Managing pain from an IUD insertion, and the importance of the pelvic floor, with Carine Carmy

[00:00:00] So I really don't like hormonal birth control.

[00:00:05] This is Carine Carmy.

[00:00:07] Really decided, hey, I want to try the copper IUD because, you know, probably the most effective non-hormonal option out there.

[00:00:14] Carine is about to tell you a story about an IUD.

[00:00:19] Intra-odering devices are inserted into the uterus to prevent pregnancy.

[00:00:24] If you've had this done, you know it's not a pleasant procedure, but it is common.

[00:00:30] This story about the IUD happened to Carine many years ago, but it's one she still thinks about today.

[00:00:38] And I, at the time, I didn't have an OB, and so I was getting care at a kind of primary care office.

[00:00:44] And so I booked an appointment to get the IUD inserted, and there just wasn't actually a lot of conversation about what to expect, kind of in those moments that day, that night, that week.

[00:00:57] I don't know that I necessarily would have chosen to have, you know, full anesthesia or even pain medication in that session.

[00:01:04] But I think just knowing what could be the spectrum of experiences, especially given my history of pelvic pain, like there was no conversation around how that history would play in here or what would, you know, happen.

[00:01:16] But I think what was alarming for me was what happened in the hours afterwards.

[00:01:22] I ended up having pretty severe kind of pain, lightheadedness, and a little bit of nausea.

[00:01:28] And over the course of the day, I was getting kind of like chills and also actually ended up getting a fever.

[00:01:34] And so I called the doctor's office, which at that time had been closed and ended up talking to someone at urgent care because I just was like, could it be infected? What's going on?

[00:01:43] They were worried that I might have had sepsis from the insertion, which would have been very scary and bad.

[00:01:49] So I was like, OK, I guess I'm taking myself to the ER.

[00:01:52] Carine's body was having an immune reaction to the IUD.

[00:01:57] And so I was alone at the ER thinking I might have sepsis.

[00:02:01] And, you know, the ER setting is just not pleasant for anyone for obvious reasons.

[00:02:06] I was questioning if it was the right thing for me to do, honestly, to come here.

[00:02:10] It felt aggressive, like an IUD leading you to the ER.

[00:02:13] Is this an overreaction? What's going on?

[00:02:16] I don't feel good, but I don't feel that bad.

[00:02:18] And so this question of like, how do I know where my pain actually is and almost buying into the own narratives of your own, like, quote, hysteria, although that's not, you know, that's kind of societally imposed views of what pain is.

[00:02:32] The team in the emergency room did blood tests to see if there was an infection and an ultrasound to try and figure out if the IUD had been placed properly.

[00:02:41] At the end, they found out that Carine did not have sepsis.

[00:02:45] I decided that night to not have it removed at the hospital because this was not someone who had been trained in, you know, IUD insertion and removal.

[00:02:53] And there was no immediate risk to my health.

[00:02:56] And I said, like, let me see how I feel tomorrow.

[00:02:57] And I luckily felt better kind of the next day.

[00:03:00] So I actually ended up keeping it in.

[00:03:01] But I think, you know, for me, even as I started this story by saying, like, it wasn't that bad when they inserted it.

[00:03:07] It was still bad, right?

[00:03:08] So, like, how do we not normalize these feelings of, you know, medical exams do not have to have pain associated with them?

[00:03:17] This is Overlooked, and I'm Golda Arthur.

[00:03:23] Carine Carmi is now the CEO and co-founder of a company called Origin, which offers pelvic floor physical therapy.

[00:03:31] Carine recently wrote about her experiences with IUDs in a post on LinkedIn.

[00:03:37] And she wrote this in response to the CDC updating their recommendations on pain management for IUD insertion.

[00:03:45] Carine's post on LinkedIn told her story clearly and honestly.

[00:03:49] It was pretty moving.

[00:03:51] I looked her up to see if she would talk more about her IUD experience and the work she's doing in women's health.

[00:03:58] My conversation with Carine is coming up after this quick break.

[00:04:01] Hi, I'm Dr. Sarah Finlayson, a gyne-oncologist with the Gynecologic Cancer Initiative.

[00:04:10] The Gynecologic Cancer Initiative is a British Columbia-based team committed to transforming research

[00:04:16] and helping women understand, prevent, and survive gynecologic cancers.

[00:04:22] From precise diagnostics to innovative prevention strategies and groundbreaking clinical trials,

[00:04:28] we are already driving change.

