I’ve given birth. I know what that pain feels like the kind that builds and breaks over you in waves, the kind your body somehow prepares you for even when you think you can’t take another second. I came out the other side of labor with a healthy baby and, eventually, a kind of hard-won peace with what my body had just done.
Nothing prepared me for getting an IUD.
I want to be careful here, because I know every body is different and every experience is its own thing. Some women breeze through IUD insertion with nothing more than a pinch and a few minutes of cramping. I am genuinely happy for those women. But I am also done pretending that my experience and the experience of countless others is some kind of statistical outlier that doesn’t deserve serious conversation.
The day I got my IUD placed, I was told to take two ibuprofen beforehand. That was the pain management plan. Two ibuprofen. For a procedure that, in my case, felt like someone was reaching inside me with a pair of hot tongs and rearranging my organs. I gripped the crinkly paper of the exam table so hard it tore. I couldn’t speak during the insertion. Afterward, I lay there for fifteen minutes because my vision had gone gray at the edges and I wasn’t sure I could stand without passing out.
My OB was kind. She wasn’t dismissive not deliberately, anyway. But the appointment had moved briskly. There was another patient waiting. And when I finally dressed and walked out to my car, I sat in the parking lot for forty-five minutes because I couldn’t safely drive.
Nobody had told me that was a possibility.
The Pain That Gets Minimized Before It Even Starts
Here’s the thing about IUD insertion pain: the medical establishment has, for a long time, had a vested interest in downplaying it. The device is widely regarded as one of the most effective forms of contraception available. It’s long-acting, low-maintenance, and doesn’t rely on user compliance the way daily pills do. From a public health standpoint, high IUD uptake is genuinely beneficial. And pain disclosures, the thinking seems to go, might scare patients away.
That calculation where patient autonomy and informed consent get quietly subordinated to public health goals is worth sitting with for a moment.
There’s also the broader, uglier context: women’s pain has historically been undertreated and underbelieved in clinical settings. Study after study has documented the gap between how men’s and women’s pain reports are received by providers. Women are more likely to be told their pain is anxiety, emotional, exaggerated. This isn’t a conspiracy theory. It’s in the literature. And it shows up in small, ordinary ways like a pamphlet that says “you may experience some discomfort” when what it really means is “a significant percentage of patients find this acutely painful and a smaller but real percentage find it nearly intolerable.”
The word “discomfort” is doing a lot of work in reproductive healthcare. It’s carrying weight it was never designed to hold.
What Actually Happens During the Procedure
To understand why insertion can be so painful, it helps to understand what the procedure involves. The cervix the narrow passage between the vagina and the uterus has to be opened to allow the IUD to pass through. For people who have never given birth vaginally, the cervical os (the opening) is typically quite small. A tenaculum, a sharp clamp, is used to stabilize the cervix. A sound (essentially a thin rod) is inserted first to measure the depth of the uterus. Then the IUD is threaded through.
Each of those steps can cause significant cramping. The tenaculum itself can cause a sharp pain distinct from the uterine cramping. For people with conditions like endometriosis, adenomyosis, uterine fibroids, or a retroverted uterus, the procedure can be substantially more difficult and more painful than average.
And yet the standard preparation advice across many clinics remains: take some ibuprofen beforehand. Maybe use a heating pad after.
A 2020 study published in Contraception found that pain scores during IUD insertion were significantly higher than providers estimated them to be. That gap between what the patient experienced and what the clinician anticipated isn’t just a data point. It represents a real failure of communication and expectation-setting that happens in real rooms with real women every single day.
The Comparison That Makes People Uncomfortable
When I say my IUD insertion was more painful than childbirth, people sometimes get uncomfortable. They hear it as hyperbole, or as an implicit criticism of people who haven’t given birth, or as some kind of competition no one asked to enter. That’s not what I mean at all.
What I mean is this: childbirth, for me, was managed. I had an epidural. I had a team. I had continuous support and monitoring, and when things got intense, there were interventions available. The pain was enormous, but it existed inside a structure designed to manage it.
The IUD insertion lasted maybe four minutes and happened in a standard exam room with a tissue paper table cover and no real pain protocol in place. The intensity peak for peak hit harder than any single moment I experienced in labor. That’s not a complaint about my OB. It’s a statement about the structural difference between how we treat pain in an obstetric suite versus how we treat it in an outpatient gynecology setting.
Some people have the reverse experience. Their labor was unmedicated and extended; their IUD insertion was a non-event. That’s completely valid. Pain is subjective, contextual, and shaped by physiology, anxiety, prior trauma, and a dozen other variables. The point isn’t that insertion is universally worse than childbirth. The point is that for some of us it is, and that should be taken seriously rather than flattened by disclaimers.
What Better Care Could Actually Look Like
There’s been growing clinical conversation about this. Lidocaine gel applied to the cervix before insertion. Paracervical nerve blocks. Anxiolytic medication for patients with high procedural anxiety. Scheduling insertions in settings where there’s capacity for closer monitoring and recovery time. Simply telling patients, honestly, that this could be quite painful and here is what we can offer you.
None of these are radical proposals. Some are already standard in certain countries and certain practices. The barrier is partly systemic short appointment windows, reimbursement structures that don’t account for extended pre-procedure care and partly cultural. A culture that has decided women’s reproductive discomfort is just the cost of doing business doesn’t rush to invest in changing its standard of care.
I still have my IUD. It works exactly as advertised, and I’m not sorry I have it. But I think about the people who went through what I went through and decided never to try an IUD again, who went back to less effective contraception, who felt like their pain was their own private embarrassment rather than a systemic failure worth naming out loud.
That parking lot I sat in for forty-five minutes I’ve heard versions of that story from more women than I can count. We deserve an honest conversation about it. And we deserve a lot more than two ibuprofen.
