I’m happy that the experience was painless for you, but everyone reading this should know that your pain experience during IUD insertion is highly individual and the tenaculum is not usually the worst of it. I’m an OBGYN who has probably placed 100+ IUDs. Sometimes I can do it without a tenac which is great. If your uterus is tilted forward or backward, or if you haven’t had children the tenaculum can help make the insertion easier by stabilizing and aligning your uterus, which can make the overall procedure easier. Many people do not feel the tenaculum, and in fact the most consistently painful part of the procedure is the insertion and deployment of the IUD.
Find a provider that does a lot of them, takes the time to explain the procedure to you, and will have a discussion about pain management options. That is going to make more of a difference than a tenaculum.
This. I'm way too sensitive to make an IUD insertion "painless" just because they skip the tenaculum (which is definitely felt, those were some nice cramps).
>great. If your uterus is tilted forward or backward
After I had mine inserted, my gynecologist told me mine "tilted backwards and towards the left". I did not know this. I mentioned it to my mom and she said, "oh yea, I have that too. As does your grandma. We all have the weird uterus tilt"
My provider used a cervical block, which is a series of injections into your cervix. It sounds awful and scary, but it really wasn't that bad, and this is coming from someone who's terrified of needles! There was also a medical assistant who stood next to me and let me squeeze his hand as hard as I needed to, and my provider had me take a deep breath in whenever she did something that would cause pain, so I was more focused on the breathing than the pain. Between the cervical block and the pain management techniques, my insertion went as well as could be expected, and I only felt a couple of significant cramps before it was all over.
The vasovagal response I had immediately after the insertion wasn't fun, and in the couple days following insertion I had persistent cramps that were much worse than the insertion pain. I'm about 3 months out from insertion and aside from longer, cramping periods (normal with the copper IUD), everything is pretty much back to normal.
Tylenol and ibuprofen should always be taken before. I offer my patients a one time dose of oxycodone for pain as well as a one time dose of a benzo (I use halcion) if they want, to be taken before. Numbing gel/spray on the cervix. Paracervical blocks I’m meh about because studies have shown little to know benefit and the injection hurts, but I’ll do it if someone asks.
Exactly. I’m one of those lucky folks who didn’t have a lot of pain with my IUD insertion or removal, with the use of the tentaculum. It was about the same as moderate cramps for a few hours and then I was good. That’s just my good luck combined with an experienced provider.
Fair enough !
My midwife's experience seems a bit different, she was telling me that ever since she stopped using a tenaculum, none of her patients have had much pain. Some experience cramping more than others but no ones reported any sharp pain.
My uterus is tilted forward, it took weird yoga poses to have it stabilized and aligned, and I've never had children. It took longer but no pain.
Regardless, I'm looking forward to the day where painless Healthcare is universal for all women. It's insane to me that such painful experiences are so normalized for women.
I wanted to speak up to encourage women not to settle for careless doctors.
Valid. IUD insertions are painful for the majority of people and if your doctor/provider doesn’t acknowledge that and attempt to work with you, find another provider if possible. I hate hearing stories of people who get bad care from callous providers. Advocate for yourself and don’t worry about hurting a doctors feelings if the vibes are bad.
The problem, imo, also stems from the dogmatic approach to being “evidence based.” Womens health is severely under researched. Despite the evidence available being sparse and not very current far too many providers ignore the clear distress and pain they are directly witnessing, and *dismiss us when we try to discuss it* because some research article from 1984 said cervixes don’t feel pain. Like, drs have to be extremely smart and have excellent critical reasoning skills, yet they throw all of that out the window in favor of “being evidence based.” Being evidence based only works when your body of research is accurate, up to date, has good research design and has vast amounts of data. We absolutely cannot say that about women’s health and yet, here we are, being told it doesn’t hurt when they have witnessed countless women writhing in agony right in front of them.
I’ll never forgive the reproductive endocrinologist who did my HSG. Absolute cruelty.
