Getting an IUD inserted generally takes 10 minutes or less1. The process—which involves placing a tiny, T-shaped device through the cervix and into the uterus—can be remarkably simple for some people. But for others those minutes are excruciatingly painful. And if you head on over to TikTok, you’ll find some doctors wondering why pain management isn’t taken more seriously when it comes to IUDs, especially because they are one of the most effective, long-lasting forms of birth control.
In February, Kunal Sood, MD, an anesthesiologist at the National Spine and Pain Centers in Germantown, Maryland, who goes by @doctorsood on TikTok, uploaded a video that sparked an illuminating discussion in the comments section. He advocated for offering local and general anesthesia—medicines that prevent the feelings of pain—during IUD insertion. In the video, he explains why it’s a “fairly invasive procedure” alongside another video that demonstrates the process. “A clamp is used to stabilize the cervix, and a cervix does have nerve endings,” Dr. Sood says.
That video has 99,000 comments and counting—and an overwhelming amount of them highlight concerning experiences. Some examples of what you’ll find in the comments section: “One of the most painful things I’ve ever done, and I’ve had two kids,” “I’m literally terrified to get it removed—it was so painful getting it put in,” and, “Worse than kidney stones.” But there were plenty of others who also shared that their IUD insertion only caused “some discomfort.”
Last month gynecologist Shannon M. Clark, MD, who goes by TikTokBabyDoc, joined the conversation by releasing her own video, in which she agreed that people should know all of their pain management options during IUD insertion. “Not every patient needs pain control, but for those who do, it should be offered to them and available to them,” she says.
So, SELF asked experts to explain what you should keep in mind if you’re considering getting an IUD, including how you can advocate for yourself if needed—because the process can feel so different for each person.
First it’s important to understand how an IUD is inserted.
During IUD insertion, a medical clinician—such as an ob-gyn, a nurse practitioner, a physician assistant, or a midwife—will insert a tool called a speculum into the vagina to hold it open so they can see the opening of the cervix, which will help guide them to the uterus for proper IUD placement2. This step creates a lot of pressure in the entire vaginal area, which doesn’t necessarily feel great for most people but can be particularly uncomfortable or painful for people who feel tense or anxious and clench their muscles.
Clinicians also typically use a tenaculum, which is a scissors-shaped device, to latch onto the cervix for stability. This can sometimes pierce the tissue of the cervix, and your doctor might try to apply traction, or pull on it (which they should do gently), to keep the uterus and cervix steady as the IUD travels further inward. “Putting that instrument on the cervix is, oftentimes, what makes people have really bad cramping,” Anne Ford, MD, an associate professor of obstetrics and gynecology at Duke University, tells SELF.
Pain isn’t universal, so medical experts can’t totally anticipate the degree of your discomfort during IUD insertion.
Research shows your doctor may underestimate just how painful the whole process might be. According to a 2014 study of 200 people published in the journal Contraception3, people who received IUDs said their pain reached 64.8 out of 100, on average, with a higher number indicating more pain. In comparison, their doctors anticipated that pain levels wouldn’t exceed 35 out of 100. A smaller but more recent 2020 study of 20 ob-gyns and 92 of their patients published in the journal Patient Education and Counseling4 found that doctors consistently underestimated their patients’ pain during not just IUD insertion, but other types of gynecological procedures too. The difference between a person’s pain estimate and their doctor’s pain estimate was greatest when the doctor had more experience performing the procedure.
But your medical history should offer your clinician some clues about what IUD insertion may feel like for you. For example, if you have vaginismus, which is characterized by involuntary vaginal muscle spasms and tightness, placement of the speculum can understandably be more painful. Or if you have a tilted uterus—meaning it is tipped backward instead of forward, which is the common position—then your clinician may have a hard time inserting the IUD, which can also contribute to pain, Dr. Ford says.
“When you start to force the IUD through the hole of the cervix, that’s when you get into trouble with things like perforation,” says Dr. Ford. In other words the IUD could tear the uterus. An experienced professional won’t force the IUD in, and in some cases, clinicians will use an ultrasound5, an imaging test that offers a clearer picture of the inside of your body, to ensure they’re placing the IUD properly.
Ultimately, doctors are responsible for discussing pain management options with you—but it’s not a requirement.
According to the experts SELF spoke with, there is no formal protocol that dictates gynecological clinicians to discuss pain management options with their IUD patients. Every clinician has their own resources and preferences based on prior experience, Alyssa Dweck, MD, a gynecologist at CareMount Medical in Mount Kisco, New York, tells SELF.