[00:04:32] I'm Joan from Surrey, BC.

[00:04:33] I'm a stage 4 uterine cancer survivor.

[00:04:36] I'm very privileged to be able to work with the GCI to help other women through research programs.

[00:04:42] It took nearly a year for my wife to be diagnosed with stage 4 high-grade serous ovarian cancer.

[00:04:49] With GCI's ongoing work and assessments, testing, and raising awareness of gynecancers,

[00:04:54] I hope physicians will prioritize the possibility of gynecancers during patient assessments to improve diagnostic times.

[00:05:03] Discover how you can join our mission and be part of the change at gynecancerinitiative.ca.

[00:05:15] Carine, hi.

[00:05:16] Thank you for joining me on Overlooked and welcome to the show.

[00:05:20] Hi.

[00:05:20] So great to be here.

[00:05:21] Thank you for having me.

[00:05:22] So I found that so powerful when I read it and I read it on LinkedIn.

[00:05:27] What prompted you to share it in the first place?

[00:05:30] For me, being in my position at Origin, we have a responsibility to continue to advocate,

[00:05:37] not just for pelvic health, but really to create this higher standard of care for women.

[00:05:42] And sometimes I think, you know, it's funny.

[00:05:45] I was not the person to talk about sex ever in public, let alone on LinkedIn.

[00:05:49] And now I really think it's a responsibility of mine to use my platform to help educate people around how these issues that we read about in the news actually play into our real lives.

[00:06:01] And whether it's my story or a patient's story, yeah, it just, it feels like it's a responsibility we have to help amplify these messages.

[00:06:09] And why I think for some people, they might just see the CDC news and say, oh, like, it's interesting.

[00:06:14] Great.

[00:06:15] But I think the context can be lost if you're not in that industry.

[00:06:18] And so I hope with these types of posts, we can just continue to put these issues into deeper perspective.

[00:06:25] What does your experience with the IUD illuminate for the rest of us, Karine?

[00:06:32] Yeah, I think there's a few themes.

[00:06:33] So one, we started with this conversation that there can be pain in different parts of the medical system, you know, in support of women's health.

[00:06:43] And that's probably true also like going to the dentist, right?

[00:06:46] Like going to the dentist is not fun sometimes.

[00:06:48] So, you know, I had actually draw surgery when I was younger.

[00:06:51] So I have a lot of like relationship to pain around teeth and body.

[00:06:56] I think ultimately, I don't actually believe that every person should be, you know, forced to have pain medication or forced to not.

[00:07:04] I think we should be given choice and having choice informed conversations with patients that enable them to understand what is their risk of pain, given their risk factors, their historic pain tolerance.

[00:07:17] What is the pros and cons of taking any pain management or medication?

[00:07:21] You know, there's obviously pros and cons to everything, but it's really just an ask for patient-centered care that offers us choice in how we manage and mitigate these experiences, I think is first and foremost.

[00:07:33] And the second theme, you know, I'm laughing.

[00:07:36] Like I've been in the hospital and had like an IUD removed and I still probably would get another IUD in the future at some point if I wanted to go down that path.

[00:07:43] I don't blame the medical community or the system for all of these issues.

[00:07:48] I think there's some structural pieces in place, but sometimes we're also limited.

[00:07:53] Like if that's the best birth control option for you, then you just need to figure out, or in my case, I had to figure out how to manage, you know, when and how and where and the ways that I could mitigate that.

[00:08:03] And I think there can be a little bit of fear around these procedures, but there's also, you know, at least for me, there was fear around taking hormonal birth control again and what that would do to my body and my mind.

[00:08:15] And so I think just making sure that we don't get caught up in the story around IUDs are 100% painful is really important.

[00:08:22] And it was something I thought about before this conversation, because I wouldn't want someone to walk away saying like, all these worst case scenarios are going to happen.

[00:08:29] It's not likely.

[00:08:30] I mean, they're rare.

[00:08:31] But the question is, how do you align yourself with providers who can help you if you are more prone to or if you have these situations arise?

[00:08:40] Yeah, I mean, it's so interesting.

[00:08:42] I think in a way, all cases are different.

[00:08:44] But at the same time, there should be some best practices around the kind of conversations that we have.

[00:08:50] And that should just be standardized.

[00:08:53] Personally, I know my listeners have heard me say this before.

[00:08:56] When I go into a doctor's office, I'm a real pain in the ass because of the last question, that's a question, that's a question.

