IUD Insertion Doesn't Need to be Painful. Here’s What Your Doctor Isn't Telling You.
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IUDs are among the most commonly inserted medical devices in the United States, one of the most effective forms of birth control available, and, for some, the source of excruciating pain. According to a 2015 study, 78 percent of women rated the pain as moderate to severe.
The fact that IUD insertion is uncomfortable (to put it mildly) has made headlines in recent months, but many of the one in five sexually active American females who have gotten the device still don’t know that they have the power to minimize, or even eliminate, the pain of the procedure. It’s “completely unnecessary and preventable,” says Anushay Hossain, a women’s-health policy analyst, and podcast host, and the author of The Pain Gap. “The thing that is so infuriating is how common it is. How is this not violence against women?”
Thanks in large part to patients posting their experiences on TikTok, the medical establishment is finally confronting the problem. IUDs have been on the U.S. market for nearly forty years, but it wasn’t until last month that the CDC updated its guidelines on contraceptive use, recommending for the first time that clinicians counsel patients on “potential pain.”
Culturally, this marks a monumental shift toward doctors taking and treating IUD pain—and gynecological pain, generally—more seriously. But practically, it probably won't make your insertion any less miserable. As Colleen McNicholas, the chief medical officer at Planned Parenthood Great Rivers notes, the recommendations “won't require and don't even recommend” that pain medication be available. Guidelines do state that lidocaine, a local anesthetic, may help, but research shows that the majority of clinicians offer no pain management options for IUDs beyond over-the-counter painkillers like Tylenol and ibuprofen—medications that have repeatedly been shown to have no impact on the pain of the insertion itself, though they can alleviate cramping afterward. For perspective, consider the fact that sedation is standard practice for colonoscopies, a comparatively less painful and complicated procedure that around 15 million Americans undergo each year.
Another issue may be a stark disconnect between providers’ and patients’ perceptions of pain: In an earlier study in 2014 of 200 women, patients rated the average maximum pain of their IUD insertion at a 65 out of 100. Their providers, on average, rated their patients’ pain at a 35. “It’s not just a little bit more,” notes Hossain. “What is so infuriating is not only how women are being gaslit about their pain but how we don’t believe women about their bodies, period.”
The good news is there are medications that dull—or completely eliminate—the pain of the procedure. The bad news is you’ll likely have to fight pretty hard to get them. The reason is the politicization of reproductive healthcare, says Keisha Ray, PhD, a professor of bioethics and medical humanities at McGovern Medical School and the author of Black Health. “Women's health is underfunded and understudied,” so gynecology has not evolved as quickly as other medical fields. Additionally, many of our present gynecological tools and procedures were developed through experimentation on enslaved Black women, a population that white doctors at the time and, alarmingly, many medical students and residents surveyed just a few years ago believed to be biologically less sensitive to pain than white people. Long after those experiments ended, male doctors remained responsible for determining the treatment of body parts that they did not have or fully understand; many assumed that women’s sexual organs were hardy (they give birth and have periods with them, after all!) and that women who begged to differ were just being hysterical (they are ladies, after all!).
“The cultural assumptions infiltrate the medical assumptions, and vice versa—that we can endure things that we should not be enduring,” says Elizabeth Comen, MD, a medical oncologist at NYU Langone Health and the author of All in Her Head. “There's no world in which we would be doing this to men.”
While we hope that mainstream gynecology will get up to speed fast, we’re not holding our breath. And in the meantime, IUDs remain an incredibly safe, effective, long-term, reversible, and convenient form of birth control that, for some, will lighten or even eliminate menstrual cramping and bleeding. Women shouldn’t have to suffer unnecessarily for these benefits. Here’s how to get the contraception you may need with the care and respect you deserve.
Know Your Options
Inconveniently, there isn’t a one-size-fits-all medication to minimize the pain of IUD insertion. First, there are several points in the procedure that can cause pain (or maybe just make a patient woozy to think about): opening the vagina, stabilizing the cervix, stretching open the cervix, measuring the uterus, and sliding the device inside.
Pain can also be impacted by non-procedural factors such as a person’s “baseline level of anxiety, history of trauma experiences with medical providers, history of medical racism,” and more, says Ghazaleh Moayedi, an OB/GYN in Texas and board chair for the healthcare advocacy group Physicians for Reproductive Health. Once McNicholas walks patients through their options and they choose what sounds best for them, “We very rarely need to do some next level of intervention,” she says. "They know exactly what they need, and they feel in control of that decision."