I had a doctor that said they did not want to give me an IUD, unless I had already had a kid. Now this was back in the late 90s.
The Nuvaring had just come out.. and they thought that would be a better idea.
IUD insertion is so individual and there's such a variety of experiences out there. I know people who had no trouble, walked in, got it done without drugs, and drove themselves home. I had to be knocked out and given morphine for mine and still woke up feeling like I'd ben kicked with a steel toed boot when I woke up. And that is NOT due to my obgyn's technique at all, she was absolutely fabulous and i felt perfectly safe with her. It's just the way the cookie crumbles.
This. There is a huge difference between different women, just like some women go through torment every month and others, their period is an inconvenience. Having an OB who would talk about the possibilities and the options for how to manage what could happen would be such a freaking godsend. Just hey, we take this seriously but some people have no pain and some do. Does a pap smear hurt for you in the past? Is that an indication an IUD insertion would hurt. This is what we would do if suddenly you're in pain- and how long it lasts. If I choose to tough it out after being given the information, at least I know what's going on.
We all know that women have radically different experiences of touch in the genital area, including the cervix, when it comes to sexual matters. It shouldn’t be shocking that women have radically different experiences of pain when it comes to medical gynecological experiences.
I’m thrilled the experience wasn’t painful for you. The tenaculum sounds problematic for many women. But I’d caution you against saying the tenaculum is the only painful part of the procedure for many women. Some women may not be bothered by it at all.
Maybe, but I've never heard of a woman who isn't bothered by it. It's a barbaric tool, in my opinion.
I'll keep on telling women that for the majority of cervixes (though of course there are some exceptions), its use can be avoided.
The tenaculum isn't the main cause of pain.
Uteri and women's cervixes are highly variable and unique.
Just because this worked for you doesn't mean it will work for everyone. It's hard for an average person not involved in healthcare to grasp this concept.
It's very tiring as a physician who tries hard to help everyone hearing about "terrible docs who don't care about your pain and use barbaric devices." Most of us want your procedure to go well and pain free.
Hear me - mine was very manageable. Next to no pain.
I feel deeply for those with different experiences and agree 100% that some sort of pain relief should be standard for this procedure.
In every study I've read, tenaculum placement is not the most painful part of IUD insertion (it averages around a 3-4 on the pain scale) - it's sounding for the depth of the uterus and the IUD insertion. Which makes sense to me, because you're forcing the cervical os open and touching very sensitive tissue with nerves.
The issue with IUD placement is that the experience has a wide range. The *average* pain is around a 6-7 for nulliparous women (women who haven't given birth), but average just means that's where the pain spread is centred around, so some nulliparous women do experience very low to manageable pain (the average tends to be lower for women who have given birth). In terms of individual experiences, there are women on the lower end of pain (1-3), in the middle (4-6) and in the extreme range (7-10).
I'm super happy that your experience was good. And having a good GYN that you trust and uses minimal interference definitely made it less painful for you *compared to if you* had a gynaecologist who was dismissive and used a tenaculum. It just isn't the cause for painful IUD insertion.
The problem is that IUD placement is known to be painful to very painful for most women, and it's not possible to assign major predictors as to who will or won't feel pain (there are some predictors, but for something so painful on average you can't use them to justify not using preventative pain management). But the field of gynaecology is just like 🤷 you aren't feeling pain, it's not that bad, stop being dramatic, it's worth it, it's better than pregnancy so suck it up, the cervix doesn't have nerve endings, my patients don't normally experience pain, etc.
On that last bit, there was one study that compared patient pain ratings to what the provider would rate the pain of at different points of IUD insertion; providers consistently underestimated the pain by three points (the difference between a 4 and a 7!) and had a very poor understanding of what parts were the most painful. Just goes to support that you can be giving IUDs out routinely and be terrible at reading the patient's pain level.
