Getting an IUD Really Doesn’t Have to Hurt: Pain Management Options You Should Know

When Jessica Hart went to get her firstintrauterine device (IUD), she expected a routine procedure: the doctor would secure her feet in stirrups, stretch her vaginal canal with a speculum, swab her cervix with antiseptic, and slowly insert the small, T-shaped contraceptive.

What she didn’t expect was the sudden, explosive pain.

The medical websites she consulted said the routine procedure would be about as painful as a period cramp. But as her doctor inserted the IUD, Hart began shaking, sweating, and let out an involuntary scream. She rated the pain as a 10 out of 10.

Hart, a 34-year-old account manager in New Jersey, isn’t alone in experiencing unexpected and unmanaged pain from anIUD insertion.

On TikTok and other social media platforms, women are sharing videos documenting painful IUD insertions, which have amassed millions of views.Many show them wincing, crying, and pleading with providers to stop the procedure.

These accounts highlight a stark disconnect between the clinical guidelines informing IUD pain management and the lived experiences of patients undergoing the common contraceptive procedure.

Patients’ pain experiences during IUD insertions often do not align with what practitioners perceive that pain to be. One study shows that women rated their highest pain during a procedure at around 65 on a scale of 100, while providers estimated it at around 35—highlighting a deep-rooted disparity between patient experiences and provider perceptions.

“Women are left in the dark about the reality of this procedure, and that needs to change,” Hart told Verywell. “For many of us, it’s not just mild pinching or cramps, and the first step is to bring this out of the shadows, validate women’s pain, and show them that there are options available to help them manage it.”

Afraid to Get an IUD? Pain Relief Measures Your Provider Wants You to Know About

CDC’s Updated Guidance on IUD Pain Management

Once in place, an IUD is among the most effective contraceptive methods available, providing protection for three to 12 years, depending on the model.

In August, the Centers for Disease Control and Prevention (CDC) updated its guidance on pain management during IUD insertion. The agency now suggests that topical lidocaine “might be useful” for pain management as well, in addition to recommending a lidocaine injection into the cervix.However, topical lidocaine gels or sprays have shown limited effectiveness.

In its updated guidance, the CDC also stated that misoprostol, a medication commonly used to soften the cervix during IUD insertions, does not reduce pain.

“For many women, the sensation during insertion can feel like severe menstrual cramps and can cause dizziness, lightheadedness, or nausea, while others experience little to no discomfort at all,” Antoun told Verywell.

Women who have given birth vaginally may feel less pain than those who haven’t, she added.

Over her 30 years of practice, Antoun said her patients have mostly reported mild pain. To help minimize discomfort, she uses an ultrasound to look at the cervix and make sure she inserts the IUD in the correct spot.

This practice, called ultrasound guidance, can enhance placement accuracy and reduce patient discomfort compared to a traditional “blind insertion,” but its routine use is neither widespread nor standard.

“The most important factor is clear and open communication; it’s essential in shaping a woman’s experience of pain,” Antoun said. “If patients aren’t properly informed about what to expect, it can heighten their pain perception, increase their muscle tension, and overall discomfort.”

IUD Side Effects to Help You Make Informed Decisions

Women Are Less Likely to Be Prescribed Painkillers

Research shows that women’s reports of pain are frequently downplayed compared to men with similar symptoms.One study found that women are more often prescribed sedatives for pain rather than the stronger painkillers afforded to men for the same conditions.

“Physical pain in women is frequently dismissed as secondary to anxiety or stress,”Jaime Zuckerman, PsyD, a clinical psychologist based in Pennsylvania. “Often, women’s reporting of pain symptoms is seen as overreaction or being ‘dramatic.’ This pervasive medical gaslighting can lead to women feeling unheard and hesitant to advocate for themselves, especially in vulnerable moments, like an IUD insertion.”

Hart said she experienced such treatment first-hand.

“I felt completely invalidated. Even now, I start to doubt myself and wonder—Am I overstating it? Am I exaggerating? Am I crazy? But I know I’m not,” she said. “I’ll put it this way: if a man had to do it, there would be more options. There would be better pain management. They might even put you under for it.”

She also emphasized that, beyond physical pain, the procedure can take a significant mental toll.

