Note: Our goal is always to be inclusive in our content. In this article, we reference research that uses terminology comparing men and women. We use the two terms to represent the studies’ findings in the section below.

Research has revealed gender differences in how doctors view and treat pain. Examples from recent studies, which focus primarily on the differences between men and women, include:

• Men wait an average of 49 minutes in the emergency room with severe stomach pain before receiving pain medication. Women wait an average of 65.
• Doctors prescribe less pain medicine for women 55 and over than for men in that same age group, and nurses gives less pain medication to women 25-54.
• Women with chest pain or symptoms of heart disease are two times more likely to be diagnosed with a mental illness than men.

This gender bias is even more pronounced for women of color and trans women. Studies show that doctors are more likely to underestimate Black patients’ pain or to attribute pain experienced by trans women to hormones.

Taking gynecologic pain seriously

Pain is a complicated topic. There are physical and psychological components. Trauma can also contribute to or be a cause of pain. In gynecology, these layers are even more complex. For example, Pap smears can be very painful for some patients. There can be a wide range of sensation, from using a speculum or from the Pap smear itself. Some patients feel nothing while others may experience severe pain.

Research on pain during gynecologic procedures shows that many patients either grit their teeth (assuming their pain is normal), or they avoid seeking care altogether. However, there are many ways your gynecologist can help.

"It's important to create an environment where people feel safe and can trust their provider," says Lisa Bayer, M.D., MPH, an OB-GYN at the OHSU Center for Women’s Health, "I never want patients to avoid care because of a painful or traumatic experience."

 Some of the myths surrounding pain and gynecologic health are:

• Periods are supposed to be painful.
• Standard procedures should feel like nothing more than “just a pinch.”
• Something is wrong with you if you experience pain during a routine exam.

The truth is that you don’t need to experience pain during your visit. Providers at the Center for Women’s Health take pain seriously and will meet you where you are. You can request pain control options for any procedure, even a pelvic exam. If your pain is concerning enough for you to fear or put off treatment, talk with your care team about options.

"I like to remind my patients that it’s rare for pelvic exam to be an emergency situation," says Dr. Bayer. "The patient is in control. If we need to stop, regroup and come up with a different plan to complete the exam or procedure, then that’s 100% ok."

Pain control options for gynecologic procedures

During your visit

Simple options are available to help relieve pain. These options do not require planning ahead of time.

Comfort measures
Sometimes a heating pad, dimming lights, having a support person or listening to music can make exams or procedures more comfortable.

Oral medicine or injections
You take a non-opiate pain medicine either orally or by injection. Common options include ibuprofen, Tylenol or Toradol.

Local anesthetic
Your doctor can either place an anesthetic gel around opening of the vagina or inject numbing medication around the cervix. Called a paracervical block, the medicine numbs the area and eases pain.

Sedation clinic options

Sedation options are available to all patients. You need to make these arrangements before your visit. Because you may be drowsy after your procedure, you will need a ride home.

Minimal sedation (anxiolysis)
Your doctor gives you a single medication to lower pain or to help you relax. You remain awake for the procedure. The medication works quickly, but may take up to 24 hours to wear off completely. Options include an opiate pain medication or an anti-anxiety medication.

Moderate sedation
This is sometimes also called conscious sedation. You receive both a pain medication and an anti-anxiety medication via IV in the sedation clinic. You may feel drowsy or even fall asleep, but can awaken when spoken to.

Deep sedation
This is a form of deep sedation that takes place in the operating room. You are asleep for the procedure.

“There is not a one-size fits all approach to pain control for gynecologic exams or procedures,” says Dr. Bayer. “Sometimes we might try a few different options until finding the right one for the patient. Other times, patients come in with prior experiences and know exactly what they want – and what they don’t want.”

"It’s important that patients know what all the different options are so they can make the best decision for themselves,” Dr. Bayer adds.