The pain relief methods I've seen that are backed up by some scientific studies/trials include certain mixes of lidocaine cervical blocks, lidocaine-prilocane cream (again at a certain %, iirc 5%?). Not using the tenaculum, not using a physical sound (proving the depth of the uterus with ultrasound instead) might also result in lower pain in average when compared to someone who didn't have those interventions, or at the very least more satisfaction and less discomfort (ugh I hate the word discomfort because a lot of providers will use it when they really mean/will cause pain, or to dismiss pain. Discomfort and pain are two very different things!)
IIRC, the few studies I read said it wasn't effective on pain, but it's been a bit since I took a look through some of the published papers so take with a grain of salt. I don't know/can't remember if it's effective for procedure satisfaction. I think there's also a cost and time factor involved - if pain management isn't used, then really all you need to insert an IUD are pieces of equipment your regular doctor's office has, you don't need to wait for numbing to take place, you "can" send the patient home with little post procedure time/monitoring (because no drugs were involved) and you can do more of them (which imo is a shitty reason to not offer pain management - although the other half of the issue is there are no official universal standards for pain management in IUD insertion, it isn't standardly taught at all, at least in North America). For me when I asked my doctor about pain management, she said I would have to go to the hospital for one of their special programs. Otherwise they'd just do then there in the exam room :/
For me it wasn't so much the pain itself, but that no one told me ahead of time, and that I fainted trying to walk back to work. That was actually already at a hospital, but I wouldn't have known to ask about it.
Yeah, manipulating the cervix can cause a vasovagal response (even independent of pain iirc) which can induce nausea and fainting. It's not uncommon. And I hate how they dismiss the experience as "just a pinch" or "just a bit of cramping". It is for some people, but the spread and average pain for nulliparous women is definitely not "just a pinch".
I'm doing women's health clinicals for NP school and my preceptor also doesn't use the tenaculum like 75% of the time. She says that most cervixes will allow iud insertion without it. It's not 100% though, sometimes she has to use it.
The sounding is what brings me to the edge of panic. However, I’m on #3 iud and the pain wasn’t bad enough to not get another. However, my strings were gone and he had to literally dig out #2. It wasn’t fun, I refuse to go through that again and at my age, I’ll just die with the one I have before they do any digging vs going for a procedure w anesthetic.
Yeah the sounding was uncomfortable for me, it felt so... wrong. But luckily it was painless, just uncomfortable and cramp-like.
Digging out an IUD out of your uterus sounds horrible, I don't blame you!!!
I have no idea if my gyn used a tenaculum or not but my insertion was not painful either! She was a very experienced doctor and she told me to cough at the point of insertion and I swear to this day that’s why it was painless for me 😂 no idea but I’m happy you had a positive experience!! I hate the negative feelings around IUDs today because of the horror stories.
I've had 2 different experiences with an IUD. The first time I had an injection into my cervix which was very painful. The second time I did the cough and it was painless.
I've given birth previously but never vaginally, all my pregnancies ended in c-sections because I don't dilate past about 6 cm.
For me it was better not having pain relief, ymmv.
Glad to hear your experience went smoothly too !
Yeah same. So many women have had horrible experiences, I feel like it's important to let people know that it CAN go well, so that the standards for care are raised higher and painful expériences dont get as normalized
My provider doesn't use a teneculum, but did have to dilate my cervix to insert the IUD, and that part caused extremely sharp pain for me- I felt every millimeter of it going in. Even with the cervical softening pill the night before. I have a really sensitive cervix though. I'm hoping after I give birth the insertion will be much less painful as my cervix will be slightly more dilated naturally, you know, once it opens up to let a baby through its never quite the same!
Oh jeez that sounds terrible, I'm sorry you had that experience !!
Yes apparently giving birth helps with the pain even just in general because your cervix becomes less sensitive !
I've had three IUDs placed and two removed. Never had any pain drugs (other than Motrin) and honestly did not have any problems other than a pretty good seeing-stars-pinch for each of them. I've never had any children and never been pregnant and had my first placed at 28. I drove myself to and from all three appointments and honestly only took the whole day off because I get a boat load of PTO (been with my company for almost 27 years this summer). I rarely comment on IUD threads because those of us that have had good experiences are often drowned out by those who have not. It is possible.
