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.
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