Lucy Cohen is no stranger to pain. As a former professional powerlifter, who represented Wales in international competitions, she knows how it feels when the human body is pushed to its absolute limits.
But nothing, says the 38-year-old from Swansea, prepared her for the excruciating agony she experienced during a recent medical procedure undergone by thousands of women every year in the UK.
This was to have a contraceptive intrauterine device (IUD) — commonly known as the coil — placed in her womb.
Lucy Cohen is no stranger to pain. As a former professional powerlifter, who represented Wales in international competitions, she knows how it feels when the human body is pushed to its absolute limits
It involves inserting the T-shaped implant into the womb via the cervix, the narrow opening at the base of the womb, using a speculum to hold it open.
The coil (so-called because original versions were coil shaped) is routinely fitted in GP surgeries and sexual health clinics across the country, and has become increasingly popular in recent years as it can provide effective contraception for up to ten years before it needs replacing.
What's more, according to the NHS website, the process of implanting it gives women little or no major cause for concern. In gently reassuring terms, it states: 'It can be uncomfortable when the IUD is put in — but you can take painkillers after, if you need to.'
Yet this description contrasts sharply with the experiences of women who, like Lucy, say it left them screaming in agony, traumatised and feeling violated.
'It was utterly excruciating,' says Lucy, who is married to Adam, 36, an engineer, and runs her own digital accounting firm. 'The whole thing took about 25 minutes, and for much of that I was screaming and shouting in pain. It was so bad I almost fainted.
'At one point, my GP asked me if I wanted her to stop but I was just desperate to get it over and done with and couldn't face going through it again. By the end, I was in a state of shock.'
Lucy's story echoes those of BBC TV presenter Naga Munchetty and author Caitlin Moran, who last month shared their own grim experiences.
'It was utterly excruciating,' says Lucy, who is married to Adam, 36, an engineer, and runs her own digital accounting firm. 'The whole thing took about 25 minutes, and for much of that I was screaming and shouting in pain. It was so bad I almost fainted
Naga said she screamed so loudly her husband, who was waiting in a nearby corridor, tried to find which room she was in so he could halt proceedings.
'I fainted twice and felt violated, weak and angry,' she said. Like Lucy, she had been told to take a couple of paracetamol or ibuprofen before her appointment.
Their stories struck a chord with many women who responded on social media. One wrote: 'I was only offered a local anaesthetic injection [known as a paracervical block] after I'd screamed the place down. I thought: 'Why didn't you just do that in the first place?'
Nor is this the only routine gynaecological procedure that women are told is virtually painless yet leaves thousands traumatised.
Good Health has revealed previously how hysteroscopies — checks that inspect the womb for causes of heavy or abnormal menstrual bleeding — are being performed without women being offered adequate pain relief.
Doctors tell women that the 30-minute procedure, performed in an outpatient clinic and undergone by more than 10,000 women a year on the NHS, will be no worse than a smear test and that, if they're worried about experiencing pain, they should take paracetamol or ibuprofen beforehand.
This is despite guidance from the Royal College of Obstetricians and Gynaecologists that a general anaesthetic or sedation should be offered to at-risk women with a 'closed' or tight cervix, such as those who are child-free or post-menopausal.
The Campaign Against Painful Hysteroscopy says it knows of at least 100 women who've been diagnosed with post-traumatic stress disorder as a direct result of painful hysteroscopies.
Women meant to grin and bear itSome women feel they're the victims of an outdated notion that, as they already endure the discomfort of periods and childbirth, they are expected to put up with the pain of gynaecological examinations or procedures. But men are treated differently.
One woman tweeted in response to Naga's story: 'When my husband went for a vasectomy he was offered a general anaesthetic — yet we don't give even local anaesthetic to women. There's a perception that women have to grin and bear it and we are all hysterical.'
In a study published in the Journal of Pain in April, participants were asked to view videos of men and women with identical shoulder injuries and who had reported similar pain scores.
Asked to rate how much pain they thought patients were in, judged by their facial and vocal expressions, women's pain was consistently judged to be less severe — by both sexes — even though they were in just as much agony.
Researcher Elizabeth Losin, a professor of psychology at Miami University, said one reason may be that women are stereotypically thought to be more expressive when it comes to pain, even though there is little evidence for this.
'The tendency therefore is to discount women's pain behaviours as overly expressive, while perceiving men to be stoic,' she says. 'So when a man makes an intense facial expression, you think, 'Oh my, he must be dying'.'
As a result she says, studies show women are often prescribed less pain-relieving treatment, and wait longer to get it, than men.
'Scissors' pierce through the tissueAn estimated 45,000 women a year in the UK are fitted with a coil, widely regarded as one of the most effective forms of female contraception, second only to surgical sterilisation. The devices, made of metal or plastic, come in two forms. Hormone-based IUDs gradually release progestin to thicken mucus around the entrance to the womb, stopping sperm entering.
Non-hormonal IUDs are made with copper, which acts as a spermicide.
To insert into the womb, a doctor or specially trained nurse first inserts a speculum to gain access to the cervix.
The thin lining of the cervix is then pierced using a tenaculum, an instrument that looks like a pair of scissors with a tiny hook on the end of each prong. This 'anchors' the tissue, securing the cervix in place while other tools are manoeuvred into the womb.
A probe called a sound (which resembles the dipstick used to check car engine oil levels) is then pushed up into the uterus to measure its length and angle, so the coil can be manoeuvred into position.
Lucy, who'd been taking the Pill, was advised to have a copper IUD in April after suddenly developing painful blood clots in her right leg.
As the Pill can increase clot risk, doctors recommended she stop taking it and have an IUD while they carried out investigations.
'When I looked up the procedure online, it didn't sound comfortable,' says Lucy, who has no children. 'So I asked my GP if I could have a stronger painkiller, such as codeine, which I've taken before. But my GP assured me that a couple of paracetamol an hour or so beforehand was all I needed.'
But soon after the procedure began, Lucy was in agony.
'The speculum was uncomfortable but not painful,' she says. 'It was when the GP inserted the sound device that the pain really hit. I was screaming and shouting in pain and became faint.
'It was so awful — it's hard to describe — but it felt like my body was being invaded and violated.
'At the end, I was really tearful. The GP was quite matter-of-fact and just said to take over-the-counter painkillers if I suffered any cramping over the next few days.
'By the next morning, when the pain had finally subsided, the shock turned to anger that at no point had anybody warned me this procedure could be so traumatic. I had only ever heard it described as a mild discomfort.'
Lucy set up an online petition for better pain relief for women having an IUD inserted and 24,000 have already signed it.