[00:09:03] And I have been lucky enough for the most part to have doctors who will patiently explain to me, your hip bones connected to your thigh bone, Golda, and that's how it works.

[00:09:11] And with every conversation, I get a little smarter about my own health.

[00:09:16] And I always encourage people to sort of do the same.

[00:09:19] But I want to ask you, knowing what we know now, like what should happen when you go into an office to have an IUD inserted or removed?

[00:09:31] When you ought to be having a conversation about pelvic floors in general?

[00:09:36] In your mind, is it clear like how we should be doing things as a standard?

[00:09:42] I think it almost starts even before you have the IUD inserted.

[00:09:46] You know, when someone is having a conversation with their provider about birth control choices, I wish there was, and maybe now we can do this with AI, you know, decision tree support around what are your goals?

[00:09:57] How do you want to think about, you know, the longevity of this particular solution for you?

[00:10:03] What's your pain tolerance?

[00:10:04] How do we think about that?

[00:10:05] But I mean, at every level of the decision, there's micro decisions to be made.

[00:10:10] So am I doing hormonal or non-hormonal, you know, of those choices?

[00:10:14] What's right for me?

[00:10:14] And how do I kind of go from there?

[00:10:16] And I think empowering providers actually with educational resources and tools that they can then have that conversation in a way that meets the constraints of the modern medical system, right?

[00:10:28] Like you have 15 minutes.

[00:10:29] I don't know that you can necessarily have that kind of conversation.

[00:10:32] So imagine if there was a tool that you could send your patients before that visit so that they could, you know, get informed and understand and then come with their top three choices and they're having that kind of question.

[00:10:43] You know, I think it's unfair for us to put all of the burden on the medical provider because of just the reality of health care in the U.S.

[00:10:50] Yes, but and we still need far more education and information.

[00:10:55] And I think just some gap in time so that there's not this decision making moment where you get like 30 seconds of information and then say, okay, great, I want pain meds or I don't.

[00:11:06] You know, how do we have a little bit of space?

[00:11:07] For myself, I ended up calling the doctor back three times and being like, wait, can I talk to the nurse?

[00:11:11] And how do I, you know, I'm pain in the ass too.

[00:11:13] Like, how do you actually take the time to make a decision that's right for you when it's going to be in your body for five to 10 years?

[00:11:19] You know, I think it's really critical.

[00:11:21] Yeah.

[00:11:22] And Kareem, was there a line that went from your experiences with the IUD to your starting origin or were those sort of different steps and stages in your life?

[00:11:34] It's a really good question.

[00:11:35] I've not explicitly connected the dots for myself before, but, you know, our mission statement is that we want to help women feel their best through every stage of life.

[00:11:46] And I'm really passionate about creating a healthcare experience within the system that is uplifting and positive and is not just about going from, you know, the negative to the baseline.

[00:11:59] Like, I think so much of healthcare is how do we go from we're below the line to, okay, now we're functioning.

[00:12:04] But, like, how do we actually feel good?

[00:12:06] And I think my experience with the IUD was just a microcosm of, you know, I'm a well-educated, privileged person who had access to really good healthcare.

[00:12:15] And if that was happening to me, how do we think about redesigning the system around empowering individuals instead of, you know, transacting?

[00:12:25] And so I think that's deeply connected and it just chips away at you, right?

[00:12:30] You know, like it started with my jaw surgery and then my IBD and then my IUD and then my pelvic pain.

[00:12:36] And then I finally realized it's like I love PT because it's also a modality, a type of care that actually enables conversation.

[00:12:46] You know, we have 45-minute appointments with patients.

[00:12:49] You can have a lot of conversation in a 45-minute appointment while you're also giving treatment.

[00:12:53] So you get the space to actually co-create an experience with the patient, whereas I'd say OB-GYN or PCP, it's just very quick.

[00:13:03] And they're both necessary.

[00:13:04] And so, again, I don't want to diminish that, but I think that's why I'm so drawn to partnering with PTs and supporting their work because it's really this intersection of mind and body, which is ultimately, you know, what I'm deeply, deeply passionate about.

[00:13:17] Tell me a little bit about the work that you're doing at Origin.

[00:13:21] Yeah.

[00:13:22] Yeah.

[00:13:22] So about one in three women in the U.S. have pelvic pain or pelvic floor dysfunction.

[00:13:26] That can look like anything from incontinence and painful sex to prolapse.

[00:13:31] Even back and hip pain are often pelvic floor issues.