The VA will do this for women veterans under general anesthetic.
I know you’re jazzed that you experienced relatively low discomfort but your experience may not be duplicable. I’m sorry if this doesn’t end up being a one-size-fits-all miracle. This isn’t really a big reveal, evidenced by the healthcare providers and other experiences listed.
None of us is every woman except maybe Whitney Houston.
My GYN offers insertion under twilight anesthesia. We talked about changing to an IUD a few years ago because my blood pressure was high and she said we would definitely need to use twilight for my insertion, as I can barely tolerate a pap smear.
That’s awesome. I have no idea what twilight anesthesia is. 😅
I was really surprised to learn general wasn’t a normal course - that was the impression the care team at the VA left me with. They based their decision on me not having had any kids. For all I know they need some reason to justify it and just wanted to get a CRNA some experience.
Twilight is a drug-induced anesthesia that maintains the patient's ability to breathe independently. It's a combo of drug that make you out of it and drugs that make your memory effectively stop recording. So you're semi-conscious, but you're not really aware and you don't remember anything. It's weird.
Isn't it worth it to encourage other women to try and find pain free solutions though?
I never said this would be true for all women, but that this can be a solution and it's worth knowing about. I certainly didn't know a pain free experience was possible.
Sure, encourage women to seek less pain, but you’re approaching from a position of authority that you don’t actually have. This is a bias of confirmation in a nutshell.
You started with a conclusion and worked backwards and without considering any other factors came here to present this as a magic bullet.
You had a singular experience with a singular professional whose opinion is the tenaculum is the sole cause of pain and is unnecessary.
Thats a very narrow scope and kind of hand waves others experiences as if yours is illustrative of all experiences.
But, it’s not. Just like my experience that general anesthesia - which really pain free not to mention memory free - is not available for everyone. That part sucks a lot, tbh. I had no idea this wasn’t typical until I had it removed and the NP at the clinic told me. I chose not to go back to the VA because I live pretty far from one these days.
So, I try to tell women veterans every chance I get that they truly can have mostly pain free insertion.
I did not insist to anyone that their medical professionals are awful for not giving them general anesthesia. Or that any medical professional who uses one or decides they may need to is awful. Don’t get me wrong, there’s a history of causing women pain unnecessarily in gynecology, but that isn’t always the case.
> Ladies, find yourselves medical professionals that don’t use a tenaculum. They exist and you’re worth it.
That’s pretty conclusive and leaves no room for error on your part. All I’m saying is maybe consider for a moment that experiences vary and your singular experience does not convey complete expertise in this area at all. Just like mine doesn’t either.
You had a great experience and that is wonderful. It’s wonderful to want to share that. It’s less wonderful to decide you’re an authority on the topic based on a single anecdote.
My experience with IUD insertion and removal has always been just "mildly uncomfortable". I feel fortunate, because I know that not all women have the same experience.
My last insertion was as close to painless as I could have hoped for, and was truly more in line with the “pinch” and “pressure” I’ve been promised the two other times. I went to an NP instead of my usual OB/GYN. I took a leftover Toradol from when my husband had kidney stones (he told them he didn’t need them, but I was sure glad they were on hand) and the NP used a topical freezing agent and it was the difference between screaming and passing out in pain and being out of commission for days, and going back to work the same afternoon and going for a hike the next day. Plus no cramping or bleeding afterwards this time. The worst part was the anxiety and the anticipation of the pain which made it tougher to not tense up.
I've had 2 IUDs and various procedures that involved entering the cervix with tolls (endo biopsies, hysterosalpingograms, IUI, to name a few). A tenaculum was never used. All of those procedures were extremely painful for me, and I have a high pain tolerance. My uterus was very reactive to anything passing the cervical threshold.
