How Should Intensity and Duration of Pain Inform Standard of Care for Pain Management in Non-Labor and Delivery OB/GYN Procedures?
Year: 2025
Type: article
Abstract: Pain experienced during gynecologic exams and procedures is dismissed, not recognized, and undertreated by some clinicians.This article considers how duration and intensity of pain experienced can be used to direct care.This article also discusses possible consequences of undertreating pain and suggests pain management standards that can be used by clinicians to provide individualized, trauma-informed care and promote shared decision-making.Historical Roots of Poor Pain Management Normalization of pain and tolerance of poor pain management in obstetrics and gynecology is pervasive.From labor pain during childbirth to menstrual pain, the belief that pain should be accepted as part of women's health, health care, and life experiences is widespread, including in clinical examination rooms.1,2,3 In addition to sex-based inequity in pain assessment, racial biases also exist, placing many patients, particularly Black patients, at increased risk for their pain being undertreated.4 Dismissal of pain in obstetrics and gynecology is not a modern phenomenon and is deeply rooted in the specialty's origins.The field of gynecology was built through the assault on and exploitation of enslaved people, who underwent forced examinations and repetitive surgical experimentation without anesthesia.5,6 Despite more recent efforts to eliminate health inequity and increase awareness of implicit and explicit bias, the subjective nature of pain assessment leaves patients vulnerable to clinician bias.Patients' pain during gynecologic procedures continues to be unidentified or undertreated by clinicians.7,8,9 In this brief review, we first describe how intensity and duration of pain can influence patients' overall experiences and the implications of unrecognized or undertreated pain.We then discuss standards of care for pain management during gynecologic procedures that should guide informed consent and shared decision-making, express clinicians' respect for patients' autonomy, and avoid harm by focusing on trauma-informed, patient-centered care.Intensity and Duration of Pain Pelvic examinations and procedures are commonly performed in ambulatory gynecology.These can last a few minutes, like collecting a Pap smear, to upwards of 30 minutes for
Source: The AMA Journal of Ethic
Authors: Lisa Bayer, Evelyn Ainsley McWilliams
Language: English
Subfield: Surgery
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W4407088642