Delia Mendoza, a PR consultant from Los Angeles, recounted her experience with an endometrial biopsy in 2021. Despite being told she would only feel "pressure, followed by a pinch," Mendoza said the procedure was excruciating. "I was sobbing and shaking with pain. It literally felt like my insides were being ripped out," she said. "I was led to believe it would be a minor pinch, but the reality was intensely painful, and my experience felt completely invalidated."
Mendoza’s experience is not unique. A 2024 Harris Poll found that 72% of U.S. women have delayed a gynecology visit, with over half citing fear or discomfort as the reason. The issue has also gained widespread attention on social media, with a 2023 study revealing that 97% of the top 100 TikTok videos tagged #IUD were related to the pain of insertion.
ACOG’s New Guidelines
In May, ACOG released updated guidelines for healthcare professionals, urging them to "not underestimate the pain" patients endure during in-office procedures and to provide them with "more autonomy over pain-control options." The guidelines outline which medications have been shown to help, including local anesthetics like lidocaine sprays, creams, or injections for procedures like IUD insertions and cervical or endometrial biopsies.
For Mendoza's specific procedure, an endometrial biopsy, the guidelines suggest that topical or injected anesthetics and NSAIDs like naproxen may help reduce pain. A January 2025 study further supports this, finding that intrauterine lidocaine significantly lowered pain scores for women undergoing the procedure compared to other pain management methods.
Innovation in Instruments
Beyond pain medication, medical innovators are also working to redesign instruments that have remained largely unchanged for centuries. The vaginal speculum, a notoriously uncomfortable device, is getting a modern makeover. While plastic speculums have become more common and are often more comfortable than their traditional metal counterparts, a new five-petal design called the Bouquet Speculum has been cleared by the FDA. Researchers hope its horizontal and vertical opening will make Pap smears more efficient and less painful.
"The basic instruments I use every day... were created in the 1800s," said Dr. Rachel Pope, a professor of obstetrics and gynecology at Case Western Reserve University. "There’s been very little innovation despite huge advances in technology and other areas of medicine."
While these innovations offer hope for a less painful future in women’s healthcare, experts caution that there's no single solution. Dr. Kristin Riley, an author of the ACOG guidelines, notes that it's difficult to predict who will experience pain, and that's why accurate communication from doctors is essential.
"Women have a range of experiences—we can’t assume it’s not going to be painful," said Dr. Louise King, a gynecologist at Harvard Medical School. The ultimate goal, it seems, is not just to reduce pain but to validate the patient's experience and ensure they feel heard and respected.
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