‘It almost felt a bit barbaric’: Scottish contraceptive coil users speak out about pain
How much pain is ‘normal’ during a coil fitting? In Scotland, patients share their experiences of dismissed suffering and demand better from reproductive healthcare
Self-care note: This newsletter talks about medical gaslighting and painful procedures. If you find this distressing or triggering, remember to take it at your own pace. You may prefer to read small sections, wait until you feel ready to read it all, or choose not to read it at all.
Last week, the UK House of Commons’ Women and Equalities Committee published a parliamentary report exposing the poor state of reproductive healthcare in England. It highlighted a reality that many women and people with uteruses already know too well: pain during gynaecological procedures continues to be ignored.
While media coverage has largely focused on delays in diagnosing and treating conditions like endometriosis and PCOS, the report also sheds light on another deeply troubling aspect of reproductive care: routine procedures that are poorly communicated, inadequately managed, and often painfully experienced.
For those who rely on the coil as a long-acting form of contraception, what should be a straightforward procedure can instead become a distressing ordeal. Many are left unprepared for the intensity of the pain, with healthcare practitioners providing little information, offering inadequate pain relief, and rushing through appointments. It’s a system that normalises suffering, leaving patients feeling unheard, disempowered, and, in some cases, violated.
In Scotland, where coil use remains common but has begun to decline, the gaps in care are equally stark — and equally urgent.
The coil in Scotland
The contraceptive coil (hormonal or copper) is a form of long-acting reversible contraception (LARC) that when fitted is inserted through the vagina and placed in the uterus during an appointment with a healthcare practitioner. Coil removal often involves using a speculum to visualise the cervix and the strings attached to the bottom of the coil, and the use of an instrument to grasp the strings and facilitate removal.
Recent statistics from 2023 show that in Scotland, the LARC prescribing rate has decreased to rates lower than before the COVID-19 pandemic, and although the hormonal coil has replaced the contraceptive implant as the most common LARC method prescribed, these rates are lower than in 2022, while the rates of copper coil prescriptions increased.
In 2021, the Scottish Government launched the Women’s health plan, with key priorities of reducing diagnosis times and ensuring appropriate support is available for endometriosis, while for contraception, priorities are set out around having access to a full range of methods, easy and quick access to appointments, providing creative and holistic services, and increasing access to LARC methods. However, pain during procedures is notably absent from these discussions. A follow-up report in November 2024 acknowledged ongoing efforts to achieve short, medium, and long-term aims for improving endometriosis and contraceptive care.
Given the relatively high — but falling — rates of coil use in Scotland and the recognition that improvements are needed in contraceptive care, my research set out to explore coil users’ histories and imagined futures of contraceptive care. I interviewed 18 past and current coil users aged 21-40 from Glasgow and Edinburgh between September and December 2023, with the aim of finding out about their experiences of contraceptive care and where improvements could be made.
‘You feel violated’: when a routine procedure goes wrong
Before attending coil fittings, participants spoke to friends or people they knew who had the coil, or accessed information about coil fittings via the NHS website or from social media.
However, many described appointments as rushed, with only minimal preparation like being told to take two paracetamol before attending and that ‘some pain was normal’ (Leanne, Glasgow, late 20s).
Most were not informed by healthcare providers about the intensity of pain or what the procedure involved, leaving them feeling unprepared. Emma (Edinburgh, early 30s) shared:
They never talked about, look, this is going to be quite invasive. When they started inserting it and it was absolutely agony… I was like, absolutely not. You feel quite violated, flinging this piece of metal in you.
Emma’s experience highlights a lack of information about the pain of coil fitting and the procedure itself, which was heightened when undergoing a painful and invasive procedure. Like Emma, Kirsten (Glasgow, mid-30s) described a similar experience of harm (despite taking pain relief before her coil fitting), which she also viewed as an instance of medical gaslighting due to being misled about possible pain:
The worst part was feeling like I was crazy. You just believe them, they’re healthcare professionals, you believe them.
While coil removal was typically considered less painful for most participants, some felt their experience of pain was similar to that of insertion, and they were dissatisfied with the lack of information provided by healthcare practitioners about removal and pain, which Katie (Glasgow, mid-20s) described as ‘barbaric’:
It was just a bit shocking how they basically rip it out, which I didn’t realise. It almost felt a bit barbaric the way it’s just yanked.
In contrast, Eve (Edinburgh, early 20s) highlighted good practice, recalling how her GP explained every step clearly and used specific language:
She was just so specific with all her word choice, which I feel is so much better than just saying: “oh it's gonna be uncomfortable,” because stinging and stretching are both uncomfy, but if one's good and one’s not, I really need to know which. That is what made me feel the most relaxed, because even when I was feeling pain, I was thinking: “okay, but that feels like that, that’s what she said it’s supposed to feel like.”
What happens when pain relief isn’t taken seriously?
In June 2021, the Faculty of Sexual and Reproductive Health recommended that during coil fittings, ‘healthcare professionals should offer appropriate analgesia (and referral on to another provider if they cannot offer this) and ensure that the patient is aware that they can request that the procedure stops at any time. Some participants who had coils fitted before 2021 were offered pain relief, others, however, were still not offered this from 2021 onwards.
