November 11th 2009 
No Pain, No Gain: The IUD Insertion Process
I wish I could say that getting the IUD was easy once I made my decision that the love affair with the Pill was over. In reality, it took me three visits (one of which was an appalling comedy of errors) before I finally baby-proofed my uterus. First, I had to get a pap smear, since STIs in IUD users can cause Pelvic Inflammatory Disorder and in rare cases, infertility. (For that same reason, doctors typically recommend that you only get the IUD if you're in a long-term, monogamous relationship.) An abnormal pap result delayed my efforts further. After a lab test determined that some cervical lesions were low-grade and no cause for alarm, I finally found myself face-to-face with a foot-long box containing my IUD. Thankfully, the size was misleading.
The IUD is actually just 1.5 inches long. Still, that little device was responsible for the most painful experience of my life and I say this as someone who's gotten five piercings and a tattoo. Forgoing anesthesia and prescription painkillers, I whimpered with my boyfriend by my side as the doctor fit the IUD into place. I felt intense cramps (similar to contractions, I imagine) the second it entered my body. Utterly shaken by the invasion of this foreign object, my legs trembled and my teeth chattered uncontrollably. I gripped my boyfriend's hand and whispered, "Remind me to get a C-section if I ever decide to have kids."
That's probably as close an approximation of childbirth as I've ever experienced, but I don't have any complaints about the IUD now that the initial ordeal is over. Despite a crampy first week and spotting (which can last for several weeks), I've been pretty pleased with the IUD, which has rendered the pesky birth control pill unnecessary. Total cost for five years of a worry-free womb? $0. My insurance policy -- and many others -- covers the device and the insertion procedure entirely. Compare that to $480 for five years of my generic pill.
Unlike me, you should take some advance measures to prepare yourself for the insertion. Becoming pregnant, even if you don't carry the pregnancy to term, makes it easier to insert the IUD in your cervix, which is why some doctors won't do insertions for never-before-pregnant women. One of my friends, who got the IUD a month after she gave birth to her first child, claimed that it even hurt more than labor. Conversely, I heard from many other women that insertion was no more uncomfortable than a pap smear. In my opinion, better safe than sorry either way. Unless you're certain you can withstand a lot of pain, going the all-natural route might lead to a rude cervical awakening. Here are a few things that you can do to avoid my experience:
- Say yes to drugs. Getting a prescription for something that dilates your cervix will do wonders to minimize pain and make insertion easier. My friend, who I accompanied to an IUD appointment a week after my own, only needed 30 relatively-bearable seconds for the procedure, which lasted four excruciating minutes for me.
- Welcome Aunt Flo. Schedule your appointment to coincide with your menstrual cycle since your cervix will already be slightly dilated then. Don't worry about what your gynecologist will think about the mess. They're used to it and many will probably recommend waiting until your period anyway.
- Midol will be your best friend. I'm so wary of over-the-counter medication abuse that I don't even take ibuprofen for headaches, but in the days following my IUD, painkillers were the only effective weapon against severe cramping that would have otherwise left me incapacitated. After your appointment, keep handy Midol and any painkillers that target lower abdominal pain and menstrual symptoms.
- Rough sex is out of the question. (At least for the first week.) Your cervix won't appreciate head-on collisions for a while. Though I only needed a couple weeks to recover, one of my friends said penetrative intercourse was uncomfortable for the first month. If you can't wait, either try to take it easy or be prepared to feel crampy in the afterglow.
- Heat up. Self-heating stick-on pads (the kind you can get at drugstores for sports injuries or menstrual pain) help alleviate discomfort throughout the day. At home, a hot water bottle or an electric blanket will also do the trick.
There are other birth control methods, many of which don't require an uncomfortable insertion process, but for many women the IUD causes relatively few side effects compared to options like the Patch. Even the Mirena, which releases progesterone, is relatively low-hormone compared to other forms of hormonal contraception. If you think you can brave the gynecologist's table, look into the IUD. It's affordable, widely available, and foolproof.
*****
Lena Chen is a senior at Harvard University and the author of the popular sex and relationship blog Sex and the Ivy. She writes about sex, feminism, and health and has been featured in The New York Times and Newsweek. She currently blogs at The Chicktionary.
What Others Have Said...
Amanda says:
I also found the insertion process excruciating. I felt traumatized and violated, and wouldn't let the boyfriend near me for a month! 18 months later I have only occasional cramps and no period. Despite the initial agony, I am really pleased with my choice- especially in comparison to libido- killing OCPs.
