Sweetspudd - Sweet & Savoury

I had a patient come in the other day because she wanted her IUD replaced. It was at the end of it's life and she loved having her IUD, this was her second one. My MA let me know that the patient was very anxious about getting the IUD replaced, she'd had painful experiences in the past with her other replacements and was dreading this visit for that reason.

I spoke with the patient and she was literally shaking with anxiety. I asked her to describe her prior experiences as well as what she liked about her IUD and what she didn't like. She said that she wished she didn't have to get it replaced so often, so I recommended we place a Mirena instead of just inserting a new Kyleena IUD. She was nervous about this because she didn't want an IUD that was big. I explained that the Mirena and Kyleena are essentially the same size but the Mirena lasts 3 years longer and would likely bridge her to menopause given her age whereas with the Kyleena she'd probably need another replacement to get there. She was okay with trying the Mirena.

I then talked to her about pain control during the procedure as this was what she was most worried about. I asked about her prior experiences and then laid out what I wanted to do to try and improve her experience during this procedure. I told her I planned to give her prescription strength ibuprofen, a heating pad, and a very dense anesthetic block in her cervix to hopefully make it a better experience. If she had had someone to drive her home I would've also given her an ativan because we have studies that show patients who report higher rates of anxiety surrounding a procedure also report higher rates of pain associated with it.

She was down for this plan. I gave her a very dense block, she only felt three small injections and then nothing else. She was shocked when I told her that her old IUD was out and the new one was in. She didn't believe me when I told her it was over.

I don't tell this story because I wanna brag about how amazing of a doctor I am because I'm not. I tell this story because this is the way IUD insertions SHOULD go and I want people to know that IUD insertions do not need to be traumatic. And I want other providers who may insert IUDs to know that a paracervical block should be your standard when it comes to IUD insertions.

When people find out I'm an OBGYN, complete strangers, acquaintances, etc. , the two things they like to tell me immediately are their horrible birth trauma story and their terrible IUD insertion story and I'm trying to at least make the latter one a little less common.

If you place IUDs and aren't doing a cervical block, you need to start. This should be the standard but over 90% of OBGYNs in the US aren't doing them and it's unacceptable. We are traumatizing people and it's entirely avoidable. We are scaring people away from one of the most effective and long lasting forms of birth control in a time when people are losing their ability to end unwanted pregnancies all for no justifiable reason.

"It takes too long:" No it doesn't, that visit took me 20 minutes with a highly anxious patient from start to finish.

"It's not worth it for such a short/small procedure." It's worth it for the patient.

"It's too expensive." You can do a paracervical block with just normal saline. You don't even need lidocaine if you use a generous amount of volume. And if you place Nexplanons I know you stock lidocaine in your office, stop being fucking cheap at the expense of women's pain.

"Patient's don't need it, they'll get over it." I'm telling you they do need it and they aren't getting over it as evidenced by literally everyone wanting to tell me about their terrible IUD insertion experience as soon as they find out I'm an OBGYN.

We should do better. The cervix has nerve endings, stop acting like it doesn't.

Make cervical blocks your standard of care, there's no excuse not to.

trying to prove a point to the boys at school

reblog this if you believe trans men are real men like this if you dont

I made these as a way to compile all the geographical vocabulary that I thought was useful and interesting for writers. Some descriptors share categories, and some are simplified, but for the most part everything is in its proper place. Not all the words are as useable as others, and some might take tricky wording to pull off, but I hope these prove useful to all you writers out there!

(save the images to zoom in on the pics)

me holding a gun to a mushroom: tell me the name of god you fungal piece of shit

mushroom: can you feel your heart burning? can you feel the struggle within? the fear within me is beyond anything your soul can make. you cannot kill me in a way that matters

me cocking the gun, tears streaming down my face: I’M NOT FUCKING SCARED OF YOU

YouGov did a whole official poll on Americans' views of the middle ages and I’m obsessed

The last days of the petition against conversion therapy are FASCINATING to watch. I have been following it pretty closely for almost a year now, and the progress was, above all, steady. There was this jump when some algorithm in Finland picked it up, but even that was local.

And now, everyone is panicking.

Which really shows.

These past three or four days, multiple countries have reached the threshold. Even more notably, the number of signatures in total, the ones that we need to get one million of, are growing rapidly. There are only 400'000 signatures missing. Two days ago, it was closer to 600'000.

You can see the progress here:

eci.ec.europa.eu

European Citizens' Initiative

Give your support !

Consider joining the fun by making everyone around you sign it!

Abolish Tesla.

Wizards are not naturally immortal, in fact creating their own form of immortality is their graduate thesis.

saw a tiktok of a mother taking her very tiny daughter to an art museum and she’s just walking around going “whoooa” “woooaah” to everything but then they got to a marble statue of a nude woman lying on her back and the girl points and goes “mommy🫵” and i just immediately welled up with tears and all the comments are just laughing about it and of course it’s funny but how are you not insanely moved by the way art connects everyone on earth from a centuries-old sculptor to a toddler in 2023