IUDs are super effective at managing periods and preventing pregnancy , but the procedure to put them in can be painful. Not everyone who gets an IUD experiences pain when the device is inserted, but many do. That isn’t surprising! The pelvic region is rich with sensory nerve endings, which is why people experience many sensations, some pleasurable and others painful, in and around the vagina , cervix and uterus .
Medical providers didn’t used to offer pain management for gynecological procedures because of the (misogynist and now debunked) presumption that these types of procedures don’t cause pain. But pain management is now widely available and should absolutely be offered to anyone who opts to have an IUD placed into their body. You don’t have to use pain management for an IUD insertion if you don’t want to, but everyone should be offered the choice.
Let’s talk about how an IUD is placed, at which points during the procedure people experience pain, and the pain management options that can be used at various points during the procedure.
(Some of what follows does include explicit descriptions of IUD placement.)
The first step in getting an IUD is to undergo a basic pelvic exam. For this, a provider will first leave the room so you can remove any clothing you have on from the waist down. Feel free to keep your socks on so your feet stay cozy! You should be offered a blanket, drape or a gown for privacy which you can place over top of your body once you are undressed. When you are ready, the provider will come back into the room and explain how to lay on the exam table and position yourself for the procedure.
Once you're comfortable, they will use a device called a speculum to open the vagina so they can see and access the cervix. Speculums may be plastic or metal, and look like the bill of a duck. They are first placed inside the vagina in a closed position. Once it is inside, it is opened just enough to be able to see the cervix which is at the end of the vaginal canal. You might hear “clicks” when the mouth of the speculum is opened: that’s normal. After looking and noticing the position of the cervix, a provider will then use a device called a tenaculum to hold the cervix still. This helps to stabilize and straighten out the pathway the IUD will take when it is inserted in the uterus. It also helps prevent the IUD from damaging the uterus during insertion. After the tenaculum is placed, the provider will measure the size of the uterus with a device called a uterine sound that looks like a round chopstick. The uterine sound is placed through the cervix and into the uterus for measuring. This also ensures the opening of the cervix is wide enough to put the IUD through. If the cervix is found to not be wide enough, it is occasionally dilated open with special dilators that are similar in appearance to the uterine sound.
After measuring (and dilating, if needed), it is time to put in the IUD. Each brand of IUD has a unique insertion device that comes from the manufacturer. For the most part, they look like very thin straws with the IUD tucked inside the straw. It’s a lot like a small tampon applicator with a tampon inside. The insertion device is put into the cervix and the IUD is then released from the applicator directly into the uterus. With the IUD now in place, the applicator is slid out the cervix and removed.
IUDs are made with strings that hang down through the cervix so that, down the road, the string can be used to remove it. The strings are generally super long so your provider will trim the strings to a reasonable length so the end hangs just below the opening of the cervix.
Once the string is trimmed the procedure is over and the speculum is removed from the vagina. The whole of this procedure goes a lot faster than describing it can sound: from start to finish, it usually takes about five to ten minutes to have an IUD inserted.
At what point during the procedure might people experience pain?
Pain can be experienced at any point during IUD insertion. Most people, predictably, have some degree of discomfort or pain with the tenaculum placement. This is because it’s sharp, and sharp things placed anywhere on the body can hurt. Some people have pain with other parts of the procedure too. For instance, during the speculum insertion, or the times instruments are passed through the cervix, or when the IUD is released into the uterus. For many, the speculum placement is experienced as uncomfortable, but not painful, tenaculum placement is often described as sharp pain, and the points during the procedure when instruments are put through the cervical opening can feel like pressure or cramping. When the IUD is released into the uterus people often describe cramping.
That being said, the degree of pain and the quality of pain each person experiences at the various points of an IUD insertion are remarkably varied. For instance, some will have minor discomfort and report that IUD insertion was no big deal, while others experience a great deal of pain the entire time. Why is there such a wide range of pain experiences? It’s hard to say. What we know for sure is that you are more at risk of experiencing severe pain if you have:
- Painful periods
- A known pelvic pain syndrome, or other chronic pain condition
- Never given birth vaginally
- A history of trauma
- A history of anxiety or anxiety about any or all of the procedure or IUD itself
Thankfully, there are many things that can be done to reduce the amount of pain experienced at every step of the IUD insertion.