Jade (Edinburgh, mid-20s) was not offered pain relief and described her coil fitting as ‘traumatic’ and that she ‘was not given any sort of decisions’. Jun (Edinburgh, early 20s) did not have her request for pain relief met while in Charlie’s experience (Glasgow, mid-20s), pain relief was offered in a vague way that did not allow her to make an informed decision about accepting it:
I remember her saying: “Would you like anaesthetic for it?” I didn't know that was going to be an option, so I was thrown by that question… I said to her, “I don't know, what do most people do?” And she went, “most people don't bother” or whatever. Big time regret. It was one of the most painful experiences of my life.
Pain is experienced differently by different people, which makes it difficult for healthcare practitioners to adequately describe the level of pain that might be felt during coil fittings or removal. Nonetheless, some participants believed the language used by healthcare practitioners such as ‘a wee nip’ or ‘a pinch’ was not appropriate and underestimated, and therefore minimised, how painful these procedures could be.
Alongside the lack of detailed and realistic information about coil removal from healthcare practitioners, Katie felt the language used to describe removal used on NHS webpages, which said the coil would be ‘pulled out’, also misrepresented the pain that could be experienced. As with the language used around fittings, this contributed to Katie’s feelings of being unprepared for the reality of removal and left her ‘in shock’.
Aftercare and accessing appointments due to pain
In terms of aftercare, the rushed nature of appointments caused many participants to feel this was lacking following coil fitting and removal. Nicole (Glasgow, late 30s) explained:
You are just, kind of, shipped out. There’s a pad, clean yourself up. You’re good. See you later. It’s a big thing for your body… or it can be a big thing for your body to process, and your mind, too.
For many participants, pain gradually decreased around a week after having the coil fitted. Others, however, experienced pain over a longer period of time which came to affect their everyday lives, and caused them to seek early removal. This was difficult to access however, particularly due to the ongoing impact of COVID-19 and the deprioritisation of contraceptive care. Leanne described being in pain for around 8 months after having the coil fitted in 2021, and the challenges she faced accessing removal:
They told me it would settle down in six months. But that’s a long time, like half a year out of your life waiting for something to settle down. I felt really sort of powerless because it was affecting my life. I was in such excruciating pain, sometimes at work I was in the foetal position lying on the floor. I remember speaking to a nurse who said, it sounds a bit like you've got a low pain threshold. So I'm thinking, am I overreacting?
Lauren (Edinburgh, early 30s) described the difficulty of booking appointments:
I wouldn’t wait months on medication for something, so why should I wait months for a coil that allows me to be pain free and not constantly bleed through my clothes. It’s a really big deal for me and I rely on it so much.
As a result of the poor experiences of contraceptive care and the pain associated with the coil, participants described an overall lack of trust and feeling misled by healthcare practitioners:
Why are they lying to us, just tell us, it’s unlikely to stop anybody taking it, just tell us the truth…We’re lied to, misled, encouraged to put foreign objects and hormones in our bodies (Kirsten, Glasgow, mid-30s)
I know they’re doing their best, and I don’t know what the right word is, but it almost made me like, not trust the information I was given…and it feels like that is still lingering in a way (Katie, Glasgow, mid-20s)
‘Just tell us the truth’: what needs to change
Based on their experiences, participants offered clear recommendations:
Detailed and transparent information about the procedure, pain, and aftercare — integrating lived experiences.
Longer, more in-depth appointments would allow for information to be relayed and give participants time to think this over.
The language used when describing fitting and removal should be communicated clearly and should be transparent, specific and accessible.
Pain relief should be available as standard and offered clearly at an appropriate time during the appointment, as well as available in different forms
Greater empathy and emotional attentiveness are needed from healthcare practitioners
Changes should be made to coils in terms of design and the process of insertion to make it less painful, along with developing new methods of contraception that are also non-hormonal and sustainable.
These changes would help users feel fully informed, respected, and better supported throughout their contraceptive care journey.
The full report this piece is based on will be available in early 2025, and will go into detail about the various experiences of pain, both physical and emotional, arising throughout participants’ contraceptive trajectories, and will unpack their recommendations for improving contraceptive care. The next stages of the research will involve consulting with sexual and reproductive health stakeholders on the feasibility of participants recommendations for improvements to care, and the views and experiences of a more diverse range of contraceptive users will also be sought, especially when certain groups are considered less likely to experience pain or as being able to ‘handle’ more pain.
Many participants were aware of, and sympathetic towards, the extreme pressures and resource constraints facing the health service, and as demonstrated here, these pressures can translate to a lack of care with implications for bodily autonomy. To echo one participant, what we are dealing with here is also a question of safety that requires longer-term structural changes to be made to our healthcare system overall, as well as challenging the social and cultural norms embedded in reproductive healthcare:
I think they need a full overhaul of the system to make it safe for women (Kirsten, Glasgow, mid-30s).
I would like to extend a massive thank you to the participants* for taking the time to be involved with the research and sharing their important experiences and recommendations. For further information about the research this piece is based on, please drop me an email at Kristina.Saunders@glasgow.ac.uk and follow @contraceptivehistoriesfutures on Instagram.
*All participants have been referred to by a pseudonym.
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