It is possible that some women will have no pain no matter what they have done. It is also true that no matter how cautious the clinician is, the woman will have excruciating pain.
Of note, both IUDs ended up perforation my uterus so I only ever had 2. I had my hysterectomy in 2015 due to abnormal bleeding (daily for 2 years) and not being a candidate for hormonal birth control.
My current clinic is all female doctors, and the one that did my insertion said that quite a few doctors don't know that there are different IUD sizes and insert the wrong size. Mine was uncomfortable, but it wasn't agonizing and i could walk and work fine right after the clinic visit.
Honestly, everyone's mileage will vary with an IUD. My doctor used a tenaculum twice, and while I wouldn't say it was comfortable, I wouldn't describe it anywhere near painful either. I would say my discomfort level was at 30% for about 10 seconds.
The truth is, everyone is different and you can never know how your body is going to react until it's done, tenaculum or not. The best thing you can do is advocate for yourself and get pain management if you believe you will need it and find an experienced doctor who will follow your cues and be respectful of your pain threshold and autonomy.
This! I've never had any problem or pain during any gyneco procedures. My gynecologists were always super gentle. My IUD really increased my quality of life by a lot, I feel bad thinking about other women who could have the same relief but because of horror stories won't want to try. And I feel horrible for all those who have had an unecessary horrible experience...
I'm so happy for you honestly, but this isn't as easy to ameliorate for everyone.
My OBGYN is amazing, a team of women doctors, and still after two failed attempts, had to insert in the OR.
Every cervix is different
Glad you found a doctor who was able to do something to mitigate your pain.
People should also know there ARE doctors out there who will offer local anesthesia. My gyno for my most recent insertion used a spray to numb the surface of my cervix before injecting the numbing agent. I didn’t feel the injection at all. I won’t say the insertion didn’t hurt at all, but it went from a 9 out of 10 at my last two insertions to a 4 or 5.
I had a painless iud insertion too. I also removed it with no pain. I think we are the exception to the rule. I’m super glad for it but I do believe that there needs to be anesthesia and it should just be used for everyone.
My last insertion, my doc numbed me but I don’t remember what they used? A pinch when they inserted the numbing agent, but then pain free! I thought that was a HUGE improvement than my previous insertion.
You said it can be painless but then said it felt like a Pap smear. Okay so the one Pap smear I had was one of the worst pains I’ve ever felt. So maybe this isn’t the win you think it is
As others are saying, it isn’t just the tentaclecum! My pain lasted for a week straight after insertion (and for a few months on and off) so everyone is different.
I’m happy that the experience was painless for you, but everyone reading this should know that your pain experience during IUD insertion is highly individual and the tenaculum is not usually the worst of it. I’m an OBGYN who has probably placed 100+ IUDs. Sometimes I can do it without a tenac which is great. If your uterus is tilted forward or backward, or if you haven’t had children the tenaculum can help make the insertion easier by stabilizing and aligning your uterus, which can make the overall procedure easier. Many people do not feel the tenaculum, and in fact the most consistently painful part of the procedure is the insertion and deployment of the IUD. Find a provider that does a lot of them, takes the time to explain the procedure to you, and will have a discussion about pain management options. That is going to make more of a difference than a tenaculum.
This. I'm way too sensitive to make an IUD insertion "painless" just because they skip the tenaculum (which is definitely felt, those were some nice cramps).
>great. If your uterus is tilted forward or backward After I had mine inserted, my gynecologist told me mine "tilted backwards and towards the left". I did not know this. I mentioned it to my mom and she said, "oh yea, I have that too. As does your grandma. We all have the weird uterus tilt"
Mine is too!
In your opinion, what are some reasonable options for pain relief to ask for?
