Pain with IUD Placements

What are patients seeing on social media pain with IUD placements?

• TikTok and Instagram are filled with patient stories of painful IUD insertions.
• In one study of the top 100 TikTok #IUD videos, nearly all highlighted pain and negative experiences; about 28% mentioned distrust of providers.
• Viral videos often show patients grimacing or crying on exam tables, with background audio of providers saying “Almost done, OK?”.
• Posts reinforce the idea that IUD placement is always “excruciating” and that providers dismiss or minimize pain.
• Patients may also hear anecdotal “tips” (e.g., take ibuprofen, ask for misoprostol) that don’t reflect best evidence.

What’s the evidence around pain with IUD placements? 

• Pain with IUD placements is real, variable, and under-treated. For many, insertion can feel like a prolonged contraction.
• Providers should not underestimate pain and should proactively discuss pain management.
  • Cervical blocks are an effective local method, though they add time and involve an injection.
  • Topical lidocaine may reduce tenaculum pain but is less effective overall.
  • NSAIDs alone are insufficient for insertion pain, but can help with post-procedure cramping.
  • Misoprostol has not shown consistent benefit and is not routinely recommended.
• Some patients may benefit from additional options such as oral anxiolytics, nitrous oxide, or other sedation strategies.
• Pain has historically been dismissed, particularly among people of color, contributing to distrust of the medical establishment.

Talking with patients about pain with IUD placements

Get curious:

Concerns may come from different places. Some patients may have seen videos online; others may have personally had a previous negative experience or talked to someone who did. Ask open-ended questions to better understand the origin of their concern:

There’s a lot of information out there about pain with IUDs. Is there something in particular that you’re concerned about?

Acknowledge concerns & normalize:

I’ll be honest, for a long time health care providers didn’t take people’s experiences of pain with IUD placements seriously enough. And we’re trying to do better now.

A lot of people describe IUD insertion as painful or intense, so it’s normal to feel nervous.

I’ve seen some of those TikToks, too. They can make it look really scary. I can also share that many of them only show the hardest experiences, often when people often aren’t offered enough pain management.

Clarify with evidence and empathy:

There are different options we offer to help with the pain. For example, we can use some numbing medicine in your cervix. Many people say that this feels a bit uncomfortable, like a strong pinch. But it’s quick, and I find my patients generally have less pain with the IUD placement if they have the numbing medicine. Is that something you’re interested in?

Address misinformation directly:

Misoprostol doesn’t usually make insertion easier or less painful and can cause side effects, so I don’t recommend it for most patients.

Diving deeper

• Don’t forget about the non-pharmacologic strategies: breathing techniques,  heating pad, lavender essential oils, cell phone, mindfulness, meditation, guided imagery.
• Center patient autonomy:

I’ll be checking in with you throughout the process. If at any point you need me to pause or stop, please let me know.

Key takeaways

• Patients’ fear of pain, amplified by social media, can be a barrier to IUD uptake.
• Validate patient concerns, discuss pain honestly, and offer evidence-based management options.
• The goal isn’t to promise a pain-free procedure, but to ensure patients feel informed, respected, and supported.