Limiting Belief: An IUD insertion will be excruciatingly painful, and not worth the superior contraception and menstrual regulation that many of these devices can provide.
Truth: Social media accounts of IUD insertion “nightmares” likely reflect a minority of patients, however there is no specific standard to address pain with IUD insertions. In my experience as a physician who inserts IUD almost every day of the week, anecdotally, my patients report that the procedure was less painful than expected when the measures below are used to help anticipate and manage pain associated with an IUD insertion.
I see patients for birth control consultations and IUD insertions on a daily basis. The number one concern of my patients who are considering intrauterine contraception is: pain. Undoubtedly, people have read personal testimonials on Reddit, YouTube or other social media platforms where they have heard “nightmare” stories about severe, excruciating pain when they had their IUDs placed. Sometimes they themselves have had negative, or even traumatic experiences with prior insertions.
Unfortunately, many people have had IUD insertions without prior counselling about what to expect during the procedure. I have even heard of some patients being advised that the procedure feels pretty much the same as a Pap test (which for most people is not a painful experience at all).
Ongoing Informed Consent
As with any procedure, it is important that patients are fully informed about the side effects, risks, and benefits of the device and procedure. For most patients, being informed of what to expect before the procedure, and communicating when they can experience moments of discomfort during the procedure itself is helpful, and empowering. While I can never anticipate exactly how a patient will feel during the procedure, I can help avoid the element of surprise, which can make discomfort more alarming, and even traumatic.
I ask my patients to pre-medicate with over-the-counter pain medication, typically a medication such as ibuprofen, about one hour before the procedure. This can help ease the cramping experienced whenever anything passes into or out of the cervix, the passage leading from the vagina to the uterus, the cavity in which the IUD is positioned.
During the procedure itself, I use a modified cervical block, to numb the cervix. Again, this helps make the insertion more comfortable, especially during the part of the procedure where the cervix may need to be stabilized using an instrument called a tenaculum, which can cause a brief, but intense cramp initially when/if it is applied.
Period-type cramping for the few days after the insertion is expected, so treating with over-the-counter pain medication is safe, and effective to manage this post-procedural cramping. Severe pain after the insertion is not normal, and should be evaluated.
Anxiety & Support
You are welcome to bring a friend, family member or partner into the room for support, and also to drive you home if you have profound nervousness requiring an anti-anxiety medication, which can be prescribed during the consultation appointment.
Seek out an experienced clinician who inserts IUDs on a regular basis, as they are more likely to be prepared to manage any challenges which may arise. IUDs should ideally be performed by experienced health care providers who have been appropriately trained and who have maintained their skills.
What Most of My Patients Report
With the above measures in place, in my experience as the clinician asking feedback about their experience of pain and cramping, most of my patients experience 1-3 minute period of a very intense uterine pain, when the uterus length is being measured and the IUD is actually being inserted. This pain generally diminishes within minutes to a moderate menstrual cramp intensity, often before the vaginal speculum is even removed. The vast majority of my patients report that the pain has further decreased before they even sit up on the table. Some patients tell me that the pain is no more intense than their typical menstrual cramps. From time to time, some patients tell me they didn’t feel anything at all – this, however, is rare.
Most of my patients walk or drive themselves to the appointment, feel well to do so on their journey home, and go back to their usual activities of the day. If you are having your first IUD placed, however, it’s a good idea to allow for the possibility that you might feel a little more cramping, and plan the rest of your day accordingly.
Even if you don’t have your IUD placed at Liberty Women’s Health, you should expect to have a comprehensive consultation to answer your questions and prepare you for the procedure. Advocate for yourself: ask how many insertions they do per week or month, about pain management strategies, and after-care.