“Because of the type of procedure this is, there are mental side effects from it that stay with you as well,” she said. “Being in such a vulnerable position with your legs open and feeling all that pinching, pulling, and pain—it does something to you. It feels almost violating. It’s hard to process.”

Pain, especially pain in the vaginal and pelvic region, can be extremely triggering and traumatic, according to Zuckerman.

“This pain must be discussed, addressed, believed, and managed appropriately,” Zuckerman said.

Hormonal Birth Control Options

“The reality is not every woman will experience the procedure the same way, and what’s routine for one might be excruciating for another. If a patient expresses that they are experiencing significant discomfort, it’s vital to listen,” saidChailee Moss, MD,an OB-GYN at The Centers for Vulvovaginal Disorders and an adjunct assistant professor at George Washington University.

Moss employs multiple pain management tools for her patients. She uses a paracervical block, which involves injecting a local anesthetic around the cervix to block deeper nerve pain. She also offers topical anesthetics, nitrous oxide for relaxation, and, when appropriate, a lidocaine instillation to numb the cervix and uterine lining for added comfort during the procedure.

A recent survey found that only 4% of U.S. doctors routinely offer a paracervical block to patients. Nearly 80% of physicians only recommend over-the-counter painkillers, such as acetaminophen and ibuprofen.

“The cramping warrants more than just ibuprofen,” Moss said.

Moss said she avoids prescribing opioids because the risks, such as addiction, often outweigh any pain relief benefits.

Antoun said she prescribes half a Xanax to patients who express extreme anxiety about the procedure to take the morning of, but that only aids in relaxation, not pain relief.

Sedative options such as twilight sedation and general anesthesia are available but largely inaccessible due to logistical and financial barriers, with most IUD placements under sedation occurring only when paired with another procedure, according to Antoun.

However, for women with a history of sexual trauma, IUD insertions can be especially distressing, compounding physical discomfort with psychological strain.In these cases, Antoun stresses that a trauma-informed approach that utilizes sedation is essential.

With the updated CDC guidance, providers are now advised to discuss potential pain in detail and offer more effective relief methods. The guidelines also emphasize shared decision-making, allowing patients to choose pain management options that fit their needs.

“In terms of pain control research, I do think more can be done to ensure research is centering patient concerns,” Moss said. “We need to continue amplifying the voices of patients who have had negative experiences to advocate for widespread change in pain management practices.”

Hart said she hopes these conversations won’t deter other women from choosing IUDs, given their reliability, effectiveness, and long-term benefits—especially in today’s uncertain landscape surrounding reproductive rights.

“The idea of this procedure being ‘routine’—another thing women have to quietly endure—needs to change,” Hart said. “If these stories coming to light don’t prompt a reevaluation of our medical practices, it raises a crucial question: Who does our current ‘routine’ really serve—and who does it fail?”

What This Means For YouPain experiences for IUD insertions can vary. Open communication with your provider about pain management options—such as local anesthesia, sedation, or ultrasound guidance—can help tailor the experience to your needs. Don’t hesitate to advocate for adequate pain relief and a personalized approach to make the procedure as comfortable as possible.

What This Means For You

Pain experiences for IUD insertions can vary. Open communication with your provider about pain management options—such as local anesthesia, sedation, or ultrasound guidance—can help tailor the experience to your needs. Don’t hesitate to advocate for adequate pain relief and a personalized approach to make the procedure as comfortable as possible.