[00:13:35] And unfortunately today, very few are getting the care that they need.

[00:13:39] You know, we've done a survey recently and have found out that 96% of the people who are having these symptoms are not getting a diagnosis or not getting access to physical therapy.

[00:13:49] But what's remarkable is that PT is the first line treatment for pelvic floor dysfunction and really for so many of the full body issues that are unique to women.

[00:13:59] And so we're really passionate about increasing access to this life-changing intervention.

[00:14:04] And we have built both clinics now in seven states in the U.S. as well as virtual care nationwide so that folks can get this kind of care also through their insurance so that it's actually much more affordable.

[00:14:16] Tell me what was the trigger for you to start Origin, right?

[00:14:20] And I suppose that's an answer to why pelvic pain because it's not a thing that we talk about as regularly as like breast health or even mental health.

[00:14:29] But I think it's fascinating and extremely important.

[00:14:32] But tell me the trigger that led you to be where you are now.

[00:14:36] No, I mean, it's so, so common.

[00:14:38] And I think it's this epidemic in the shadows right now for women.

[00:14:43] I started having painful sex in my early 20s after I think what was an infection, although I don't really know how it started.

[00:14:50] And I was living in New York and was going to a bunch of different doctors there trying to figure out what was going on.

[00:14:56] They did biopsies, which I later learned was not what you should be doing in this situation.

[00:15:01] And ultimately, you know, I was kind of told we don't really know what this is.

[00:15:04] It might be vaginismus or dyspareunia or they, you know, throw all these words at me, but kind of gave me shrugged shoulders and said, try some of these creams and, you know, have a glass of wine before you have sex.

[00:15:14] Like really learn how to calm down, which is insane.

[00:15:17] This was a while ago, so I don't want to age myself, but I'll just tell you it was over a decade ago.

[00:15:21] But, you know, the message I took from the medical community was this isn't like this is kind of a weird you're you're on the fringe.

[00:15:28] This doesn't really happen. We don't really know what's going on here.

[00:15:31] And, you know, good luck. This might be your sex life.

[00:15:34] And so about a decade later, I was in L.A. where I grew up and where I moved back recently.

[00:15:41] And a friend of mine recommended that I go to a pelvic floor PT.

[00:15:45] So I went to this clinic and after 10 years of, you know, really suffering, I had a diagnosis and a plan of care.

[00:15:53] And in two sessions, I started feeling better, which was just mind blowing to me.

[00:15:57] PT, it's non-invasive. You know, there's no surgical intervention.

[00:16:02] And it is so, so effective for so many issues that we experience that I have just been on a mission to make this more accessible for folks.

[00:16:11] And you know what, Corinne, I should have started with this question.

[00:16:15] What is the pelvic floor?

[00:16:17] Yeah, it's a great question.

[00:16:20] The pelvic floor is really the center of our body, right?

[00:16:23] It's the basket of muscles and tissues and ligaments that stitch together at the base of our pelvis.

[00:16:30] It holds up our organs.

[00:16:31] So it's responsible for core stability, for sexual pleasure and function, for bowel and bladder function.

[00:16:39] So anything related to incontinence, bladder or bowel, lymphatic flow.

[00:16:43] So it's really like at the center of our body.

[00:16:46] And it also holds up our reproductive organs as well.

[00:16:48] That's a fantastically important section of our body.

[00:16:52] Yeah, I know.

[00:16:53] Exactly.

[00:16:54] This is not taught to us.

[00:16:56] But, you know, I think if folks have backgrounds or exercise modalities like Pilates or yoga, sometimes they'll talk about that there.

[00:17:03] But it's really cursory.

[00:17:05] And I always joke, everyone thinks the Kegel, you know, like the clenching exercise is the thing that everyone should do.

[00:17:11] But actually, the number one pelvic floor exercise is diaphragmatic breath because it's learning how to lengthen your pelvic floor.

[00:17:17] Sometimes Kegels can actually be counterproductive if you are having painful sex or if you have kind of any issues related to tightness.

[00:17:26] So kind of this breathing technique, diaphragmatic breath is a really helpful lengthening technique that's effective for everybody.

[00:17:33] Okay.

[00:17:34] I have so many questions based on what you said.

[00:17:38] You know, medicine is a whole lot better than it used to be in so many ways.

[00:17:44] I mean, I'm really curious about a word, a phrase that you used.

[00:17:49] You called it an epidemic.