Athena says:
Wonderful article. I just had my IUD put in less than 2 days ago. My experience was also rather unpleasant. The first time I went in they weren't even able to measure my uterus because they couldn't get past the inner wall of the cervix. Simply getting measured was extremely painful and they ended up sending me home with a rescheduled appointment less than two weeks later.
For some background, I am 24 and haven't been pregnant.
They sent home with me some Misoprostol which is used to soften the cervix. I was instructed to take that 12 hours before my exam and 800 mg of painkillers. While I am sure this all helped, it didn't FEEL like it helped. I'm not someone who handles pain very well anyway so I started crying during the process and having a hard time not wanting to scramble off the table and say "Ok, I'm done, thanks for the effort."
For those ladies that haven't been pregnant before, it WILL make you rethink ever wanting to. Or at least make you rethink doing it without drugs if you wanted to go natural.
Now, despite how painful it was to put in (and how violated you feel for about an hour afterward) I didn't have any cramps once they were done. The doctor warned me I would probably spot and may cramp up for a week or more. I have had some spotting but otherwise I have been feeling fine.
If you are someone who doesn't manage pain well, I would suggest asking the doctor before your appt. to get some of the Misoprostol to make it a little easier on yourself. Also, if you need a heating pad for cramps I've always enjoyed the Original Bed Buddy. You can get one at Walgreens for $20.
K says:
Hey, just read this article and it really helped me prepare for what i should expect in a few days when I get my IUD inserted, Mirena. I have never had children and know that I should expect it to be, well, more then uncomfortable, but my situation is more medical as my body doesn't deal well with even the lowest amounts of estrogen in birth control pills. I hope my experience isn't that bad, thanks for the great advice on medication prior to the procedure. :)
Abby says:
What I find interesting is that no one finds this procedure sexist. My friend feels pressure to get an IUD after her husband refused the idea of a vasectomy. According to Planned Parenthood, one of the disadvantages to a vasectomy is pressure to having one. However that was not listed as a disadvanted for women getting an IUD.
My friend has taken birth control pills for YEARS. They have effected her metabolism, her happiness, and at times her sanity. Horomones will do it to you. But her husband doesnt care to budge on the issue, or compromise.
Seeing as a vasectomy has one day of downtime, while an IUD causes pain for weeks, plus there is a foreign body isnide you constantly that may slip or goof up your periods... I just dont get the reasoning here.
CHERELL says:
You right my iud was painful!i justgot mines today and i cant stop crying!cramps hitting me hard!
Scent Hive says:
Hey Lena,
I'm a certified nurse midwife and I'm sorry you had such a painful IUD insertion experience, but I'm glad you are liking it now and that you have a terrific form of birth control in place!
I'd like to clarify something though. A woman with an IUD is at no higher risk of getting an infection (which can lead to PID) than a woman without an IUD. Back in the 70's there was an IUD that did cause infections, but it has been off the market for decades. It is no longer the case and is a myth that needs to be dispelled. Hopefully your provider did not give you that misinformation.
For the first 20-30 days after the insertion you need to watch for signs of infection because you had a procedure done, but not because of the IUD itself.
Women who have not had babies are fine to get IUDs but the insertion process can be more painful. Your advice to have the placement during menstruation is terrific. Taking 600-800mg of ibuprofen prior to insertion can be helpful as well. Additionally, there is a medication you can take the night before insertion to help soften the cervix and make the process easier. I highly recommend that for women who have never had a vaginal birth.
I hope this information has been helpful.
~Trish
Karen says:
Great article. I just had an IUD (copper, non-hormonal) inserted last week, and the procedure was pretty easy for me, though I've had 2 children. I also had it inserted while on my period. One thing I read online that I think helped me was that I took Ibuprofen (600 mg) about a half hour or 45 minutes *before* the procedure. Ibuprofen works on the chemicals that cause menstrual cramps, and it works best if you have it in your system before the cramping starts or really builds up. Same thing for period cramps for that matter. I did have some cramping after the procedure, but they were mild. I didn't need a second dose of Ibuprofen, though my CNM (certified nurse midwife) told me I could take 600mg as needed every 6-8 hours.
I was told no penetrative sex for a week, then to use condoms for another week after that, mostly to allow things to heal and as a precaution against infection. It's been 6 days for me, and my husband and I are looking forward to tomorrow (and to next week!!)
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