Zijn artsen laconiek over vrouwelijk leed? (De snijtafel #87)

Episode Overview

The episode examines how doctors and medical organizations have responded to reports of pain during IUD insertion. Hosts Kasper C. Jansen and GP Madelief Wijdeveld discuss a column by GP Rinske van de Goor and a statement from the Dutch College of General Practitioners (NHG).

Patient Reports and the Evidence

Van de Goor’s column argues that alarming accounts of IUD insertion could discourage women from using effective contraception. The hosts agree that people deserve reliable, balanced information when choosing contraception. They also note weaknesses in an opinion piece by the AVA Foundation: its claim that “many” doctors dismiss pain is vague, and the accounts it presents are not a scientific study.

However, the hosts argue that patient reports should not simply be dismissed. Pain and whether patients feel heard are important, and reports of distress can be a reason to investigate further.

Their main criticism of the column concerns its use of a study in which 93% of participants received local anesthesia. Most participants rated their pain as absent, mild, or uncomfortable, but the study also recorded painful experiences and found that doctors tended to rate patients’ pain lower than the patients did. The column initially cited the study without mentioning the anesthesia. The hosts say a later correction, added after AVA raised the issue, did not adequately address how the anesthesia affected the argument.

The hosts also discuss other studies with higher pain ratings, while cautioning that the research varies and does not establish a single experience for everyone.

Later research commissioned by AVA among Dutch women found that more than half reported severe or unbearable pain during insertion. Some reported pain lasting weeks or months. Local anesthesia was rarely offered in the survey. The hosts say these findings make it difficult to dismiss women’s concerns as simply a reaction to media coverage.

They also stress that insertion pain can be substantial even when a procedure is performed correctly, and that feeling dismissed can make a painful experience emotionally worse.

The NHG’s Response

The episode also scrutinizes the NHG’s response. Its statement said that IUD insertion can be briefly painful and advised discussing pain relief. However, the existing standard mainly mentions paracetamol or an anti-inflammatory painkiller; it does not clearly recommend local anesthetic gel or injections.

The hosts question the NHG’s rationale for not recommending these options, noting that its evidence review appears limited and that newer research was available. They also criticize the statement’s ambiguity about whether clinicians should routinely discuss options that are not included in the standard.

Pain Relief and Clinical Guidance

The discussion considers practical trade-offs. Sedation may reduce distress, but it requires hospital care, adds cost and travel, and may make the procedure less accessible.

The American guidance discussed in the episode takes a more individualized approach, including assessing risk factors and considering local anesthetic options. AVA’s later guideline for healthcare providers is described as more comprehensive and up to date than the current NHG standard, though the guests raise concerns about parts of its advice and presentation.

Post-Recording Update

After recording, the hosts discovered that a study accounting for half the evidence in a systematic review cited in support of anesthetic gel had been retracted. This makes them more confident in the case for local anesthetic injections than for gel, while leaving the broader case for improved pain management intact.

Conclusion

The episode argues that the debate should not focus only on whether advocacy might deter contraception use. Medical professionals should acknowledge pain honestly, communicate available options clearly, and avoid treating patient reports as misinformation or an attack on doctors. The hosts also question why the NHG’s promised guideline revision has taken so long.

Van de Goor later attended the episode’s premiere for a discussion.

Presenters and Contributors

• Kasper C. Jansen
• Madelief Wijdeveld
• Rinske van de Goor
• Camilla Bazaer
• Mandy Leeuwis — column voice-over
• Simon Burgers — NHG statement voice-over
• Harry Merry — promo music