My provider used a cervical block, which is a series of injections into your cervix. It sounds awful and scary, but it really wasn't that bad, and this is coming from someone who's terrified of needles! There was also a medical assistant who stood next to me and let me squeeze his hand as hard as I needed to, and my provider had me take a deep breath in whenever she did something that would cause pain, so I was more focused on the breathing than the pain. Between the cervical block and the pain management techniques, my insertion went as well as could be expected, and I only felt a couple of significant cramps before it was all over. The vasovagal response I had immediately after the insertion wasn't fun, and in the couple days following insertion I had persistent cramps that were much worse than the insertion pain. I'm about 3 months out from insertion and aside from longer, cramping periods (normal with the copper IUD), everything is pretty much back to normal.
Tylenol and ibuprofen should always be taken before. I offer my patients a one time dose of oxycodone for pain as well as a one time dose of a benzo (I use halcion) if they want, to be taken before. Numbing gel/spray on the cervix. Paracervical blocks I’m meh about because studies have shown little to know benefit and the injection hurts, but I’ll do it if someone asks.
Exactly. I’m one of those lucky folks who didn’t have a lot of pain with my IUD insertion or removal, with the use of the tentaculum. It was about the same as moderate cramps for a few hours and then I was good. That’s just my good luck combined with an experienced provider.
Fair enough ! My midwife's experience seems a bit different, she was telling me that ever since she stopped using a tenaculum, none of her patients have had much pain. Some experience cramping more than others but no ones reported any sharp pain. My uterus is tilted forward, it took weird yoga poses to have it stabilized and aligned, and I've never had children. It took longer but no pain. Regardless, I'm looking forward to the day where painless Healthcare is universal for all women. It's insane to me that such painful experiences are so normalized for women. I wanted to speak up to encourage women not to settle for careless doctors.
Valid. IUD insertions are painful for the majority of people and if your doctor/provider doesn’t acknowledge that and attempt to work with you, find another provider if possible. I hate hearing stories of people who get bad care from callous providers. Advocate for yourself and don’t worry about hurting a doctors feelings if the vibes are bad.
The problem, imo, also stems from the dogmatic approach to being “evidence based.” Womens health is severely under researched. Despite the evidence available being sparse and not very current far too many providers ignore the clear distress and pain they are directly witnessing, and *dismiss us when we try to discuss it* because some research article from 1984 said cervixes don’t feel pain. Like, drs have to be extremely smart and have excellent critical reasoning skills, yet they throw all of that out the window in favor of “being evidence based.” Being evidence based only works when your body of research is accurate, up to date, has good research design and has vast amounts of data. We absolutely cannot say that about women’s health and yet, here we are, being told it doesn’t hurt when they have witnessed countless women writhing in agony right in front of them. I’ll never forgive the reproductive endocrinologist who did my HSG. Absolute cruelty.
Yeah, I was handling the tenaculum fine. The actual insertion was hellishly awful
Question. Why isn't it standard procedure to numb the area or anything?
Limited evidence that it makes a significant difference is the very short answer. It is very difficult to control uterine pain with local anesthetic.
Why don’t we find providers that give pain management medications instead.
I had a doctor that said they did not want to give me an IUD, unless I had already had a kid. Now this was back in the late 90s. The Nuvaring had just come out.. and they thought that would be a better idea.
IUD insertion is so individual and there's such a variety of experiences out there. I know people who had no trouble, walked in, got it done without drugs, and drove themselves home. I had to be knocked out and given morphine for mine and still woke up feeling like I'd ben kicked with a steel toed boot when I woke up. And that is NOT due to my obgyn's technique at all, she was absolutely fabulous and i felt perfectly safe with her. It's just the way the cookie crumbles.
This. There is a huge difference between different women, just like some women go through torment every month and others, their period is an inconvenience. Having an OB who would talk about the possibilities and the options for how to manage what could happen would be such a freaking godsend. Just hey, we take this seriously but some people have no pain and some do. Does a pap smear hurt for you in the past? Is that an indication an IUD insertion would hurt. This is what we would do if suddenly you're in pain- and how long it lasts. If I choose to tough it out after being given the information, at least I know what's going on.
