Many women have been complaining for years about the pain of having an IUD inserted for contraception, to no avail. In light of the growing outrage on social media, the US Center for Disease Control and Prevention (CDC) is now calling on healthcare providers to listen to women and show them ways to relieve pain.
There are more than 100 million posts on TikTok alone about IUD pain. One woman says the pain of having her IUD removed was so bad that she “spent the whole drive home sobbing because of how my doctor made me feel.” Another user says, “Putting the IUD in is the worst pain you can imagine” and “it’s like having a baby all over again.”
While pain during IUD insertion and removal has long been a concern for women, social media has definitely given patients a new platform to talk about it. And that outcry may now bear fruit, says Beverly Gray, MD, associate professor of obstetrics and gynecology at Duke University Medical Center in Durham, North Carolina.
“Social media platforms can provide people with a large audience of other people who have had similar experiences and highlighted negative experiences,” says Gray. “That outcry has changed the conversation, which I think is a positive thing.”
New CDC recommendations for pain management in IUDs
“Before IUD insertion, all patients should be counseled about potential pain during insertion, as well as the risks, benefits, and alternatives of various pain management options,” the updated CDC guidelines state. “When considering the patient’s pain, it is important to recognize that pain perception is individual and can be influenced by past experiences such as trauma and mental health conditions such as depression or anxiety.”
Lidocaine – either as a so-called paracervical block injected into the area around the cervix, or as a topical gel, cream or spray – should be offered to women routinely as an option for pain management, the CDC now recommends. Previous guidelines from 2016 only recommended lidocaine injections.
“More and more women come to me asking about a cervical block or lidocaine, and they ask about their options for pain relief if they are terrified of needles – and the CDC emphasizes that women should have those options,” says Aileen Gariepy, MD, MPH, chief of the Section of Complex Family Planning in the Department of Obstetrics and Gynecology at Weill Cornell Medicine in New York City.
Another medication that may help reduce the pain of IUD insertion is misoprostol. It is not routinely recommended, but may be considered for certain patients, including those who have recently had an IUD insertion failure, according to new CDC recommendations.
“There is a lot of evidence that routine administration of misoprostol causes significant side effects without improving insertion or the experience of insertion or pain,” says Dr. Gray. “But it may be helpful if someone has cervical scarring or an attempt to insert an IUD has failed, to soften the cervix and make insertion easier.”
What exactly are IUDs and why does it hurt to have one inserted?
Some IUDs, like the Paragard IUD, contain a copper coating that repels sperm. Others, like Mirena and Kyleena, are hormonal IUDs that release the hormone progesterone to prevent pregnancy. Some women also get hormonal IUDs to relieve painful periods or have IUDs inserted within 120 hours of unprotected sex as a form of emergency contraception, according to Planned Parenthood.
An IUD can be painful because the doctor has to insert it through the cervix. “It’s like a locked door. When you go through the cervix, that’s the most uncomfortable part,” says Dr. Gariepy, “especially for women who haven’t had a baby yet and whose cervix hasn’t dilated during labor.”
Many other gynecological procedures can also be painful because they require access through the cervix to other parts of the reproductive system, Gariepy says. These can include biopsies and treatments for cervical cancer, endometrial biopsies, exams of the fallopian tubes in women with infertility problems, abortions and treatments for miscarriages.
“In all of these procedures, it is incredibly important to have a patient-centered conversation about the range of experiences people might have and how to successfully manage pain,” says Gray.
