Federal officials affirmed this month that the pain people might feel when getting an IUD can be more than doctors’ promises of “just a pinch.” The local anesthetic lidocaine “might be useful for reducing patient pain” when inserting intrauterine devices, according to new guidance from the U.S.

Centers for Disease Control and Prevention, which also encourages doctors to have a conversation with patients about pain management. Women have used social media to advocate for more pain-management options, even recording and posting videos to document their grimaces, screams and tears as IUDs are put in. But complaints of pain are not limited to the small, long-lasting birth control device.

Many relatively quick outpatient procedures can cause pain, including biopsies and examinations of the uterus and cervix. Gynecologists and patients say there need to be more conversations about options for local anesthetics — as well as other pain-relief options for these procedures. Pain relief options Lidocaine spray or gel used as a local anesthetic and other pain treatments — think ibuprofen or an injection of an anesthetic — are safe for most patients and can be effective, gynecologists say.

The CDC’s new guidance is just that — not a hard rule. And the American College of Obstetricians and Gynecologists spokesperson Rachel Kingery said in an emailed statement that there’s no timeline for the group to provide clearer guidance on pain management for in-office procedures.