IUD insertion: Is it painful or just uncomfortable?

Let’s be real. If you’ve spent more than five minutes on TikTok or Reddit looking into birth control, you’ve probably seen the horror stories. Women gripping the sides of exam tables, tears streaming down their faces, or even fainting from the "pinch" of a copper coil or a hormonal device. It's enough to make anyone cancel their appointment. So, let’s get into the messy reality of it: iud insertion is it painful? The honest answer is that it varies wildly, and for a long time, the medical community didn't do a great job of acknowledging that.

For some, it’s a quick cramp. For others, it’s a level of pain they weren't prepared for.

Dr. Jennifer Lincoln, a board-certified OB-GYN and author who often debunks reproductive myths, has been vocal about how we need to stop gaslighting patients about this. It isn't just a "little pinch." While the actual procedure takes about five minutes, the physiological response can be intense. We’re talking about a small plastic or copper device being guided through the cervix—the gateway to your uterus—which is normally kept tightly shut. It doesn't exactly want to be poked.

Why some people swear it’s fine and others don't

Everyone’s anatomy is a bit of a snowflake. If you’ve given birth vaginally, your cervix has already done the heavy lifting of dilating to 10 centimeters. In those cases, the small opening required for an IUD usually feels like a minor annoyance. But if you’ve never had a baby, or if you have a "stenotic" (extra tight) cervix, that passage is a lot more resistant.

✨ Don't miss: Anatomy and Physiology Quiz: Why You Keep Failing the Cranial Nerves Section

The pain actually happens in stages.

First, there’s the speculum. That’s the standard "open wide" tool you’re used to from Pap smears. Most people handle that fine. Then comes the tenaculum. This is a stabilizing tool that holds the cervix steady. Honestly, this is where a lot of the sharp "stinging" comes from. Finally, there’s the "sound," a thin rod used to measure the depth of your uterus, followed by the IUD inserter itself. This causes the "IUD cramp." It’s a deep, visceral ache because your uterus is basically reacting to a foreign object by trying to contract it out.

The "Take an Ibuprofen" Myth

For decades, the standard advice was: "Take 800mg of Advil an hour before you come in."

Research, including a significant study published in the journal Contraception, has shown that while ibuprofen helps with the cramps after the procedure, it doesn’t actually do much for the acute pain of the insertion itself. It’s a bit like taking an aspirin before getting a tattoo; it might help the swelling later, but it won't stop the needle from hurting.

Patients are starting to demand more. And doctors are starting to listen.

There are actual options now. Some clinics offer a paracervical block, which is a local anesthetic injected into the tissue around the cervix. It sounds scary—a needle in the cervix?—but it can completely numb the sharpest part of the process. There’s also lidocaine gel or spray. While the evidence on gel is a bit mixed, many patients report it makes a psychological and physical difference. If your doctor tells you "it’s just a pinch" and refuses to discuss pain management, it might be time to find a provider who recognizes that iud insertion is it painful is a valid concern.

What it actually feels like (Step-by-Step)

You’re on the table. Feet in the stirrups. The room is probably a little too cold.

1. The Cleaning: The doctor wipes the cervix with an antiseptic. It’s cold and feels weird, but it doesn't hurt.
2. The Tenaculum: This is the "pinch." It can feel like a sharp sting or a localized cramp. Breathe through it. Seriously, don't hold your breath.
3. The Sounding: As they measure the uterus, you’ll feel a deep, heavy cramp. This is often the part where people feel a bit "woozy" or lightheaded. That’s your vasovagal nerve reacting. It's totally normal.
4. The Insertion: The IUD goes in. Another big cramp.
5. The Trim: They cut the strings. You won't feel this part at all.

Then it's over. Usually, the whole thing from speculum-in to speculum-out is less than three minutes. But those three minutes can feel like twenty if you’re tense.

The Vasovagal Response: Why you might feel faint

Some people don't just feel pain; they feel like they’re going to pass out. This is the vasovagal response. When the cervix is manipulated, it can trigger a sudden drop in heart rate and blood pressure. You get sweaty. You get nauseous.

If this happens, tell your doctor immediately. They can tilt the table back to get blood to your brain. This is why you should never rush out of the office. Sit there. Drink the juice they offer you. Eat a granola bar. If you’ve had a history of fainting during blood draws or other procedures, tell the nurse beforehand. They can have you lie in a specific position to minimize the risk.

Choosing your device: Does size matter?

There are several types of IUDs available in the U.S. and Europe. You have the copper ParaGard, which is hormone-free but famously causes heavier periods for the first six months. Then you have the hormonal options like Mirena, Kyleena, Liletta, and Skyla.

Kyleena and Skyla are slightly smaller in diameter than Mirena. For someone with a very small uterus or someone who has never been pregnant, a doctor might suggest these because the inserter tube is thinner. Does it make a massive difference in pain? Maybe a little. But the bigger factor is usually the skill of the provider and how relaxed your pelvic floor muscles are.

Real-world prep that actually works

If you’re nervous, don't just show up on an empty stomach. That’s a recipe for a "vasovagal" disaster.

Eat a decent meal about two hours before. Stay hydrated. Some doctors suggest coming in during your period because the cervix is naturally slightly more open (dilated) then, which can theoretically make the insertion smoother. However, this isn't a hard rule. You can get an IUD at any point in your cycle as long as you aren't pregnant.

Heat is your best friend. Bring a portable heating pad or one of those stick-on heat patches for the ride home. The "after-cramps" are real. They feel like intense period cramps and can last for a few hours or a couple of days.

When to worry after the appointment

Most people feel "blah" for the rest of the day. You might want to curl up with Netflix and a heating pad. That’s standard.

But you should call the office if:

• You have a fever or chills.
• The pain is getting worse after 24 hours instead of better.
• You have foul-smelling discharge.
• You can feel the plastic of the IUD (not just the strings) coming out of your cervix.

The strings should feel like thin fishing line or dental floss. They will eventually soften and curl around the cervix, but in the beginning, they might feel a bit stiff.

Advocating for your comfort

The most important thing to remember is that you are the boss of your body. When you book the appointment, ask: "What are your options for pain management during IUD insertion?"

🔗 Read more: Derila Ergo Pillow for Sleep Apnea: What the Marketing Doesn’t Tell You

If they say "just ibuprofen," ask about lidocaine. If you have severe anxiety or a history of trauma, you can even ask about conscious sedation, though that usually requires a different setting than a standard exam room. Some clinics are now offering "nitrous oxide" (laughing gas), which doesn't stop the pain but makes you care a whole lot less about it.

The question of iud insertion is it painful shouldn't be met with a shrug. It’s a medical procedure. You deserve to have it handled with the same care as any other procedure involving sensitive tissue.

Next Steps for a Smoother Appointment

• Call ahead: Specifically ask if the clinic provides a lidocaine spray or a cervical block. If they don't, and you're worried about pain, look for a provider who does.
• Schedule "me time": Don't plan to go back to work or lead a board meeting right after. Give yourself a 4-hour window to just rest.
• Vocalize your needs: During the procedure, if you need a moment to breathe, say "Stop for a second." The doctor works on your timeline, not the other way around.
• Track your strings: Once the cramping subsides after a few days, wash your hands and feel for the strings. Knowing what "normal" feels like now will prevent anxiety later.