Update August 7, 2024:
According to a recent CDC report, the group updated its recommendations to docs on IUD insertion and pain. Basically, the CDC’s new guideline tells physicians that they should actually provide meds like lidocaine or other anesthetics when inserting an IUD. These are updates to the org’s 2016 guidelines.
On top of that, the CDC also says that patients should be told that pain might be a part of the process, as well as their options to minimize it. “Pain management should be made based on patient preference,” reads the report. “When considering patient pain, it is important to recognize that the experience of pain is individualized and might be influenced by previous experiences including trauma and mental health conditions.”
Whether every single doc follows this guideline remains to be seen, of course, but regardless, now you’re able to advocate for yourself with the muscle of a federal organization behind you. Read our original story below to hear about IRL women’s experiences with painful IUD insertions and why this new guideline is a step in the right direction.
Original story from February 22, 2023:
Your work wife. Your sister. All of #IUD TikTok. And anyone else part of one of the loudest whisper networks in the health space. They’ll tell you about the pinching, the stabbing, the searing cramps that made them see God. And sure, people like to embellish when recounting horror stories, so it’s important to look at hard data too. Like the fact that 78 percent of women found getting an IUD to be moderately or severely painful, according to a study in the Journal of Family Planning and Reproductive Health Care. Or that in a recent Cosmopolitan poll, 69 percent of respondents said getting the procedure was “pretty awful, actually.”
So here’s the big question then, the reason this story is even a story: Why do many (if not most) doctors still tell patients that IUD insertion involves just “some discomfort”? The answer is—as you’ve already guessed—complicated. Let’s start with the procedure itself, which honestly just sounds ouch.
First, a doctor will use a tenaculum on the outside of your nerve-packed cervix, aka the tubelike tissue at the top of your vagina. They’ll insert a probe-like ruler through your cervical opening to measure your uterus, then remove the ruler and push through a slightly wider device that deploys the IUD, placing it at the tippy-top of your uterus. Next, they’ll withdraw the device, cut the IUD strings (leaving them peeking out of your cervix for when it’s time to take this thing out), and remove the tenaculum. The entire process takes about five minutes or less, says Amanda M. Silbermann, MD, medical director of New York University’s Langone Obstetrics and Gynecology Associates.
When Meghan’s* doctor explained she’d feel some light cramping but only for a few seconds during her IUD insertion, “I wasn’t nervous about it,” she says. “Then I remember saying, ‘Oh, fuck,’ because it was pain I had never experienced before.” She took deep breaths, thinking, Oh my god, it’s never going to end. Ultimately, Meghan was happy with her IUD; she’s just frustrated by the disconnect between the way her doctor described what was coming and what she actually felt.
In the medical community, the thinking is that even if IUD insertion is uncomfortable, it’s over quickly and you can get a decade of contraception for your trouble, says Jessica Horwitz, MPH, chief clinical officer at national women’s health care clinic Tia. It’s the kind of reasoning often rooted in the institutional dismissing of women’s concerns and complaints—a systemic (and sexist) issue that allows many docs to accept that “discomfort” as status quo.
But Still...Why??
Look, it’s not that doctors DGAF about your pain. It may just be that there’s not much they can do about it. Unlike with, say, a biopsy, practitioners typically don’t offer any kind of medical-grade relief during or after IUD insertion. Topical lidocaine hasn’t been proven to work. Paracervical blocks, where a local anesthetic is injected into your cervix before the procedure, could help with the tenaculum part of the process, but might do nothing for when the IUD goes in (anecdotally, the most painful part). Some clinicians will recommend up to 600 milligrams of ibuprofen—according to a Cochrane Review, though, most nonsteroidal anti-inflammatory drugs like ibuprofen aren’t effective in reducing insertion pain in people who haven’t yet given birth. And per other studies, ibuprofen taken in advance may not reduce post-IUD-insertion pain either. Feeling frustrated? You should be.
“Sometimes I joke that if men were having this procedure, it would be done under general anesthesia,” Horwitz says. But the danger associated with undergoing general anesthesia is significantly higher than the danger of the IUD insertion process alone, she adds. And injecting lidocaine into the cervix is also painful and could just prolong the entire process.
Plus, despite so many women sharing their stories, it’s hard to predict who will and won’t feel blinding pain. Some lucky patients do experience that mild-level discomfort doctors speak of (especially after giving birth vaginally, says Horwitz) or almost no pain at all. Anecdotally, says Dr. Silbermann, “we know the procedure is pretty uncomfortable, but overall, patients tolerate it rather well.” (See our earlier note about feeling frustrated!)
The Pain Versus the Gain
Until science takes a more active interest in women’s bodies, we’re left with a birth control option that for many is ridiculously painful to get but is incredibly effective for all (IUDs are more than 99 percent effective, to be precise).
In the meantime, your best bet is to team up with an honest doctor. That’s what Claire*, herself an MD, did before getting an IUD. Her physician told her it’d be “about seven seconds of the worst pain of your life.” And it was. “Once the process started, I thought, I am so fucked,” she remembers. But she still feels thankful that her doctor was up-front about what felt like being “overzealously whacked in the cervix during the most intense period cramp of your life.” All good doctors, she adds, should be equally straight-up with their patients.
You should also feel free to ask a lot of questions. If you’re nervous, request help for your anxiety or inquire about a paracervical block. Get your doctor to detail the different types of IUDs (some are smaller than others), and align your procedure with the tail end of your period, when your cervix is slightly more open. If you don’t feel like you’re being taken seriously, find another doctor.
Finally, let your provider know what the insertion really felt like—especially if they downplayed the whole thing. It’s not on you to change the entire system, but being real might encourage more honesty for the next person in the stirrups.
*Last name has been omitted to protect anonymity.
Ashley Oerman is a contributing writer at Cosmopolitan, covering fitness, health, food, cocktails, and home. You can follow her on Instagram @AshleyOerman. She is pro-carbs.