Pain Management Options
Pain management without medication
There are many things people can do to reduce pain without using any kind of medication. Some people choose these options alone, and some use them with medications. Either way, these methods can be really useful.
Distraction
Distracting yourself during IUD placement gives your brain an alternative task to focus on which takes your attention away from the procedure. This can decrease some of the bandwidth the brain has for pain perception – the brain may be complex, but it still can only experience so many sensations at once. Techniques like listening to music, watching a video, holding hands with or making small talk with a support person can help people dramatically. Not all institutions allow a support person outside of the medical team, but if this is something you feel would be helpful you can absolutely ask to bring a friend, family member, or partner along for comfort.
Mindful Breathing
Slow deep breathing exercises can lower the heart rate, calm the body, reduce anxiety, and even decrease pain. Some people are able to do breathing exercises without a prompt, but if prompts are helpful there are loads of vids available on social media that offer guided breathing exercises – it’s completely okay to load one up, put in some ear buds, and listen away during the procedure.
Heat
It sounds simplistic, but having access to a heat pack over your belly, or a warm blanket during an IUD placement can help your body relax which will ultimately decrease pain. Not all providers will have heated blankets, but most have heat packs, even if just the single use disposable kind. Some offices even keep a warming pad under speculums so they are warm before they go in the body. If your medical office doesn’t have that, a provider can run a speculum under warm water to heat it up before it is used.
Verbal walkthroughs
Some people do much better during medical procedures if they know what’s going to happen before it happens. You can ask your provider to do things like tell you when the speculum will be inserted, when it will open, when the tenaculum will be placed, or when the IUD will actually be put in. A provider should absolutely be able to walk you verbally through the procedure as it’s happening, if you want. For many, this can reduce pain and anxiety as it can help a person be more mentally prepared for the more painful parts of the procedure, and for when they’ll be getting a break.
Get your IUD placed during your period
Getting an IUD placed during a menstrual period can reduce pain during an IUD placement. When you are menstruating, your cervix is more open all by itself, which makes insertion easier. If you don’t get a period , or are unable to wait for a period before your IUD placement, that’s okay. But if you are able to have it inserted during a period, it can be beneficial.
Pain Management with Medication
Although distraction, mindful breathing, and other non-medication strategies can be super useful, you also have the option of using medications during an IUD placement. All IUD providers should offer medication management. If they don’t, consider it a red flag and inquire about who in your community does. Not everyone chooses to use medication for an IUD placement, but it should definitely be an option for all people. There are loads of medications that can be helpful and you should work with a provider to choose what makes sense for your body and your unique needs.
Anxiety Medication
It’s normal to feel nervousness or anxiety before a medical procedure, but sometimes these feelings can be overwhelming, cause you to feel physically ill and even lead to a panic attack. Further, anxiety brings a lot of tension into the body and causes people to have trouble taking deep breaths, which can definitely increase the body’s perception of pain.
One way that healthcare providers are able to help ease anxiety, is by offering a one-time dose of anxiety medication. That will usually need to be ordered before the day of the IUD placement, picked up from a pharmacy, and brought to the procedure by the patient, so it’s something that they will need to offer you — or you will need to ask for — before the day of your appointment. If you opt for anxiety medication, your provider should have you take the pill only after talking with you about the procedure, answering your questions, and getting your consent to do the procedure. This is because anxiety medication can impair one’s ability to process information and think clearly which can interfere with consent. Further, if you opt to take anxiety medication, you will generally be required have a support person available to help you get back to the place you are staying after the procedure is over. Also, you may not be able to return to school, work or other obligations until it wears off.
Analgesics (Pain Medication)
Oral Medications
NSAIDs —non-steroidal anti-inflammatory drugs — are the mainstay of oral medicine management for IUD placement. These medicines, like ibuprofen or naproxen, are generally taken before the procedure to ensure they’ve started working before your IUD is placed. They work by decreasing pain, in general, and decreasing cramping in the uterus both during and after the procedure. Not everyone can safely take NSAIDs. Talk with your provider about whether or not it’s safe for you, which one to take, how much and how often if this is something you are interested in.
