The CDC Updates Guidance For IUD Pain

It doesn’t take much digging to know that IUD insertion hurts. One scroll through #IUDexperience on TikTok will show you plenty of anecdotal evidence — from past IUD insertion horror stories to visceral reactions being filmed in real-time. But despite the millions of views and thousands of patients commiserating in the comments, doctors still don’t seem to care, often refusing pain management altogether. Now, possibly worn down by the commentary on social media, the Centers for Disease Control and Prevention is finally offering some guidance on IUD insertion and pain management. But is it actually enough? And does this mean that IUD pain will actually be taken seriously?

On Aug. 8, the CDC released new guidelines for IUD pain management. And they come to a clear conclusion: doctors can (and should) be doing more.

First and foremost, the CDC suggests pain management counseling before the IUD insertion even takes place. That includes going over the risks, benefits, and alternatives or options for pain management. “When considering patient pain, it is important to recognize that the experience of pain is individualized and might be influenced by previous experiences including trauma and mental health conditions, such as depression or anxiety,” the CDC writes in its new guidelines. The CDC also suggests that lidocaine — used topically as a spray or gel, or as a paracervical block — might help reduce pain during IUD placement. Previously, lidocaine had only ever been recommended as an injection into the cervix.

These updated guidelines are definitely a start, but many patients find it disheartening that it’s taken so long to receive official guidelines. A 2023 study in the journal “Obstetrics & Gynecology” analyzed the platform’s 100 most popular IUD-related posts, including 31 that highlighted patients’ experience with insertion or removal; of the latter, “all had a negative or ambiguous tone and 96.8% highlighted pain,” the study authors wrote.

“The trending TikTok videos documenting . . . painful experiences and medical gaslighting around IUD insertion . . . highlight a real problem of female pain not being taken seriously,” says Melanie Bone, MD. This, she says, can erode patient trust in their doctors and the medical system. This was also reflected in the Obstetrics & Gynecology study, with over a quarter of creators expressing distrust towards their providers and some instances of having their experiences invalidated or denied.

No one deserves to have their pain ignored or invalidated. But in a post-Roe world where reproductive rights are being curtailed, anything that interferes with access to effective birth control is even more dangerous. As the CDC acknowledges in its new guidelines, IUD pain could potentially deter people from using IUDs — one of the most effective forms of contraception. It’s important to address IUD pain management now, so as to protect patients down the line.

The CDC’s updated recommendations are definitely a step in the right direction, but there’s still work to be done. Here’s what experts have to say about IUD pain, and what you can do to protect yourself if you’re interested in getting (or removing) an IUD.

Experts Featured in This Article

Melanie Bone, MD, is a consultant ob-gyn and US Medical Director at the gynecological health company Daye.

Michael Reed, MD, is an ob-gyn and cosmetic gynecologist based in California.

Stephanie Hack, MD, is an ob-gyn, podcast host, and public speaker.

Gunvor Ekman Ordeberg, MD, is an ob-gyn and co-founder of DeoDoc Intimate Skincare.

Why Is IUD Insertion Painful?

Pain is subjective, and some individuals may find IUD insertion or removal more or less uncomfortable than others. But it’s clear that many people find the procedure to be borderline agonizing. “Getting my IUD inserted hurt worse than my C-section did,” says Caitlin Kavanaugh, a mother to twins. “Having not gone through labor, I had no idea what cervical dilation felt like. I remember feeling like I had to dissociate from my body to make it through.” Similarly, Myra Chavez tells PS that her second IUD insertion hurt worse than her three vaginal, unmedicated births. Another patient, Heaven Taylor, says that she fainted upon standing up after the procedure.

Stephanie Hack, MD, an ob-gyn, explains that multiple steps during an IUD insertion are “uncomfortable, due to the need to manipulate and pass through the cervix.” The worst pain occurs “the moment the IUD passes through the cervical canal into the uterus,” Dr. Hack says, adding that patients describe this as a sharp pain or cramp that can last for a few minutes.

Michael Reed, MD, notes that the instruments used also play a role. The tenaculum (gynecological forceps that are used to stabilize the cervix during IUD insertion by pinching the tissue) has scarcely been updated since the Civil War era, she says. It has sharp ends that can cause cramping and bleeding.

Why IUD Pain Is Under-Addressed

Even if some people tolerate IUD pain well, it’s clear that others find the procedure to be debilitating. So why isn’t the pain better managed? “The [macro-level] answer is simple: women’s health is not a priority of big pharma,” says Gunvor Ekman Ordeberg, MD.

