It generally takes 10 minutes to get an IUD in place.1. The process—which involves placing a tiny, T-shaped device through the cervix and into the uterus—can be remarkably simple for some people. For others, however, these minutes can be 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, MDAn anesthesiologist at The National Spine and Pain CentersWho goes to Germantown, Maryland? @doctorsoodTikTok uploaded a videoThis sparked a lively 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.”
Shannon M. Clark (MD, gynecologist) was last month. TikTokBabyDoc, joined the conversation by releasing her own videoShe also agreed that IUD insertion should include information about pain management options. “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.
For stability, doctors often use a tenaculum which is a small, scissors-shaped device to attach to the cervix. Sometimes, this can pierce the tissue in the cervix. Your doctor may try to apply traction or pull on it. ShouldDo this gently, to help keep the uterus & cervix still as the IUD moves inward. “Putting that instrument on the cervix is, oftentimes, what makes people have really bad cramping,” Anne Ford, MDAssociate Professor of Obstetrics and Gynecology Duke UniversitySELF, you tell.
Pain isn’t universal, so medical experts can’t totally anticipate the degree of your discomfort during IUD insertion.
Research suggests that your doctor might underestimate the pain of the entire process. A 2014 study of 200 people, published in the journal Contraception3People who had IUDs reported that their pain was 64.8 out of 100 on average. A higher number means more pain. In comparison, their doctors anticipated that pain levels wouldn’t exceed 35 out of 100. The journal published a smaller but more recent 2020 study involving 20 ob-gyns as well as 92 patients. 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.