Intrauterine devices (IUDs) are an effective long-term contraceptive option, providing pregnancy prevention for anywhere from 3 to 12 years. However, the insertion and removal process can cause significant discomfort. In response, new medical guidelines aim to alleviate this pain and make the procedures more tolerable.
Notably, many women have turned to social media to share their experiences, highlighting the pain associated with IUD insertion and removal. This public response may have influenced the Centers for Disease Control and Prevention (CDC) to update its recommendations, particularly in regard to managing pain during these procedures.
Healthcare providers are now encouraged to use pain-relief methods such as lidocaine-based treatments. These include lidocaine gels, creams, sprays, and injections to reduce discomfort and improve patient experience during IUD procedures.
For years, many women have voiced concerns about the intense pain associated with the insertion and removal of intrauterine devices (IUDs) for birth control. Until recently, those complaints largely went unheard. Now, however, a growing outcry on social media is amplifying their voices, leading to changes in medical guidelines aimed at improving patient comfort. The U.S. Centers for Disease Control and Prevention (CDC) is advising healthcare providers to acknowledge this pain and offer more options to manage it.
Social media platforms, particularly TikTok, have been central to this movement. With over 100 million posts discussing IUD pain, many women are sharing their painful experiences. One woman recalls the removal of her IUD as so agonizing that she “spent the drive home sobbing because of how my doctor made me feel.” Another describes the pain of insertion as “the worst pain imaginable,” comparing it to “giving birth all over again.”
Beverly Gray, MD, an associate professor of obstetrics and gynecology at Duke University Medical Center in North Carolina, notes that social media has given women a new platform to speak up about IUD pain. “Social media platforms can give people a large audience of others who have had similar experiences and have highlighted negative experiences,” Gray explains. “This outcry has resulted in a change in the discussion which, from my perspective, is a positive thing.”
New CDC Recommendations for Pain Management
In light of these mounting concerns, the CDC recently updated its recommendations, emphasizing the need for healthcare providers to discuss the potential for pain before performing IUD insertion or removal procedures. The new guidelines stress that patients should be made aware of pain management options available to them.
“Before IUD placement, all patients should be counseled on potential pain during placement as well as the risks, benefits, and alternatives of different options for pain management,” the updated guidelines state. The CDC also highlights that pain is a highly individual experience, which can be influenced by previous trauma, mental health conditions, or past painful medical procedures.
The CDC’s recommendations suggest that lidocaine—whether administered as a paracervical block (injections around the cervix) or applied as a gel, cream, or spray—should be routinely offered to women undergoing IUD procedures. This represents a change from earlier guidelines, which in 2016 only supported the use of lidocaine injections.
Aileen Gariepy, MD, MPH, director of complex family planning in the department of obstetrics and gynecology at Weill Cornell Medicine in New York, sees this shift as a step forward. “More women are coming in and asking for a paracervical block or lidocaine, and they’re asking about their options to manage pain if they’re petrified of needles,” says Gariepy. “The CDC is reinforcing that women should have these options.”
While the new guidelines offer multiple approaches to pain relief, one drug, misoprostol, is not recommended for routine use. Misoprostol may be considered for specific cases, such as after a failed IUD placement, but routine use has been found to cause side effects without significantly reducing insertion pain.
“There’s a lot of evidence showing that routine misoprostol causes significant side effects without improving ease of insertion or insertion experience or pain,” Dr. Gray says. “But it can be helpful if someone has scarring of the cervix or a failed attempt at an IUD insertion to soften the cervix and ease insertion.”
Understanding IUDs and Why the Procedure Can Be Painful
An IUD is a small, flexible, T-shaped plastic device that is placed inside the uterus to prevent pregnancy. IUDs work by blocking sperm from fertilizing an egg and can remain effective for 3 to 12 years, depending on the type. According to Planned Parenthood, some IUDs, like Paragard, use copper to repel sperm, while others, such as Mirena and Kyleena, release hormones to prevent pregnancy. Hormonal IUDs can also help manage painful periods and may even be used as emergency contraception if inserted within five days of unprotected sex.
The procedure to insert an IUD can be particularly painful because it requires the device to be pushed through the cervix—a sensitive and narrow passage leading to the uterus. As Dr. Gariepy explains, “It’s like a door that’s locked, so when you go through the cervix that’s the most uncomfortable part, especially for women who haven’t had a baby and haven’t had their cervix dilate during labor.”
This discomfort isn’t limited to IUD insertions. Many other gynecological procedures, such as biopsies, treatments for cervical cancer, and fertility exams, also require access through the cervix, causing similar levels of pain. Abortions and treatments for miscarriages can also be painful for the same reason.
“For all these procedures, it is incredibly important to have a patient-centered discussion about the range of experiences people might have and how pain could be managed successfully,” adds Dr. Gray.
Why These Conversations Matter
The pain women experience during IUD insertion and removal has long been overlooked, but the tide is beginning to turn. With the rise of social media and platforms like TikTok, patients now have an avenue to voice their concerns, and those voices are having a real impact.
Thanks to these conversations, healthcare providers are starting to pay closer attention to their patients’ needs and offer more comprehensive pain management options. This shift toward a more patient-centered approach is a crucial step forward in ensuring that women have greater control over their reproductive health and comfort during medical procedures.
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