For years, women have reported significant pain associated with the insertion and removal of intrauterine devices (IUDs) for birth control, often feeling their concerns were dismissed. Recently, a surge of discussions on social media platforms has prompted the U.S. Centers for Disease Control and Prevention (CDC) to issue new guidelines, emphasizing the importance of addressing pain management for these procedures.
Social media, particularly TikTok, has become a major platform for sharing experiences about IUD-related pain, with over 100 million posts on the topic. Many women have expressed their distress, with one individual recounting how the pain during her IUD removal left her in tears throughout her drive home. Another described IUD insertion as “the worst pain imaginable,” likening it to giving birth.
This increased visibility has spurred action, according to Dr. Beverly Gray, an associate professor of obstetrics and gynecology at Duke University Medical Center. “Social media has provided a broad audience for shared experiences, highlighting adverse outcomes and driving a shift in discourse,” Gray comments. “This heightened awareness is leading to positive changes.”
CDC’s Revised Recommendations on IUD Pain Management
Earlier this month, the CDC introduced revised recommendations advising healthcare providers to proactively discuss the potential for pain and pain management strategies with patients before IUD procedures. According to the updated guidelines, patients should receive information about the pain they might experience, as well as the risks, benefits, and alternatives for pain management.
The CDC now advocates for the routine use of lidocaine in the form of a paracervical block or topical applications to manage pain, an update from the previous 2016 guidelines which only recommended lidocaine injections. Dr. Aileen Gariepy, director of complex family planning at Weill Cornell Medicine, notes that many patients are increasingly requesting alternatives to needles, reinforcing the need for diverse pain management options.
Misoprostol, another medication sometimes used to alleviate insertion pain, is not routinely recommended but may be considered for certain cases, such as those involving a failed previous insertion. Dr. Gray explains, “While misoprostol can help in specific situations, such as with cervical scarring, its routine use is associated with significant side effects without necessarily improving the overall insertion experience.”
Understanding IUDs and Associated Pain
An IUD is a small, T-shaped plastic device inserted into the uterus to prevent pregnancy. It works by stopping sperm from reaching an egg and can remain effective for 3 to 12 years, depending on the type. Some IUDs, like the Paragard, use a copper coating, while others, such as Mirena and Kyleena, release hormones to prevent pregnancy and manage painful periods or serve as emergency contraception.
The insertion process can be painful as the device must pass through the cervix, described by Dr. Gariepy as “the most uncomfortable part,” particularly for women who have not given birth and thus have not experienced cervical dilation. Similar discomfort can occur in other gynecological procedures requiring access through the cervix, including biopsies and treatments for conditions such as cervical cancer.
Dr. Gray emphasizes the importance of patient-centered discussions to address pain management effectively for these procedures, highlighting the need for personalized care to improve patient experiences.
