that we can try because why not? Like they don't hurt and there's no side effects to putting music on or, you know, talking know, through it and like validating people's experiences. Is so um

0:37:16 Lydia: Yeah, I way I understood your question earlier, was that in advance, if that would've helped me, but I think what would have helped is someone responding to how I was in that moment, and kind of having a variety of techniques to kind of help me through it, even if there's no like pharmacological thing we can do in the moment, of course, because that's just not going to happen. And also needles. But I like someone validating what I was experiencing, not telling me to just like deal with it, put my butt back on the table and I needed to stay still and to kind of like, yeah, leading through those breathing exercises and things like that, like helping with the pain and the kind in some ways and that moment specifically to help me get through it I think would have been really beneficial

0:38:00 Thomas: Well, yeah. And having some sort of context, I if you're going in for something, no matter what it is, like if you go to a doctor, if you were going in for something and they're like, yeah, you know, pretty easy procedure, no problem. And then all of a sudden it's like a world of pain. You're going to think something's wrong.

0:38:13 Thomas: Like you're gonna think like, oh, did they, they, they went up the wrong pipe. And I don't know, it's like to have the context makes a big difference. If it was presented more in terms of like, you you haven't had a kid before. So I don't know for some people, this could, be as painful as like, you know some amount of childbirth. I bet that would have put you in the headspace of like like, okay, if I feel this enormous amount of pain, at least, you know, that like, it's not because you're dying possibly like in any procedure makes a big difference.

0:38:44 Lydia: If you're talking about informed consent too right like I don't know that I was necessarily totally informed um into it I mean, I know. It's it's tough. Because Like, there talking about percentages and who's going to react in specific ways. It's impossible to tell. Everybody is different. Everybody is different.

0:39:03 Thomas: Well, same but the thing goes for dentistry, actually. I mean, I've talked to my dentist a lot about that, because everyone's nerves are different. And like, for me, I have one like quadrant where sometimes the shot doesn't take, you Now, because like, not everyone's nerves are bundled in exactly the same way. And but like people, don't look at that and go like, okay, well then the default should be just assume everyone's cool. And then if anyone like, yeah, if anyone makes it, it's just good. Hey, stop moving. I'm trying to drill over here. And if somebody makes a fuss, then like, oh, okay. I guess we can maybe do something about it. Like the default is like, Oh no, we're doing a bunch of shots. And talked to my dentist about this again, because I had a big issue one time with a filling because I couldn't get numb in one part. And they're like, yeah, it's, everybody's different. He was telling me like, he has some people, they don't even like need a shot. Like you could just drill on their teeth. They don't care somehow. And it's like, Yeah, bodies people are obviously way different. But even that being the case with dentistry, again, the default is still assume this could be really painful and,

0:39:24 Lydia: Just keep drilling. Oh wow yeah

0:40:03 Thomas: You deal accordingly. And, and you know it's hard to go based on your, you one experience you have, hun, um, but like, it's enough of a thing that that article got written.

0:40:09 Jenny: And and I think that's like the the goal that I feel that I and a lot of other providers um similar to me want to have is that you the default should be here's a bunch of different options for pain and you can pick which one works the best for you and we will do it. And I think the other option that I didn't mention is that you don't have to get it while you're awake, right? Like you can get an IUD placed in the operating room or under sedation. So I think that's another option that, you know, we offer here. You Know, I think That sometimes can be a little bit tricky from a, like a coverage perspective, like sometimes insurances don't always cover you being able able to go to the OR for it. But, you the right patient, you know, it's totally possible, like people don't have to be awake to get an IUD.

0:40:47 Lydia: Wow I was gonna say insurance they're gonna say no yeah man that's interesting

0:40:58 Thomas: I don't want to be awake for anything. I know I'm tired of just any, any dentist, any, anything like I just is sleeping and all these an option there there's risks to that though. Right. Like,

0:41:07 Jenny: Yes, yeah. So then I think the risks are, you know, there may be more risk going to sleep than it is otherwise. But and, talk about trying to get contraceptive access for a lot of people. And that's just not an option from, you financial know, barriers and all that. So it's, you know, regardless of it, we should figure out a way of making, I I mean, even just pap smears and pelvic exams are more comfortable for people.

0:41:28 Thomas: So what's some practical advice for people? Um, maybe, I don't know, in the position to consider, um an IUD or or any other form of thing like is there are the things they should look out for in a doctor are they think you know would you get have any kind advice for people is this the kind of thing that you you still you know recommend despite the what you might have seen on tiktok right oh

0:41:47 Jenny: Yeah, I mean I'm I think like when you look at the data, the most popular form of birth control amongst OBGYNs is an IUD. So, you know, we all love IUDs. We think it has so much great benefit, you now.

