So you're thinking about getting an IUD (intrauterine device). Maybe because it's an effective form of birth control, and studies show that most people who got them were happy they did. But you might have some concerns. Valid. Because IUD insertion can be painful. And anecdotes from real women who experienced it run the gamut from ‘worst pain ever’ to ‘barely felt a thing.’
How does IUD insertion work?
Quick refresh: An IUD is a form of long-acting contraception. Meaning it can be left in from three to 12 years. The IUD is inserted into the uterus in a doctor’s office and typically takes just a few minutes.
“It starts just like a pap smear would,” said Dr. Venuti. The doctor first performs a pelvic exam, where they examine the vagina internally and externally. Next, they’ll insert a speculum into the vagina so they can see the cervix. Once they can see it, they’ll clean it with an antiseptic solution.
The doctor may use a tool called a tenaculum to straighten and stabilize the uterus and help prevent it from puncturing the uterine wall (aka perforation), said Dr. Venuti. But tenaculums have gotten a bad rap on TikTok lately. “It does look barbaric, as most things in medicine do. But it has a very important purpose,” she said. Once the uterus is stabilized, your doctor will place the IUD with an insertion tube.
Side note: Some providers will sound first, said Dr. Venuti. Meaning: “They'll put something in the uterus to see how deep it is. So we know we're placing it in the right place.” But some docs will just use the IUD itself to do that.
Finally, they’ll place the IUD. And trim the strings that dangle from the bottom of it.
Just tell me. Does IUD insertion hurt?
“It's definitely uncomfortable. I don't lie to people,” said Dr. Venuti. But the level of discomfort varies from person to person. Some factors that can contribute to how painful insertion is: personal pain tolerance and/or how tight your cervix is.
Dr. Venuti said there are two parts of the procedure that might be particularly uncomfortable. The first is when the tenaculum clamps over your uterus. Some people say it feels like period cramps or a pinch. Then again, “some people don't feel it at all,” Dr. Venuti said. The second potentially uncomfortable moment is when the IUD is inserted. Enter: More cramping. Which typically lasts about a minute.
After the procedure, you’ll likely be able to drive yourself home. For the few days afterward, you may feel cramping or backaches, or experience spotting.
Will my doctor give me anything to manage the pain?
If you’re anxious about your IUD placement, you can ask your doctor about pain management options. Such as:
Prescription oral medications. Think: Misoprostol. Which is taken before insertion. And in some cases, may dilate the cervix and ease pain.
Sedation. If you have a lot of anxiety around the procedure, Dr. Venuti said IV sedation may also be possible. Heads up: If you opt for this, you'll probably be told not to eat or drink for a certain number of hours before the procedure. And you'll need someone to take you home.
What should I do before and after IUD insertion?
Dr. Venuti recommends taking 600 to 800 milligrams of OTC ibuprofen one to two hours before your IUD insertion. “It can really help with the cramping,” Dr. Venuti said. And afterward, use backup contraception (think: use condoms) for seven days if you plan to have sex. A heating pad and ibuprofen (post-procedure) may help ease any pain from the insertion, Dr. Venuti said.
Can your IUD move?
It’s uncommon. Think: It only happens 0.001% of the time. Sometimes within the first few months after insertion. And usually when the IUD gets expelled by the uterus or perforates the uterus. Which could happen if it was placed wrong to begin with, said Dr. Venuti.
A displaced IUD may cause unusually heavy bleeding or cramping. Or put you at risk of getting pregnant. Doctors recommend doing regular self-checks to see if you can feel the IUD strings yourself. If you can’t feel the strings, though, it doesn’t automatically mean your IUD has moved — the strings may have just curled up into the cervix. So it’s a good idea to have your doctor check it out.
An IUD insertion can range from being mildly uncomfortable to very painful — depending on the person. If you’re concerned about the pain, ask your doctor ahead of time about your pain management options.