Finally, a first step in taking women's health seriously
Key Takeaways
Industry Buzz
“Systemic racism and bias as to how pain is experienced and who experiences it also has, unfortunately, influenced pain management considerations.” — Christopher M. Zahn, MD, FACOG
“Patients know their own bodies best and know what their priorities are for a procedure—whether they want it to be completed as quickly as possible, whether their priority is reduction in acute pain, or whether they’d prefer to be able to pause the procedure if needed to try a different intervention.” — Kimberly Hoover, MD, FACOG
In a long-overdue shift, the American College of Obstetricians and Gynecologists (ACOG) is calling for clinicians to routinely offer pain relief during in-office gynecologic procedures like IUD insertions, cervical biopsies, and endometrial sampling.[]
While it may seem obvious to patients and many practicing clinicians, this is the first time ACOG has clearly stated that procedural pain in women’s health deserves attention, intervention, and shared decision-making.
“As a women’s health nurse practitioner, I treat patients every day who express anxiety about pain related to common procedures like IUD placement,” Genevieve Hofmann, DNP, WHNP, coauthor of the guidance, said. [] “Unfortunately, many patients feel their pain has been diminished or dismissed by their clinicians, which data shows can lead to patient dissatisfaction and distrust. ACOG’s new guidance provides critically important patient-centered recommendations on how to help our patients have better experiences and will help improve trust between patients and clinicians.”
What’s new in the guidelines?
The new guidance emphasizes that pain during in-office procedures is highly variable and often underestimated—and that failing to offer relief can erode patient trust and delay care.
Rather than a one-size-fits-all approach, ACOG recommends clinicians discuss options in advance and tailor interventions to the patient’s preferences and history.
Recommended options include:
Topical or injected lidocaine (including paracervical blocks)
NSAIDs for pre- or post-procedural cramping
Misoprostol (oral or vaginal), in some cases like endometrial biopsy or hysteroscopy
Sedation or general anesthesia, if clinically indicated
Danielle Tsevat, an OB-GYN at the University of North Carolina at Chapel Hill, noted in an interview with NPR that lidocaine cream and spray are potential options for patients who want to avoid needles. However, she acknowledged that there's limited research on how effective those topical applications are compared to injected anesthetics.[]
Related: Women and pain: When gender bias affects pain managementWhy now?
This shift didn’t happen in a vacuum. Over the past several years, patients have increasingly spoken out—especially on platforms like TikTok—about experiencing intense pain during IUD insertions with no warning and no pain relief offered.
At the same time, studies have consistently shown that women’s pain—especially among Black and Latina women—is more likely to be dismissed or downplayed.[] ACOG’s advisory doesn’t shy away from this reality, calling for equitable, person-centered care that takes both individual experience and systemic disparities into account.
“What I hope clinicians will take away from this guidance is the absolute importance of comprehensive pain management counseling—not just for mitigating pain in the moment but also for improving trust with our patients and ensuring better access to gynecologic health care for every person,” said Christopher Zahn, ACOG’s Chief of Clinical Practice.[]
What this means for practice
This isn’t just a philosophical shift—it’s a clinical one. ACOG is asking providers to move away from the outdated norm of “just breathe through it” and instead default to evidence-informed, proactive pain control.
That may require operational adjustments—like stocking lidocaine, updating intake protocols, and managing insurance hurdles—but the underlying message is clear: the era of ignoring procedural pain in women’s health needs to end.
And this guidance is one real, institutional step in that direction.
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