0:41:59 Thomas: I like that they always say like oh he's the comedian's comedian or whatever and it's like IUDs they're the they're just birth control yeah

0:42:07 Jenny: Yeah, it's the birth control of the gynecologist. Like we love IUDs and has just so many benefits. So I always recommend an IUD for people because I think it's, you such a great set it and forget it. You know, you want to not have a baby for a certain amount of years, and then you want a baby, we pull it out and you return to your normal fertility. You maybe even I think there's new data suggests that it has the fastest return to fertility of all the different forms of contraception. So it's so great in so many different ways. But I that if pelvic exams are uncomfortable or there's a lot of anxiety associated with the procedure, I think it's worth talking to your provider about if they offer pain management options and what the pain management options are. Thing about these online communities is that they tend to amplify these people, right? Like I went here because they were able to do that for us. And so I think that is a benefit of our internet world is that people who care about these, you know, are probably getting more of these patients coming to see them, which is great, right? Because I think then people are getting better experiences with it. But I do think that all of us should be probably providing better pain management. Management. It's hard, you know, I think I know, you the situation was on and like in your state, but like I only have 20 to 30 minutes with my patients and to consent them for this to talk about the different pain management options to do the entire procedure usually takes longer than 20 minutes and people want to be able to like talk through all this stuff. And so then you're talking about doing two appointments and then the appointment times are three or four months in advance. So,

0:42:11 Thomas: I love that wow Wow.

0:43:44 Jenny: You think there are like logistical issues that come into play for why, why providers aren't talking about this as much as we should, because we just don't have time to. But at the same time, you are ways to think about this in a, you sophisticated and, you know, sustainable way that improves people's experiences. Because, you sense is that if you had a traumatic experience getting a pelvic exam, you're just not going to come back and get them. And that's so important for STI screening, for pap smears, for all the other things that are, you of your routine, you gynecological care.

0:44:16 Lydia: I don't the paper went out, Jenny, and, you know, you mentioned it, findings impacted the way that you approach your practice. Did you hear from other folks in your industry and you're in that practice area that also changed how they approach their office and how they were interacting with their patients? Chance okay

0:44:38 Jenny: So I the interesting story related to that, and essentially one of the top 100 videos is a patient who um that similar to dr that had a horrible experience her IUD, actually wanted to get her tubes tied because she never wanted to have a baby and like just had such a bad experience with IUD and went to her gynecologist and her gynaecologist said, oh, well, we can do it in the operating room under sedation. And then she like name dropped that gyneecologist in the comments. So that gynaecolegist has done a lot of practice of people coming to see her because you know it's one of the most popular videos on tiktok um the time that we did a study on tictok not even from business perspective but just like you know I think that these things get amplified right like people talk about the stuff and then then they talk about who did it and then these people you know get known for that and similarly like that entire practice has changed their practice around IUD placements right like they do lidocaine sprays with all their IUDs and so it's just you this issue becomes more and more important and as patients are advocating for themselves and want this want as part of their care like we as providers just have to change in this way yeah

0:45:19 Lydia: Is popping

0:45:50 Thomas: Absolutely. All right. Well, thanks so much for taking the time and speaking

0:45:54 Jenny: Thank you you so much for having me um

0:45:56 Thomas: Yeah, we always ask is there anything you would like to, you point listeners to? Do? Any, anything, uh, or, um, know it's a little weird depending on people. People are usually like, you know, selling a book or something, but are you selling any more gynecology or no,

0:46:12 Jenny: Oh gosh I don't know I I wish I was selling something because this would be a great a great time to do it um I

0:46:19 Thomas: It's okay. Do you have social media or anything or,

0:46:22 Jenny: I question mean I get a lot is like do you want to be an influencer I'm like absolutely not I do not want to be an influence um I just love like studying this and thinking about it but I I don't have have the personality to be an influencer.

0:46:34 Thomas: There you go. That's an okay answer. A hundred percent. So don't try to contact her, everybody.

0:46:38 Lydia: Thank

0:46:40 Jenny: Actually, you know, I've gotten a couple of patient emails, and I've always really appreciated them. But I think the thing that I would like for people people, to know is that I think it's important to advocate for yourself with your provider and to talk about this and to express your concerns at I really want people to know that I our generation of gynecologists are really care about this issue and that this This is something that we are thinking more and more about.

0:47:04 Thomas: Excellent. Thank you so much for taking the time. Really appreciate it.

0:47:07 Jenny: Thanks so much for having me.

0:47:28 Lydia: Know I mean I only have downers so I don't really want to bring them up I have more examples about how much it sucked Perfect.

0:47:37 Thomas: Yeah, Lydia's not done. She's got a yeah.

0:47:39 Lydia: Buckle up, everybody.