Online stories can supplement scientific literature and experience, and doctors, particularly in obstetrics and gynaecology, should acknowledge the importance of forums like TikTok and the crucial role they play in bridging communication with patients.
So write Catherine Stratis and Lauren Kus in Medpage Today, who say the impact of social media should not be under-estimated.
Last month, the American College of Obstetricians and Gynaecologists (ACOG) issued updated clinical guidelines underscoring the importance of effective pain management during intrauterine device (IUD) insertion and other in-office gynaecologic procedures.
The guidance encourages clinicians to engage in shared decision-making and to utilise evidence-based interventions like lidocaine, while cautioning that clinicians should balance the need for misoprostol against its potential adverse effects.
These recommendations reflect a growing recognition within the medical community of patient-reported pain, marking a meaningful step toward aligning clinical practice with lived experience.
Setting the stage for ACOG’s update, the CDC also revised its contraceptive guidelines in August 2024. In the immediate aftermath, major news outlets published articles highlighting the widespread and often unaddressed pain associated with the procedure.
These reports all took the opportunity to call attention to the scores of young individuals speaking out about their experiences with IUD insertion online, particularly through TikTok videos portraying IUD insertion pain and its dismissal by some healthcare providers.
Has social media become the driving force for societal recognition of the very real pain many women experience with IUD insertion?
Over the past decade, researchers have identified the need for more patient-centred pain management strategies. For example, a 2015 study found that nearly eight out of 10 nulliparous participants who underwent IUD insertion experienced moderate-to-severe pain.
Other studies showed that providers under-estimate IUD insertion highlighted patient accounts that describe insertion as “traumatic”, and elucidated the link between anxiety and pain perception.
Still, the research findings and conversation failed to reach the medical mainstream or change clinical practice until videos of patients crying on their way home from gynaecology appointments captured the eyes and ears of healthcare providers, who comprise some of the 150m American TikTok users. Via social media, patients have secured a seat at the table and prompted this long overdue dialogue.
A Duke University study reported that the top 100 videos under the hashtag #IUD on TikTok received 471m views in total, garnering 32m likes and 1m shares. More videos had a negative than a positive tone, and of the 31 videos that discussed IUD placement or removal, almost all (96.8%) mentioned pain.
Despite high levels of user satisfaction, many patients have come to an agreement that IUDs are synonymous with pain, both anticipated and experienced.
Similarly, researchers have found pain to be one of the prevailing topics of other gynaecology-focused TikTok videos under the hashtags #colposcopy and #endometriosis.
Although it is difficult to quantify in research, shame – like pain – deters patients from seeing a gynaecologist.
Searching “Embarrassing Gynaecologist Visit” on TikTok results in a myriad videos, each with up to hundreds or thousands of views, describing at best awkward and at worst harmful interactions with gynaecologists. The videos’ comment sections further relay patients’ physical and psychological discomfort, demonstrating how providers have failed to remedy these issues, which were established long before TikTok even existed.
TikTok’s broad reach, combined with the predominantly negative tone of gynaecology-related videos, poses a threat to patient-physician relationships.
The therapeutic alliance incurs a shaky foundation when patients arrive at their appointments expecting pain and judgment from their providers based on accounts from friends and strangers online. These barriers to seeking reproductive healthcare perpetuate gynaecology’s long history of mistrust among patients, especially those who identify as black, indigenous, or queer.
Yet, TikTok serves as a widely accessible platform for patients to talk about their pain, relate to others’ tales of shame, and converse with TikTok-savvy physicians, who post responses to correct misconceptions about pain management options and placate fears.
As a result, physicians with social media literacy may be better prepared to treat pain and reduce anxiety.
The high consumption of TikTok by 18-to-29-year-olds compared with other age groups is advantageous to “Generation Z” physicians-in-training who can use social media to supplement the knowledge and skills procured through their medical education.
This new generation of social media-conscious doctors will be better tuned into patients’ experiences and equipped to manage pain.
Physicians of all ages can follow suit and view TikTok videos as analogous to focus groups, rather than overlooking this valuable database of patient stories.
This is not to say that social media awareness can or should replace a seasoned physician’s personal library of direct patient interactions or insights gained by exploring the scientific literature on pain, but rather that it can supplement them.
By staying up to date with patient discourse on social media, physicians can better manage expectations and communicate with empathy and transparency. Patients must know that their doctors intend to make them feel heard and as comfortable as possible.
The recent ACOG guidelines have highlighted the critical, ongoing conversation on TikTok and other social media platforms about pain with IUD insertion.
Like their future patients, the next generation of doctors is online, carefully paying attention to patient voices and experiences. The era of dismissing patients’ concerns and pain is long gone. When patients speak, in person or online, we must listen.
Catherine Stratis is a medical student at the Icahn School of Medicine at Mount Sinai in New York City. Lauren Kus, MD, is an ob/gyn specialising in complex contraception and abortion care. They conduct research investigating IUD insertion pain.
Medpage Today article – Ob/Gyns on TikTok Are Tuning Into Patient Pain (Open access)
See more from MedicalBrief archives:
Doctors urged to treat pain for IUD insertion in new guidelines
Updated guidelines for IUDs acknowledge insertion pain
Social media fuels birth control backlash