There’s a general focus on IUD efficacy over patient experience, Dr. Bone says. There’s also an established gender bias in medicine toward women’s pain, and especially toward Black and Latina women’s pain — sometimes called the Gender Pain Gap — that leads to it going dismissed and overlooked. As a result, there’s a lack of evidence-based research into IUD pain management. Plus, that research isn’t being prioritized by professional societies like the American College of Obstetricians and Gynecologists, which would help doctors devise better treatment plans and get IUD pain management covered by insurance companies, Dr. Bone says.

As a result, until recently, there’s been no standard protocol for managing IUD insertion pain, according to a 2024 review published in the journal “Cureus.” Prior to the Aug. 8 update, the CDC’s guidelines were undefined, stating that a lidocaine injection — a technique that’s been shown in a study in “Obstetrics & Gynecology” to ease IUD discomfort — “might reduce” IUD insertion pain.

The latest recommendations are expanded to include topical lidocaines as well, and encourage practitioners to counsel their patients on the pain they might experience and about their different pain management options to come up with an individualized plan. The hope is that the expanded guidance will help standardize pain management protocols.

In the absence of a standard protocol, different medical practices take different approaches toward pain management. For instance, Kerry Giannantonio says her doctor rescheduled her insertion appointment to prescribe an intravaginal pain tablet to improve her experience. But Kavanaugh, who considered her IUD insertion to be more painful than her C section, was counseled to “take a dose of Ibuprofen” when she proactively inquired about pain management before her appointment. It clearly didn’t make much of a dent in Kavanaugh’s pain, and in fact, Dr. Reed tells PS that Naproxen and ibuprofen are not shown to help with insertional pain, only post-procedure discomfort.

Why IUD Pain Is a Problem

Dr. Ordeberg and her research team believe the unmanaged pain of IUD insertion deters people from using the long-acting reversible contraceptive. Dr. Hack agrees that there are many people opting for other forms of birth control due to the pain of IUD placement at medical practices.

This is discouraging because the IUD does have many advantages. It’s the most effective contraceptive when it comes to preventing unwanted pregnancies. It also comes in a non-hormonal option, for those who don’t tolerate hormonal birth control well. “Pain management should be offered to all patients considering an IUD,” Dr. Reed says. “The one positive of this recent social media attack on [the IUD insertion experience] is that it has highlighted the need for physicians to be more aware of the patient experience, and to discuss solutions for decreasing insertional pain before IUD placement.”

“This [problem of unaddressed pain] needs to change and it needs to change quickly if we want to provide excellent healthcare experiences to patients,” Dr. Bone agrees. “The medical community needs to believe pain experiences and to proactively discuss and manage patient pain. Normalizing pain relief can help make IUDs a more attractive option, producing positive contraception experiences for patients.” He says that in addition to regulators like the CDC offering clear guidance to providers about offering pain management options during IUD insertions, some responsibility falls upon the mezzo-level organizations that help to direct and fund the direction of future research. There’s still not enough data out there about what pain management options are best; once an optimal protocol is established, insurance companies will theoretically get on board.

What You Can Do to Make IUD Insertion More Bearable

All the experts encourage you to proactively ask for pain management and to advocate for yourself if your physician pushes back. If they refuse, Dr. Hack encourages you to seek a second opinion. “A good physician will be open to discussing and providing appropriate pain management strategies,” she says, especially in light of the updated CDC guidelines. Dr. Bone adds that you should not be intimated to ask why they aren’t offering a solution.

It can be useful to come armed with specific asks, Dr. Reed says. He names the following pain management options to know about. “There’s evidence-based research that shows that ketorolac [an NSAID] helps with insertional and post-procedure pain,” he says. “Other options that can help to make the insertion less painful include local analgesia like numbing creams or paracervical blocks and cervical ripening agents.” Contrary to what you might expect, he says that placement during a menstrual cycle might also make the procedure less painful, due to the cervix being slightly opened.

Ultimately, the hope is that doctors will be the ones providing these options to you. But until then, knowing that your concern over IUD pain is valid and there is effective pain management available to you can go a long way toward ensuring you have a positive IUD experience.

Jessica Ourisman is a freelance beauty and wellness editor who frequently writes about skincare and cosmetic dermatology for PS, Harper’s Bazaar, Allure, InStyle, The Zoe Report, Coveteur, WWD, and more.

Chandler Plante is an assistant editor for PS Health & Fitness. Previously, she worked as an editorial assistant for People magazine and contributed to Ladygunn, Millie, and Bustle Digital Group. In her free time, she overshares on the internet, creating content about chronic illness, beauty, and disability.