At Dr. Ford’s practice, she uses research from the American College of Obstetricians and Gynecologists (ACOG) to guide the conversations she has with her patients—but the research isn’t conclusive. According to a 2016 paper published in ACOG Clinical6, one study of 199 people found that local anesthesia didn’t reduce pain during IUD insertion compared to a placebo gel. But another study of 1,353 people, cited in that same ACOG paper, found that local anesthesia did help reduce pain when the clinician was using the tenaculum and inserting the IUD. The conflicting and evolving data could potentially explain why some clinicians don’t discuss options like anesthesia before the procedure.
However, an empathetic medical professional should absolutely explain the procedure in detail and discuss how to best deal with the potential pain during all stages of the process, Dr. Dweck and Dr. Ford agree.
How should you talk to your doctor about pain management before, during, and after IUD insertion?
You have the final say over your body—so it’s crucial to speak up if any part of your IUD insertion is making you uncomfortable or straight-up causing you pain. Here’s what to keep in mind during each step:
If your health care professional doesn’t mention pain management during your IUD consultation, then you can and should bring it up by asking what your options are. They might recommend taking an anti-inflammatory pain reliever like ibuprofen before the procedure, which is common. But if you’re truly worried about the potential pain, ask their opinion on giving you a paracervical block7, which is a type of local anesthesia injected around the cervix, Erica Pettigrew, MD, JD, MPH, family medicine specialist and assistant professor in the department of family medicine at UNC Health at Chapel Hill in North Carolina, tells SELF.
This can also help you segue into expressing any anxiety you may feel about the procedure, which you should definitely do, Dr. Pettigrew says. “It’s great to let the clinician know beforehand if you’re nervous, and to tell them if there’s anything specific that might help,” she says. If you’re anxious because previous Pap smears have been painful or you’ve experienced sexual trauma, it’s important to let your clinician know so you can work through that together. For example, you can set an expectation to stop the procedure at any time that you want to. “You can let your clinician know that if you say or do something specific, and it can be as obvious as saying ‘Stop,’ that you’d like them to pause what they are doing,” Dr. Pettigrew says.
At the end of the consultation, it’s a good sign if you feel confident about the plan you’ve created, which should be a “joint effort,” Dr. Dweck says. It’s a red flag if your health care clinician tells you what’s best without asking for your input. And if you feel like they’re blowing off your concerns entirely, consider searching for another professional who feels like a better fit for you and your needs if you can. (The ACOG and Planned Parenthood both have helpful directories for finding care in your area.)
On the day of your IUD insertion, reiterate your preferences to your doctor before it starts. “If at any point you’re in too much pain, let them know. Clearly state ‘Stop’ or ‘I need you to pause what you’re doing. I’m in too much pain,’” Dr. Pettigrew says.
Once you’re ready to, you can talk to your clinician about the best way to proceed. “If I have a difficult IUD insertion, I would bring the patient back another time and have them come into the office when I could do it under ultrasound guidance,” Dr. Ford says.
Your clinician should also offer advice about how to take care of yourself after your IUD is successfully placed. If yours doesn’t, be prepared to bring that conversation up yourself. Write down any questions you have about post-procedure care, including what signs could signal potential complications, like the rare instance of infection8.
Many people feel pain similar to menstrual cramps after IUD insertion. While that should generally subside after a couple of days, it may come and go for a couple of months, according to the National Library of Medicine (NLM). Ask your clinician how you can tell if what you’re experiencing after the procedure is common and what you should do if something truly bothers or worries you. “I usually tell people they might have some cramping in the first 48 hours after we put the device in,” Dr. Ford says. “If you have continued pain after that, you have heavy bleeding, or you have a foul-smelling discharge, those things aren’t normal. I would want to see you back again.”
Getting an IUD is a personal choice, and your health care professional should make you feel empowered—not dismissed. “We want things to go well for you,” Dr. Pettigrew says, “and clinicians should be happy to accommodate your needs.”
Sources:
- Journal of Pediatric and Adolescent Gynecology, Intrauterine Device Insertion Procedure Duration in Adolescent and Young Adult Women
- StatPearls, Intrauterine Device
- Contraception, Accuracy of Providers’ Assessment of Pain During Intrauterine Device Insertion
- Patient Education and Counseling, Physician Experience Is Associated with Greater Underestimation of Patient Pain
- American Journal of Obstetrics & Gynecology, Uterine Structural Abnormality and Intrauterine Device Malposition: Analysis of Ultrasonographic and Demographic Variables of 517 Patients
- ACOG Clinical, Clinical Challenges of Long-Acting Reversible Contraceptive Methods
- Obstetrics & Gynecology, Paracervical Block for Intrauterine Device Placement Among Nulliparous Women: A Randomized Controlled Trial
- Journal of Obstetrics and Gynaecology Canada, Practices to Minimize Risk of Infection With Intrauterine Device Insertion
Related:
