An unknown number of women are experiencing vaginismus after painful contraceptive coil (also known as IUD (intrauterine device)) fittings. Vaginismus is a psychosexual condition. For sufferers, all kinds of vaginal penetration become painful, uncomfortable and, for some people, impossible.
Hannah, a 24-year-old student from west Surrey (UK), is among this number. She is now dealing with painful and life-changing vaginismus after a coil fitting which, she says, left her "in agony".
Vaginismus is caused by the body’s automatic reaction to the fear of penetration. Something in your brain triggers your vaginal muscles to tighten, sometimes to the point where you can’t even see the vagina’s opening anymore. There are two types of vaginismus: primary, where you have the condition before you start having sex, and secondary, where something triggers it later in life – a painful medical procedure, infection or a sexual assault.
Hannah has secondary vaginismus. When she went to her GP for a preliminary consultation to discuss having the IUD – a T-shaped contraceptive device, sometimes referred to as a 'coil', which is inserted into the uterus to prevent pregnancy – fitted, she didn’t expect to be offered the procedure there and then.
"I was a little taken aback," she tells Refinery29. "But I’d already made up my mind [to get the coil], so I thought, Why not?"
Having had a rough time on the pill, Hannah decided to go for the coil because she didn’t want to worry about remembering to take the pill every day, or the other side effects related to hormonal contraception (such as mental health issues). "The pill messed with my emotions," says Hannah.
The non-hormonal coil is 99% effective at preventing pregnancy, according to the NHS, and lasts between five and 10 years. Hannah thought it was a no-brainer.
"The procedure was unlike anything I’ve experienced before," Hannah continues. "A nurse held my hand and I felt the coil go in. It was a weird and uncomfortable sensation but not necessarily painful at first."
Though she initially felt fine, Hannah began to feel faint within minutes. She vomited as soon as she got back into the surgery waiting room. She was put in a wheelchair and taken to lie down. Then her GP told her that her "cervix had gone into shock" following the procedure, which can occur due to stimulation of the nerves to the cervix. Once recovered, Hannah’s dad picked her up and took her home.
Every time we [had sex], I was in excruciating pain afterwards. I'd have to lie down on the floor as I felt dizzy if I stood up, and I'd never felt pain like it.
The pain didn’t stop there. "The days that followed were agony," she says. "Before getting my IUD I'd never really experienced period cramps but I started getting them so badly […] that I’d have to lie down on the floor."
"I felt so sick and dizzy and I couldn’t do anything but wait for them to pass, including work," Hannah continues. "Nothing really helped fully with the pain, I'd take pain relief and have a hot water bottle but it didn't take it away."
Hannah was in a new relationship at the time and after waiting the recommended amount of time (around three days), she attempted to have sex with her boyfriend.
"Every time we [had sex], I was in excruciating pain afterwards," she tells Refinery29. "I'd have to lie down on the floor as I felt dizzy if I stood up, and I'd never felt pain like it. Weeks passed and nothing really changed but my doctor had said it would take about 12 weeks to settle down, so I waited."
Twelve weeks passed. Still nothing changed.
"Sex after getting my IUD was never the same – I no longer enjoyed it," Hannah says. "I think psychologically I'd linked sex with pain, not pleasure, so my libido decreased massively, and every time my boyfriend and I did have sex, my vagina could never relax; it was always really tight and sore. We were also limited in what positions we could go in; with some, if he went too deep it hurt and I felt the IUD knock against something inside of me."
Eventually, Hannah went back to the doctor for a scan and some blood tests. She told her GP that she suspected she was suffering from secondary vaginismus. "They wanted to get the test results back before looking into it further," she says. "But afterwards they seemed to lose interest. One GP suggested that it's a common thing among my age group – that I'd 'grow out of it' – and even recommended having a drink before sex to help me relax." As Refinery29 has previously reported, Hannah is not the only vaginismus sufferer to have been told by a GP to drink alcohol.
Dr Laura Jarvis, speciality doctor in sexual and reproductive health and a spokesperson for the Institute of Psychosexual Medicine, which works with the Royal College of Obstetricians and Gynaecologists (RCOG), told Refinery29: "The causes of vaginismus are not always clear but it is possible that an unpleasant or uncomfortable experience can induce a fear of penetration, which could cause the body to have this automatic reaction in the future."
"How women experience IUD fittings is very varied," she added. "While many women find the pain manageable, some women find IUD fittings can be very painful, and then this could lead to a negative association or feeling of pain."
Crucially, Dr Jarvis says that while having an IUD fitted is "similar to experiencing period cramps" for some women, others do "experience severe pain" and it can "be difficult to predict how an individual’s body will react to the pain".
Vaginismus can have an enormous impact on sufferers' self-esteem, mental health and overall quality of life. "I felt so abnormal for the longest time," says Hannah. "All of my friends were talking about how amazing their sex lives were, and I felt like a failure."
"I'm not enjoying my life like I used to," she adds. "The experience has impacted my relationship quite a bit […] and it caused quite a divide between myself and my boyfriend. I just can't quite believe that they gave me that procedure so easily, without a warning about the pain or any time to prepare and, crucially, that I wasn’t given any pain relief."
Hannah is one of many women to make this complaint. Last year a petition calling for pain relief to be offered for IUD insertions and removals gained more than 33,000 signatures. Lucy Cohen, who started the petition, reportedly heard from 1,500 women who had the coil fitted. Forty-three percent rated their pain as a 7 or higher out of 10, with some describing the pain as "excruciating" and "almost unbearable".
Lucy’s petition sparked a national debate. The BBC presenter Naga Munchetty opened up about her own painful experience of getting the coil, during which she "fainted twice". Despite having a high pain threshold, she wrote for Refinery29 last August that having the IUD fitted was "one of the most traumatic physical experiences" of her life.
This sort of pain is known to be common for women who – like Munchetty – have not given birth. According to one study, 70% of women who had not given birth experienced mild to moderate pain during insertion, while a further 17% experienced severe pain.
If this was a known risk of coil insertion within the medical community, why did it take until 2021 for the standard-setting organisation for sexual health physicians in the United Kingdom – the Faculty of Sexual and Reproductive Healthcare (FSRH) – to change its guidelines to say that all women should be offered pain relief when having a coil fitted?
The FSRH’s updated guidance to members reads: "We recommend healthcare professionals to create a supportive environment and offer appropriate analgesia […] Not all clinics or GP practices are able to offer local anaesthesia – and where this is the case, referral to another service should be in place."
Refinery29 asked the FSRH why these guidelines were not updated until 2021. They did not respond.
Refinery29 also asked the National Institute for Health and Care Excellence (NICE) to comment. NICE declined to comment but explained that its guidelines state that healthcare professionals advising women about contraceptive choices should be competent to help women to consider and compare the risks and benefits of all methods relevant to their individual needs and manage common side effects and problems. NICE is a public body of the Department of Health and Social Care in England which oversees clinical practice guidelines.
The real-life impact of the administration of coils without pain relief cannot be underestimated.
Liberty, a 23-year-old trainee primary school teacher from Devon, suffers with endometriosis, with which she was diagnosed at 17. This condition means that sex was already painful for her. As a result, it was decided by her consultant that she would have a hormonal coil fitted under general anaesthetic to alleviate her symptoms. The procedure went well and afterwards Liberty was fine.
However, almost in August 2021, Liberty attended a routine appointment with her consultant and was told her coil needed to be changed due to complications relating to her endometriosis. This time, she was not given pain relief.
My body closed up. I think it was the psychological impact of being unaware of what was going to happen. If I'd have known, I could have prepared.
"I wasn't prepared for the second fitting," she says. "I had odd socks on and it was an all-around awkward experience. It was painful, because I wasn’t given time to take painkillers beforehand."
For a year and a half after that appointment, Liberty says, having sex was impossible.
"My body closed up," she tells Refinery29. "I think it was the psychological impact of being unaware of what was going to happen in that appointment. If I’d have known, I could have prepared. I'm quite a nervous person and the shock must have been too much for me."
"Living with vaginismus is painful, both physically and emotionally," Liberty continues. "I felt upset that my consultant had put me in that situation but I was also frustrated with myself because my body felt like it had finally given up, and my confidence was knocked massively, which has been a journey in itself."
Dr Jarvis told Refinery29 that "having an IUD removed will not necessarily stop the vaginismus."
As for how healthcare professionals can better support women who decide to get the coil, Dr Jarvis said: "We encourage healthcare professionals to explain what will happen before fitting the IUD and check in with women during the procedure. If they are struggling with pain then the procedure should be stopped or they should be offered the appropriate pain relief. Nobody should ever feel like they ‘have to’ go through with something, and should never have their concerns dismissed by a healthcare professional."
"What is vital is that all practitioners recognise that we are all different and that whatever the circumstances all patients have the opportunity to consider anaesthesia options – even if that means delaying the procedure or having it performed somewhere else," she added.
Both Dr Jarvis and the RCOG say they "support more research to better understand why such different levels of pain are experienced, and to help identify who may experience more severe pain".
There is a problem with gender inequality when it comes to healthcare in the UK. As a result, women and people with cervixes are not receiving the treatment they deserve. The government itself confirmed this in a report published at the end of 2021.
That report followed a consultation where women and girls in England were asked to share their experiences of healthcare (and which Refinery29 readers were invited to participate in as part of our Uncharted Bodies series) in an effort to close the gender health gap. The government has since vowed to "reset the dial on women’s health". It plans to set out what it is calling a "Vision for Women’s Health" which will include key government commitments while recognising the system-wide changes required to tackle some of the issues raised by the consultation. This will be included in the government's women’s health strategy, which is expected to be published in spring 2022.
Dr Jarvis said that anyone suffering with vaginismus should "contact their doctor, and ask to be referred to a specialist". She added that treatment for the condition includes "relaxation techniques and vaginal muscle exercises can help to make the removal [of a coil] a less uncomfortable experience". This is usually carried out under the guidance of specialist therapists, who will help to explore a woman’s feelings around penetration. These specialists are known as 'psychosexual therapists' because they are trained to look at both the mind and body in their approach to treating conditions like vaginismus.
As Lucy’s petition and Naga’s story show, Hannah's and Liberty's experiences are not unique. There might now be more awareness of the potential impact of a painful coil fitting but the question remains: why, until now, were women not routinely offered decent pain relief for this type of procedure? Why was the pain it can cause downplayed? Will the new women’s health strategy mean that such oversights do not happen in the future? That remains to be seen.