Picture this- you're at the doctor’s office, feet in stirrups, gripping the sides of the exam table like you’re about to give birth. No one has offered you more than suggesting a deep breath and explaining that “this might feel like a pinch.” But it definitely doesn’t feel like a pinch. This is the reality of IUD insertion. 

An Intrauterine device, or IUD, is a small but mighty method of birth control that doctors have studied since the early 20th century. Throughout its interesting history, IUDs have taken on different forms, but modern IUDs are tiny T-shaped plastic devices that your gynecologist inserts through the opening of your cervix into your uterus. 

IUDs are also the most effective form of birth control. IUDs can stay inserted and effective for three to twelve years depending on the type of IUD. Note: since IUDs can be a long-lasting contraceptive, they are sometimes referred to as LARCs (long-acting reversible contraception). Because the device stays put in your uterus, you’re protected from pregnancy without the chance of making a mistake like forgetting to take a daily pill (we’ve all been there...yes, more than once). This is one of the reasons IUDs are over 99% effective in preventing pregnancy! 

Now that we’ve established what an IUD is, we understand the importance of making this form of care accessible. Pain should not be a barrier to access, yet it is for so many people seeking out long term birth control. A 2022 study published in Contraception found that fear of insertion pain was one of the main reasons people avoided or removed their IUDs early. 

Historically, IUD insertion has been treated with about as much medical weight as getting your ears pierced. Most providers told patients to pop some ibuprofen and power through. No numbing. No sedation. No real conversation about options. 

Why? For years, this experience has been normalized. A piece of the answer is in the history of medical sexism. Women are less likely than men to be taken at their word in medical settings. Some people call this the “trust gap.” Some call it “medical gaslighting” or “medical sexism.” No matter what terminology you use, the point is that medical professionals are less likely to believe that women, as compared to men, accurately and reliably report their own symptoms. Particularly, clinicians are more likely to underestimate and undertreat women’s pain, especially if the patient is a woman of color. 

This month, some long-awaited change finally arrived. Updated clinical guidelines from leading OBGYN associations are making a clear statement: pain management during IUD insertion is not optional, it’s essential. The recommendations emphasize:

• Pre-procedure counseling
• Offering numbing options, like a paracervical block
• Discussing oral sedation or anxiety meds for those who want them
• Validating patient pain instead of dismissing it with “you’ll be fine” energy
  

Pain should never be the price of pregnancy prevention. The pain of IUD insertion isn’t imaginary, and you shouldn’t have to white-knuckle your way through it. The new guidelines say what we’ve known all along: pain is real, pain is valid, and pain deserves treatment. 

So if you're thinking about getting an IUD? Walk in stocked with facts and options.