12 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Wu J, Trahair E, Happ M, Swartz J.TikTok, #IUD, and user experience with intrauterine devices reported on social media.Obstet Gynecol. 2023;141(1):215-217. doi:10.1097/AOG.0000000000005027Planned Parenthood.What’s an IUD insertion like?.Maguire K, Morrell K, Westhoff C, Davis A.Accuracy of providers' assessment of pain during intrauterine device insertion.Contraception. 2014;89(1):22-24. doi:10.1016/j.contraception.2013.09.008Planned Parenthood.How effective are IUDs?.Curtis KM, Nguyen AT, Tepper NK, et al.U.S. selected practice recommendations for contraceptive use, 2024.MMWR Recomm Rep. 2024;73(3):1-77. doi:10.15585/mmwr.rr7303a1Daidone C, Morris K, Colquitt J, Jackson G.Provider perspectives on analgesic use in intrauterine device insertion procedures: a mixed methods analysis.Cureus. 2024;16(3). doi:10.7759/cureus.56580Maged AM, Nada AM, Abdelwahab H, et al.The value of ultrasound guidance during IUD insertion in women with RVF uterus: a randomized controlled trial.J Gynecol Obstet Hum Reprod. 2021;50(4):101875. doi:10.1016/j.jogoh.2020.101875Nowitzki KM, Hoimes ML, Chen B, Zheng LZ, Kim YH.Ultrasonography of intrauterine devices.Ultrasonography. 2015;34(3):183-194. doi:10.14366/usg.15010Zhang L, Losin EAR, Ashar YK, Koban L, Wager TD.Gender biases in estimation of others’ pain.J Pain. 2021;22(9):1048-1059. doi:10.1016/j.jpain.2021.03.001Calderone KL.The influence of gender on the frequency of pain and sedative medication administered to postoperative patients.Sex Roles. 1990;23(11-12):713-725. doi:10.1007/BF00289259Ovsepyan V, Kelsey P, Evensen AE.Practical recommendations for minimizing pain and anxiety with IUD insertion.J Am Board Fam Med. 2021;34(4):695-705. doi:10.3122/jabfm.2024.240079R1Reeves JA, Zapata LB, Curtis KM, Whiteman MK.Intrauterine device training, attitudes, and practices among U.S. health care providers: findings from a nationwide survey.Womens Health Issues. 2023;33(1):45-53. doi:10.1016/j.whi.2022.08.002

12 Sources

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Wu J, Trahair E, Happ M, Swartz J.TikTok, #IUD, and user experience with intrauterine devices reported on social media.Obstet Gynecol. 2023;141(1):215-217. doi:10.1097/AOG.0000000000005027Planned Parenthood.What’s an IUD insertion like?.Maguire K, Morrell K, Westhoff C, Davis A.Accuracy of providers' assessment of pain during intrauterine device insertion.Contraception. 2014;89(1):22-24. doi:10.1016/j.contraception.2013.09.008Planned Parenthood.How effective are IUDs?.Curtis KM, Nguyen AT, Tepper NK, et al.U.S. selected practice recommendations for contraceptive use, 2024.MMWR Recomm Rep. 2024;73(3):1-77. doi:10.15585/mmwr.rr7303a1Daidone C, Morris K, Colquitt J, Jackson G.Provider perspectives on analgesic use in intrauterine device insertion procedures: a mixed methods analysis.Cureus. 2024;16(3). doi:10.7759/cureus.56580Maged AM, Nada AM, Abdelwahab H, et al.The value of ultrasound guidance during IUD insertion in women with RVF uterus: a randomized controlled trial.J Gynecol Obstet Hum Reprod. 2021;50(4):101875. doi:10.1016/j.jogoh.2020.101875Nowitzki KM, Hoimes ML, Chen B, Zheng LZ, Kim YH.Ultrasonography of intrauterine devices.Ultrasonography. 2015;34(3):183-194. doi:10.14366/usg.15010Zhang L, Losin EAR, Ashar YK, Koban L, Wager TD.Gender biases in estimation of others’ pain.J Pain. 2021;22(9):1048-1059. doi:10.1016/j.jpain.2021.03.001Calderone KL.The influence of gender on the frequency of pain and sedative medication administered to postoperative patients.Sex Roles. 1990;23(11-12):713-725. doi:10.1007/BF00289259Ovsepyan V, Kelsey P, Evensen AE.Practical recommendations for minimizing pain and anxiety with IUD insertion.J Am Board Fam Med. 2021;34(4):695-705. doi:10.3122/jabfm.2024.240079R1Reeves JA, Zapata LB, Curtis KM, Whiteman MK.Intrauterine device training, attitudes, and practices among U.S. health care providers: findings from a nationwide survey.Womens Health Issues. 2023;33(1):45-53. doi:10.1016/j.whi.2022.08.002