[00:17:51] So what, you know, that's very intriguing to me.

[00:17:55] Tell me what you base that on.

[00:17:57] You know, the data I started with in this conversation is that about one in three women are experiencing pelvic floor dysfunction.

[00:18:04] But when we actually look at how many people are experiencing symptoms that are indicators of dysfunction, it's much higher.

[00:18:11] So we did a survey in partnership with Ipsos in the beginning of the year.

[00:18:16] And 86% of women between the ages of 18 and 59 were having at least one pelvic health symptom.

[00:18:23] At least, I think it was 70 plus percent were having multiple.

[00:18:27] And so this is, you know, incredibly common.

[00:18:30] And as I said before, the vast majority are not getting care.

[00:18:33] And these symptoms might not be true, like classically defined pelvic health dysfunction, but it could be, you know, I leak when I sneeze or I have painful sex or I have chronic hip pain.

[00:18:46] And I think it is an epidemic because we are essentially normalizing dysfunction.

[00:18:53] We're essentially telling women that you should continue to be in this kind of pain or that it's normal to have bladder leaks.

[00:19:01] And, you know, unfortunately, these issues don't get better on their own necessarily over time, right?

[00:19:06] As we age and if we go through menopause, one in two women in menopause will experience vaginal atrophy.

[00:19:11] So their muscles weaken.

[00:19:13] Just very common issues, right?

[00:19:14] Our bodies age.

[00:19:15] We have to continue to build strength in a supportive and healing way.

[00:19:19] And we just haven't been doing that for the pelvic floor.

[00:19:23] And as a result, you know, millions of people are experiencing pain and discomfort.

[00:19:27] Well, let me draw us to a close, Karine, by asking you a question that I ask all of my guests, which is what, you know, this is a podcast called Overlooked.

[00:19:36] What do you think has been the most overlooked aspect of some of the topics we've been talking about today?

[00:19:43] And you can pick any.

[00:19:44] And where do you think this inequality is felt most deeply?

[00:19:48] I do believe that pelvic pain is incredibly overlooked.

[00:19:53] It's incredibly stigmatized.

[00:19:55] We have not historically talked about sex or bladder, right?

[00:19:59] These are typically taboo subjects that you don't talk about unless you're having a kind of whispered conversation with friends or you're giggling and saying, oh, this happens to me too.

[00:20:08] Like, you know, and you find that camaraderie.

[00:20:09] And these are real health care issues, right?

[00:20:12] They impact our function, our well-being, our mental health.

[00:20:16] Incontinence is actually highly correlated with depression and anxiety.

[00:20:20] If you don't feel like you have a physical recovery after you give birth, C-section or vaginal, it's really hard to feel like you're progressing, you know, into this integrated life again.

[00:20:29] And so I think if we've overlooked our pelvic floors, which are really the center of our bodies and we have pain there, it's so deeply integrated with identity that I'm just so passionate about helping women in particular, but really all people, because this impacts all genders, understand how to feel good again and get to that level of function.

[00:20:52] And I do think the societal norms around these conversations is actually one of the number one root causes because that impacts the lack of medical research.

[00:21:02] It impacts the lack of medical training, even the willingness to cover this as a benefit with insurance.

[00:21:08] And so all of these things kind of start with, as a society, are we saying that women's bodies matter, that this pain is real?

[00:21:16] And if you say it's real and it matters, then everything else can flow from that.

[00:21:21] Yeah. Yeah, that's fascinating.

[00:21:23] Well, Corinne, thank you so much for talking to me today about all of this.

[00:21:27] Yeah, it's a pleasure.

[00:21:28] What an education just in this short time.

[00:21:31] Thank you so much again for joining me on the show.

[00:21:33] Thanks for having me and thank you for your work.

[00:21:36] Overlooked is written and produced by me, Golda Arthur.

[00:21:40] Jessica Martinez-Eos is our producer.

[00:21:42] We're building a community around women's health so that no one is overlooked.

[00:21:46] If you'd like to be part of it, sign up for the newsletter at overlookedpod.com.

[00:21:51] And you can get in touch with us by emailing hello at overlookedpod.com.

[00:21:57] What you hear and read on Overlooked is for general information purposes only and represents the opinions of the host and the guests.

[00:22:04] The content on the podcast and website should not be taken as medical advice.

[00:22:10] Every person's body is unique.

[00:22:12] So please consult your healthcare professional for any medical questions that may arise.

[00:22:17] Thanks for listening.