IUD Pain Gets the Recognition It Deserves

Research backs up what many women already know from experience: there are sex-based disparities in how pain is experienced, assessed, and treated. Women are less likely to be offered adequate pain management and more likely to be told their pain is due to anxiety or stress. Perhaps unsurprisingly, then, gynecologic care (including IUD insertion) is more painful than expected for many women.

As a health psychologist, I’ve heard many women describe feeling blindsided by how much it hurt to have an IUD inserted. The story often goes something like: “The doctor told me it might just pinch a bit, and I could take an ibuprofen if I wanted before the procedure, which made it sound like no big deal. I had no idea what I was in for.”

A Win for Women’s Health: ACOG’s New Guidelines

This month, the American College of Obstetricians and Gynecologists (ACOG) announced new recommendations on pain management for IUD insertions and other in-office gynecologic procedures. In this clinical consensus, the ACOG noted that many in-office gynecologic procedures—including IUD insertion and cervical biopsies—can be painful.

The guidelines clearly state that clinicians should:

• Inform patients ahead of time about what to expect,
• Offer pain relief options before and during the procedure, and
• Use a trauma-informed, patient-centered approach.

While some providers are already doing these things, these guidelines set a new standard of care to improve women’s experience of pelvic care across the board.

Why This Matters

There are a variety of factors that predict how painful IUD insertion may be for a particular person; some find it very painful, while others may hardly feel it. This could be part of why some doctors choose not to mention potential pain–there is a common fear that bringing that up could make the patient anxious and cause them to experience pain they would not have otherwise.

The problem with this approach is that when a woman does experience pain during an IUD insertion, lack of preparation can make the experience not only physically painful but also emotionally distressing. When pain is dismissed, minimized, or not even mentioned, many women walk away feeling confused, embarrassed, or ashamed for having a strong reaction.

The psychological impact can persist beyond that one experience, leading to consequences like:

• Avoidance of future medical care
• Medical trauma or increased anxiety
• Difficulty trusting providers in the future

Better Care Starts with Better Communication

When people are offered a transparent explanation of what to expect and are engaged in a collaborative discussion of appropriate pain management options, they are more likely to feel safe–even during painful procedures. This is especially important in pelvic healthcare, where vulnerability is already heightened.

These guidelines highlight and reinforce the crucial importance of listening to patients—including women—and providing accurate, transparent information about their care and options.

If you are preparing for an IUD, biopsy, or any other in-office procedure, you deserve to know what to expect and to be able to engage in shared decision-making about pain relief.