Topical Medication
Topical anesthetics are commonly offered to numb the vaginal opening and the surface of the cervix. This type of medication can be helpful for all people and is especially helpful for those with vaginal pain syndromes like vulvodynia, vaginismus, and dyspareunia. There are many types of topical anesthetics including gels, creams and sprays. Some providers are even okay with a patient putting them on their body themselves if you prefer, especially if you desire numbing medicine at the opening of your vagina. It can be harder to reach your cervix yourself, but that’s an option, too. Using a product like this won’t make it so you feel nothing during the IUD procedure, but they will almost always decrease pain.
Injectable Medication
Injectable anesthesia can be used to block pain in and around the cervix. It involves injections into the cervical area that numb the surrounding nerves. The injections themselves can be painful, which is something worth talking about with your provider, but once the anesthetic starts to work the area will become numb. It can be hard to know ahead of time what will feel worse, the pain of an injection or the pain of the IUD insertion, but a provider can help you weigh the pros and cons of each option.
This method of numbing the cervix is a lot more effective than a topical numbing medicine like a gel or cream. It’s a lot like getting anesthetic injections before dental work to numb your mouth and tooth area. The shots can help a lot with pain during the parts of the procedure that involve the holding the cervix steady and putting tools through the cervical opening.
Inhaled Medication
Although not offered everywhere, nitrous oxide — which you may know as “laughing gas” — can be used to help people feel calm and provide a certain degree of analgesia during IUD insertion. It’s a medicine that is inhaled during the length of the procedure. The effects wear off super quickly once you stop breathing it in. It doesn’t do a great job at preventing pain, but many still opt for it because it is low-risk, out of your system fast, and does often have a big calming effect. This medicine can be expensive though, and is rarely covered by insurance companies. People who choose it may have to pay for it on their own.
Sedation
There are two different ways sedation can be offered for IUD placement: a way where you are awake during the procedure, but will feel calmer and may not remember some or all of it (conscious sedation) and a way that puts you into a sleep-like state the entire length of the procedure (moderate or deep sedation.) Sedation is generally only done in offices with procedure rooms or at hospitals in an operating room. Not everyone can use sedation safely. If this is a method that interests you your provider will ask a lot of questions about your medical history to determine if sedation is safe for your body.
If you choose sedation you will usually be asked to bring a person along with you that will be able to take care of you and get you home afterward since you’ll likely be groggy or a bit out of it. Sedation is not a common way to have an IUD insertion, but it is possible for anyone who desires an IUD but does not feel they could go through with the procedure without it, like someone who gets panic attacks. Sometimes sedation is also necessary for people with anatomy that make it hard to get to the cervix, or for those who have a lot of scarring in the area the IUD is to be inserted.
IUD Removal
You can also choose pain management for an IUD removal. All of the options that are available for IUD insertions can also be used for removal. For many people though, removal is much easier and quicker than the insertion. Like anything else, there can be complications that make it challenging, but you can talk with your provider about your specific circumstance to determine if pain management would be a good idea for your removal.
How do I choose?
It can be hard to know what type of pain management you’ll want before you have an IUD placed. That’s okay. You will need to talk with your provider about your options anyway, and they can help you narrow them down. If you choose a method, and then during the procedure you change your mind, that’s sometimes okay too! For instance, if you opt to not use pain management and then, during the procedure, the pain becomes more than you anticipated, it’s always okay to ask the provider to stop so you can take a break and rethink your choices. Sometimes adding an extra pain management strategy can accommodated at the same visit and sometimes it may mean rescheduling your visit for a different time. If instead it’s more that you don’t like the pain management option you chose, for instance, how you feel on an anxiety medicine, the provider may not be able to offer you anything to make the feeling go away. In cases like this you may have to wait for the medicine it to wear off. Even if a medication can’t be taken away once it’s started, it’s still always ok to tell your provider it you’re not liking the experience and to talk it through.
The most important takeaway in all of this is that you should feel empowered when making decisions around pain management for an IUD placement. Providers should be discussing all pain management options with you, without pressuring you toward, or away from, any particular option. They should also be supporting your decisions around what you’d like to do.
Western medicine has a troubling history of mistreating patients, particularly those who are female, trans, Indigenous, Black or other people of color. This is especially true in gynecology. As a patient, you should never feel pressured to do something you don’t want to, and you shouldn’t be asked to endure a painful procedure without being offered options to help manage the pain. It’s always your body your choice, even (and especially!) during medical procedures.
Getting an IUD may not be the most enjoyable experience, but it should be an experience you have total power over, including the autonomy to choose a pain management plan that makes sense for you.