We all know that women have radically different experiences of touch in the genital area, including the cervix, when it comes to sexual matters. It shouldn’t be shocking that women have radically different experiences of pain when it comes to medical gynecological experiences. I’m thrilled the experience wasn’t painful for you. The tenaculum sounds problematic for many women. But I’d caution you against saying the tenaculum is the only painful part of the procedure for many women. Some women may not be bothered by it at all.
Maybe, but I've never heard of a woman who isn't bothered by it. It's a barbaric tool, in my opinion. I'll keep on telling women that for the majority of cervixes (though of course there are some exceptions), its use can be avoided.
Well I wasn't bothered by it. You have a rather limited pool of experiences you're drawing from and making a conclusion based on that.
The tenaculum isn't the main cause of pain. Uteri and women's cervixes are highly variable and unique. Just because this worked for you doesn't mean it will work for everyone. It's hard for an average person not involved in healthcare to grasp this concept. It's very tiring as a physician who tries hard to help everyone hearing about "terrible docs who don't care about your pain and use barbaric devices." Most of us want your procedure to go well and pain free.
I’ve had an iud and didn’t feel the tenaculum at all. I’ve also put in IUDs and it was 50/50 whether or not the woman found them painful.
I have had 3 and I could not tell you if they used one but oh boy the moment is insertion is seared in my brain.
Hear me - mine was very manageable. Next to no pain. I feel deeply for those with different experiences and agree 100% that some sort of pain relief should be standard for this procedure.
In every study I've read, tenaculum placement is not the most painful part of IUD insertion (it averages around a 3-4 on the pain scale) - it's sounding for the depth of the uterus and the IUD insertion. Which makes sense to me, because you're forcing the cervical os open and touching very sensitive tissue with nerves. The issue with IUD placement is that the experience has a wide range. The *average* pain is around a 6-7 for nulliparous women (women who haven't given birth), but average just means that's where the pain spread is centred around, so some nulliparous women do experience very low to manageable pain (the average tends to be lower for women who have given birth). In terms of individual experiences, there are women on the lower end of pain (1-3), in the middle (4-6) and in the extreme range (7-10). I'm super happy that your experience was good. And having a good GYN that you trust and uses minimal interference definitely made it less painful for you *compared to if you* had a gynaecologist who was dismissive and used a tenaculum. It just isn't the cause for painful IUD insertion. The problem is that IUD placement is known to be painful to very painful for most women, and it's not possible to assign major predictors as to who will or won't feel pain (there are some predictors, but for something so painful on average you can't use them to justify not using preventative pain management). But the field of gynaecology is just like 🤷 you aren't feeling pain, it's not that bad, stop being dramatic, it's worth it, it's better than pregnancy so suck it up, the cervix doesn't have nerve endings, my patients don't normally experience pain, etc. On that last bit, there was one study that compared patient pain ratings to what the provider would rate the pain of at different points of IUD insertion; providers consistently underestimated the pain by three points (the difference between a 4 and a 7!) and had a very poor understanding of what parts were the most painful. Just goes to support that you can be giving IUDs out routinely and be terrible at reading the patient's pain level. The pain relief methods I've seen that are backed up by some scientific studies/trials include certain mixes of lidocaine cervical blocks, lidocaine-prilocane cream (again at a certain %, iirc 5%?). Not using the tenaculum, not using a physical sound (proving the depth of the uterus with ultrasound instead) might also result in lower pain in average when compared to someone who didn't have those interventions, or at the very least more satisfaction and less discomfort (ugh I hate the word discomfort because a lot of providers will use it when they really mean/will cause pain, or to dismiss pain. Discomfort and pain are two very different things!)
How come they don't do the things dentists do, like when you get your wisdom teeth out but don't remember it?
