Endometrial biopsies. Hysteroscopies. Insertion and removal of IUDs. Colposcopies.
Providers for the St. Charles Center for Women’s Health can do an array of procedures in the clinic, said Clinical Division Director Dr. Amy Yuan.
But with those procedures often comes physical pain and anxiety because of a prior experience, because of the unknown, or because of the sensitivity of the area of care.
“This is a very private thing for many people. It isn’t as simple as just getting a biopsy from your arm or something like that,” Yuan said. “And I think a lot of women don’t really know what kinds of tools we have available to help them with that pain and anxiety.”
That tool kit expanded recently with the implementation of nitrous oxide throughout the Center for Women’s Health’s clinics across Central Oregon. Nitrous oxide — commonly known as “laughing gas” — has been used by dentists and other specialists to alleviate patient anxiety for years. But it has been slow to adoption in women’s health, Yuan said.
“I think historically, we think, ‘Oh, labor and delivery is natural. Contractions are natural. Pain is natural.’ But that doesn’t mean we have to endure it, and it doesn’t mean we have to just suffer through these other procedures, either,” she said. (To be clear: Nitrous oxide is not currently available in St. Charles Family Birthing Centers.)
“Addressing women’s pain has come more to the forefront thanks to social media and more people speaking about it, and providers are offering more pain and anxiety relief now than they were even 10 years ago,” she continued. “So in our clinical setting, we’re really trying to approach this proactively.”
That line of thinking aligns closely with a recent recommendation by the American College of Obstetricians and Gynecologists, said Tricia Clay, administrative director for Women’s and Pediatric Services. “There is an urgent need for health care professionals to have a better understanding of pain-management options,” the recommendation says, “and to not underestimate the pain experienced by patients and for patients to have more autonomy over pain-control options during in-office procedures.
Nitrous oxide is not a pain medication but a treatment for anxiety — though the two often go hand in hand, Yuan said — and whether or not it is used is up to the patient. In fact, it is administered through a handheld mask over the nose and mouth, which means the patient can put on the mask and remove it to breathe fresh air when they want to, giving them more of a sense of control during a procedure. That alone can help relieve anxiety, in addition to the effects of the gas, Yuan said.
Lower levels of anxiety, of course, usually means a patient who is less tense, which makes it easier for a provider to do their job as efficiently and effectively as possible.
“We’ve used it quite a bit already and I think patients are just really appreciative to have something else that can help them feel better about their procedure,” Yuan said.
“I think it helps some people just to know that we’re taking their pain and anxiety seriously, too,” she continued. “Some people have trauma for various reasons around anything happening in what is a very private area, and we want to be sensitive to that. I’ve offered patients nitrous for a very simple exam, like a pap smear.”
The primary alternative to nitrous oxide is an anti-anxiety medication like Xanax or Valium, which typically take longer to work, Yuan said. That means patients must arrive early for consent paperwork and to take the pill so it can take effect before a procedure. Those medications also tend to last for a variable amount of time, as well, she said, whereas the effects of nitrous usually wear off in about 10 minutes, allowing most people to drive themselves home.
It’s also very safe, she said.
“There are very few contraindications to using nitrous, and we go over that with the patient when we’re looking at their health history,” she said. “So it's a good tool, and I think it can help a lot of people. I’m glad we have it.”
