An intrauterine device, or IUD, insertion can be very, very painful. Not for all women, but for many. In recent TikTok videos documenting the experience, women grimace, cry and clutch the exam table. Often a provider can be heard in the background reminding a woman to breathe, or chirping, “Almost done, OK?”

Seemingly in response to growing concerns over doctors dismissing women’s pain, the Centers for Disease Control and Prevention recently recommended, for the first time, that providers counsel patients on the “potential pain” from IUD insertion. They also suggest that doctors can offer options for pain management, including using the local anesthetic lidocaine.

I’m glad the agency is joining the conversation. But as a physician who performs hundreds of gynecologic procedures every year, including IUD placements, I can say with certainty that lidocaine will not solve the problem. And although counseling about pain is important, the fact that the C.D.C. has to remind doctors about this basic component of informed consent shows how deep the problem runs.

The impetus behind the C.D.C.’s timidly worded guidance isn’t a preponderance of new or convincing data. The agency acknowledges that the evidence for lidocaine is unsettled. Some studies have found that patients report lower pain scores when using lidocaine. Others find that it makes no meaningful difference. What we do know is that providers tend to underestimate patients’ pain during IUD placement. This might be explained by the longstanding, paternalistic tradition of physicians trying not to scare patients away (“This won’t hurt a bit …”). But there are other, more practical considerations at work. In the grueling pace of modern medicine, it’s tempting for providers to downplay a potentially painful procedure to patients (and to ourselves), because admitting otherwise could require much more time. It’s much faster to rush through the procedure, assuring the patient that her “discomfort” is “totally normal” and then dash out the door to the next waiting patient.

We do so at a very real cost to women.

Imagine: You are alone, half-naked behind a closed door with a person in a position of power. This person assures you that this isn’t going to hurt, then places a gloved hand and cold instruments inside you. The instruments do hurt. You cry out, or you fight back tears. But the pain continues. Afterward, you’re told it wasn’t that bad.

For many women, this is deeply unpleasant. For those who have experienced sexual violence (more than half of women), IUD insertion can be downright traumatic. This is not to say that most women getting IUDs feel assaulted by their doctors. But for too many the experience is of violation, a deep betrayal of the sacred bedrock of the doctor-patient relationship: trust.