Here are options to discuss with your doctor, ranging from mildest to most intensive intervention. They should all be covered by most insurance plans, but since prescription pain medication of any sort is still not standard care for an IUD insertion, it’s best to confirm your coverage in advance so you aren’t hit with a $700 bill. Also keep in mind that many of these are only available in certain clinics or on certain days, so call ahead if you can: If you know what to ask for—and how to ask for it by name—it will be much easier for your provider to help you have exactly the experience you want.
Anxiety Medication
While prescription anxiety medication like Xanax won’t numb the pain of the actual procedure, studies have found that anxiety leading up to the appointment and the higher levels of anticipatory pain may increase the experience of pain once you’re in the stirrups. If you are feeling nervous pre-appointment, ask your provider to call in a prescription to take in advance. Discuss with your provider how long the drug’s effects will last so you can plan the rest of your day accordingly.
Local Anesthetic
Local anesthetics numb the pain of a targeted body region (in this case, the cervix and vagina) while the patient remains fully conscious. Lidocaine, the drug the CDC namechecks in its updated guidelines, is the most widely studied and commonly used local anesthetic for IUD insertions. It can be applied topically as a gel, spray, or cream that primarily helps with the pain of stabilizing the uterus with a device known as a tenaculum; or it can be injected around the cervix in what is known as a “paracervical block,” which chiefly alleviates the pain of dilating—or opening the “mouth” of the uterus—and squeezing the IUD through, which is usually the most uncomfortable part of the procedure.
Paracervical blocks involve injecting a needle around the edges of the cervix, which for some patients causes more discomfort, or is simply more anxiety-provoking than the dilation itself. While the numbing effects often outweigh the pain of the injection, this, like every other part of the procedure, is highly subjective.
Nitrous Oxide
Also known as “laughing gas,” nitrous oxide is commonly used in dental procedures because it is very safe and leaves your system quickly—no downtime needed. Despite its nickname, you likely won’t be giggling while under the influence, but it does cause a sense of calm euphoria. Results are mixed as to whether it mitigates the pain of the insertion itself, but patients do tend to report more satisfaction in their experience of the procedure overall.
IV Sedation
IV sedation will significantly dull—if not completely block—the pain of the procedure. You should expect to spend an additional 15 to 20 minutes in the office while the drugs wear off, and you will need to arrange a ride home.
In general, there are two levels of IV sedation available for IUD insertion:
Moderate or “Twilight” sedation: You might doze off while under moderate sedation, but most likely you will be in a relaxed, drowsy state, achieved through medications such as ketamine, Versed, and fentanyl.
Deep sedation: You will likely be completely asleep for the entirety of the procedure thanks to propofol, a drug that is much less risky and easier to administer than general
anesthetic. Propofol is standard care for most colonoscopies in the United States. For some patients, including gender nonconforming or trans patients or those who have experienced medical or sexual trauma, it makes sense to be truly out for the entirety of the procedure. However, you do not need to fall into any of these groups to feel justified in requesting deep sedation: Moayedi considers propofol the gold standard “for safe pain management,” for several outpatient treatments, and believes that it should be available as an option for IUD insertions.
Pick the Right Provider
According to Moayedi, your best bet for the least painful IUD insertion is at a clinic that also provides abortions, as they will likely have all or most of the pain-management options listed above. Clinicians who are experienced in abortion care will also be most skilled in IUD insertions and most aware of the procedure’s pain points, which will lead to a less painful insertion even if no medications are used. Be aware that, depending on your state, these clinics may be extremely overbooked or unable to accept insurance.
Rosa Topp, director of medical-standards implementation for the Planned Parenthood Federation of America, notes that it may be more efficient to reach out to larger hospital networks or a Planned Parenthood branch rather than individual clinics, as the operators of their phone lines will likely be aware of when and where in their network you will be able to access various options. Last, consider a consultation so you can talk through the pros and cons of each option in more depth.
While it’s frustrating to hop through bureaucratic hoops to get what should be standard care, it’s important to know that things are changing. McNicholas’s Planned Parenthood branch made headlines earlier this year when it became the first in its region of southwestern Missouri to advertise IUD sedation options for all patients who want them, and many other branches have since followed suit, a trend that Topp feels certain will continue. Also, a number of healthcare companies are (finally) working to upgrade outdated gynecological tools.
Many of these changes, McNicholas notes, are driven by patients themselves: "I think we are seeing a reckoning with the historic misogyny and patriarchy that have been part of women's reproductive healthcare” she says. “And we are seeing a population of people more empowered to talk about their experiences, advocate for themselves, and demand something better."
Any content published by Oprah Daily is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. It should not be regarded as a substitute for professional guidance from your healthcare provider.
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