Our Approach: Anesthesia for Gynecological Care
Dr. Matthew Lindemann and staff
Early in my career, I was taught that we didn’t need to use anesthesia for office gynecology procedures. Even when we biopsied the cervix or grabbed it with a sharp instrument called a tenaculum. This never made sense to me so I’ve always used local anesthesia for minor procedures like endometrial biopsies, colposcopies, and IUD insertions. I was challenged at times by other doctors and told that it hurts as much to inject the lidocaine as it does to do the procedure. But this is not how we approach biopsies of any other part of the body, and certainly not of male genitalia. I didn’t believe that there was a unique phenomenon of the female genitalia that made it hypersensitive to the injection of lidocaine compared to performing biopsies and grasping with a tenaculum.
Treating the Whole Person
I knew from my training that there are many reasons that people need anesthesia, from reducing feelings of anxiety, to improving comfort and the success rate of procedures. So I continued to use lidocaine and spoke frequently about the benefits of pain relief as well as psychological sense of comfort that the doctors were concerned about the patient’s comfort. I trained my residents in this technique and was often complimented for my empathy and compassion. But I remained unsettled. I am acutely aware that many people feel very anxious about going to the gynecologist. I felt horrible when my patients stated they would rather see the dentist than the gynecologist because I know how much I hate to go to the dentist! But I was able to rationalize this by saying that I was at least doing more than other doctors to alleviate my patients pain and anxiety.
I am aware of the criticism from social media of gynecologists not providing more anesthesia. I always thought that at least I use lidocaine and my patients generally do very well. Anesthesia requires more monitoring, more expense, and more risk.
I founded Borealis LIFE with the intention of providing a safe setting for gynecological care. For some patients it is really very scary to see the gynecologist, the vulnerabilities, and dealing with possible previous traumas. My intention has been to do this differently, to create a safe space, physically and virtually, where all patients are treated with respect and dignity and their experience is validated.
I have always said that we need to meet the patients where they are, not make them adjust to us. To treat the whole person.
An Epiphany about Anesthesia
Today I had an epiphany. I was speaking with a nurse anesthetist about providing anesthesia for hysteroscopies in my office. A hysteroscopy is a procedure that allows a doctor to see inside the uterus. The technology for office hysteroscopies has existed for decades but I was reluctant to embrace it for fear of causing undue pain and trauma to my patients. But that fear is alleviated when I can offer safe anesthesia. Then it occurred to me. I can offer anesthesia for any gynecological procedure. Even routine exams and pap smears. The analogy with dentistry holds true but dentists figured this out decades ago. I remember when I was young I went to the regular dentist who gave me lidocaine. I didn’t really feel much pain, though I was sure scared. My sister was 3 years younger and better able to advocate for herself. She requested sedation and our mom found an office that offered this. Four decades ago, dentists had recognized this need and were willing to make adjustments in their practice to accommodate.
Last week I placed an IUD in a patient I had known for many years. I told her that there would be a stick and a burn from the lidocaine and a strong cramp when I placed the IUD. While I was performing the procedure I looked up and she was in quite a bit of pain, more than usual. I asked her to tolerate it for a few more seconds and she was able to. But I felt bad that this was so painful for her. Two days later I had my realization. I now recognize that I can do better. Most patients do very well with lidocaine but some will benefit from sedation provided by a Certified Registered Nurse Anesthetist. I am excited to be able to offer safe, (pain-free, gentle, comfort gynecology)beginning early next year.
Read more: Welcome Angelia Trujillo, WHNP (Women’s Health Nurse Practitioner)
Dr. Matthew Lindemann has been treating pelvic and Fibroid pain for over 20 years.