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

Wu J, Trahair E, Happ M, Swartz J.TikTok, #IUD, and user experience with intrauterine devices reported on social media.Obstet Gynecol. 2023;141(1):215-217. doi:10.1097/AOG.0000000000005027Planned Parenthood.What’s an IUD insertion like?.Maguire K, Morrell K, Westhoff C, Davis A.Accuracy of providers' assessment of pain during intrauterine device insertion.Contraception. 2014;89(1):22-24. doi:10.1016/j.contraception.2013.09.008Planned Parenthood.How effective are IUDs?.Curtis KM, Nguyen AT, Tepper NK, et al.U.S. selected practice recommendations for contraceptive use, 2024.MMWR Recomm Rep. 2024;73(3):1-77. doi:10.15585/mmwr.rr7303a1Daidone C, Morris K, Colquitt J, Jackson G.Provider perspectives on analgesic use in intrauterine device insertion procedures: a mixed methods analysis.Cureus. 2024;16(3). doi:10.7759/cureus.56580Maged AM, Nada AM, Abdelwahab H, et al.The value of ultrasound guidance during IUD insertion in women with RVF uterus: a randomized controlled trial.J Gynecol Obstet Hum Reprod. 2021;50(4):101875. doi:10.1016/j.jogoh.2020.101875Nowitzki KM, Hoimes ML, Chen B, Zheng LZ, Kim YH.Ultrasonography of intrauterine devices.Ultrasonography. 2015;34(3):183-194. doi:10.14366/usg.15010Zhang L, Losin EAR, Ashar YK, Koban L, Wager TD.Gender biases in estimation of others’ pain.J Pain. 2021;22(9):1048-1059. doi:10.1016/j.jpain.2021.03.001Calderone KL.The influence of gender on the frequency of pain and sedative medication administered to postoperative patients.Sex Roles. 1990;23(11-12):713-725. doi:10.1007/BF00289259Ovsepyan V, Kelsey P, Evensen AE.Practical recommendations for minimizing pain and anxiety with IUD insertion.J Am Board Fam Med. 2021;34(4):695-705. doi:10.3122/jabfm.2024.240079R1Reeves JA, Zapata LB, Curtis KM, Whiteman MK.Intrauterine device training, attitudes, and practices among U.S. health care providers: findings from a nationwide survey.Womens Health Issues. 2023;33(1):45-53. doi:10.1016/j.whi.2022.08.002

Wu J, Trahair E, Happ M, Swartz J.TikTok, #IUD, and user experience with intrauterine devices reported on social media.Obstet Gynecol. 2023;141(1):215-217. doi:10.1097/AOG.0000000000005027

Planned Parenthood.What’s an IUD insertion like?.

Maguire K, Morrell K, Westhoff C, Davis A.Accuracy of providers' assessment of pain during intrauterine device insertion.Contraception. 2014;89(1):22-24. doi:10.1016/j.contraception.2013.09.008

Planned Parenthood.How effective are IUDs?.

Curtis KM, Nguyen AT, Tepper NK, et al.U.S. selected practice recommendations for contraceptive use, 2024.MMWR Recomm Rep. 2024;73(3):1-77. doi:10.15585/mmwr.rr7303a1

Daidone C, Morris K, Colquitt J, Jackson G.Provider perspectives on analgesic use in intrauterine device insertion procedures: a mixed methods analysis.Cureus. 2024;16(3). doi:10.7759/cureus.56580

Maged AM, Nada AM, Abdelwahab H, et al.The value of ultrasound guidance during IUD insertion in women with RVF uterus: a randomized controlled trial.J Gynecol Obstet Hum Reprod. 2021;50(4):101875. doi:10.1016/j.jogoh.2020.101875

Nowitzki KM, Hoimes ML, Chen B, Zheng LZ, Kim YH.Ultrasonography of intrauterine devices.Ultrasonography. 2015;34(3):183-194. doi:10.14366/usg.15010

Zhang L, Losin EAR, Ashar YK, Koban L, Wager TD.Gender biases in estimation of others’ pain.J Pain. 2021;22(9):1048-1059. doi:10.1016/j.jpain.2021.03.001

Calderone KL.The influence of gender on the frequency of pain and sedative medication administered to postoperative patients.Sex Roles. 1990;23(11-12):713-725. doi:10.1007/BF00289259

Ovsepyan V, Kelsey P, Evensen AE.Practical recommendations for minimizing pain and anxiety with IUD insertion.J Am Board Fam Med. 2021;34(4):695-705. doi:10.3122/jabfm.2024.240079R1

Reeves JA, Zapata LB, Curtis KM, Whiteman MK.Intrauterine device training, attitudes, and practices among U.S. health care providers: findings from a nationwide survey.Womens Health Issues. 2023;33(1):45-53. doi:10.1016/j.whi.2022.08.002

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