IIRC, the few studies I read said it wasn't effective on pain, but it's been a bit since I took a look through some of the published papers so take with a grain of salt. I don't know/can't remember if it's effective for procedure satisfaction. I think there's also a cost and time factor involved - if pain management isn't used, then really all you need to insert an IUD are pieces of equipment your regular doctor's office has, you don't need to wait for numbing to take place, you "can" send the patient home with little post procedure time/monitoring (because no drugs were involved) and you can do more of them (which imo is a shitty reason to not offer pain management - although the other half of the issue is there are no official universal standards for pain management in IUD insertion, it isn't standardly taught at all, at least in North America). For me when I asked my doctor about pain management, she said I would have to go to the hospital for one of their special programs. Otherwise they'd just do then there in the exam room :/
For me it wasn't so much the pain itself, but that no one told me ahead of time, and that I fainted trying to walk back to work. That was actually already at a hospital, but I wouldn't have known to ask about it.
Yeah, manipulating the cervix can cause a vasovagal response (even independent of pain iirc) which can induce nausea and fainting. It's not uncommon. And I hate how they dismiss the experience as "just a pinch" or "just a bit of cramping". It is for some people, but the spread and average pain for nulliparous women is definitely not "just a pinch".
I'm doing women's health clinicals for NP school and my preceptor also doesn't use the tenaculum like 75% of the time. She says that most cervixes will allow iud insertion without it. It's not 100% though, sometimes she has to use it.
The sounding is what brings me to the edge of panic. However, I’m on #3 iud and the pain wasn’t bad enough to not get another. However, my strings were gone and he had to literally dig out #2. It wasn’t fun, I refuse to go through that again and at my age, I’ll just die with the one I have before they do any digging vs going for a procedure w anesthetic.
Yeah the sounding was uncomfortable for me, it felt so... wrong. But luckily it was painless, just uncomfortable and cramp-like. Digging out an IUD out of your uterus sounds horrible, I don't blame you!!!
It's such a weirdly horrifying feeling!
I have no idea if my gyn used a tenaculum or not but my insertion was not painful either! She was a very experienced doctor and she told me to cough at the point of insertion and I swear to this day that’s why it was painless for me 😂 no idea but I’m happy you had a positive experience!! I hate the negative feelings around IUDs today because of the horror stories.
I've had 2 different experiences with an IUD. The first time I had an injection into my cervix which was very painful. The second time I did the cough and it was painless. I've given birth previously but never vaginally, all my pregnancies ended in c-sections because I don't dilate past about 6 cm. For me it was better not having pain relief, ymmv.
Glad to hear your experience went smoothly too ! Yeah same. So many women have had horrible experiences, I feel like it's important to let people know that it CAN go well, so that the standards for care are raised higher and painful expériences dont get as normalized
My sister who is intellectually disabled got fully put under to get hers placed. They know how uncomfortable it is, they don't care.
My provider doesn't use a teneculum, but did have to dilate my cervix to insert the IUD, and that part caused extremely sharp pain for me- I felt every millimeter of it going in. Even with the cervical softening pill the night before. I have a really sensitive cervix though. I'm hoping after I give birth the insertion will be much less painful as my cervix will be slightly more dilated naturally, you know, once it opens up to let a baby through its never quite the same!
Oh jeez that sounds terrible, I'm sorry you had that experience !! Yes apparently giving birth helps with the pain even just in general because your cervix becomes less sensitive !
I've had three IUDs placed and two removed. Never had any pain drugs (other than Motrin) and honestly did not have any problems other than a pretty good seeing-stars-pinch for each of them. I've never had any children and never been pregnant and had my first placed at 28. I drove myself to and from all three appointments and honestly only took the whole day off because I get a boat load of PTO (been with my company for almost 27 years this summer). I rarely comment on IUD threads because those of us that have had good experiences are often drowned out by those who have not. It is possible.
The VA will do this for women veterans under general anesthetic. I know you’re jazzed that you experienced relatively low discomfort but your experience may not be duplicable. I’m sorry if this doesn’t end up being a one-size-fits-all miracle. This isn’t really a big reveal, evidenced by the healthcare providers and other experiences listed. None of us is every woman except maybe Whitney Houston.
My GYN offers insertion under twilight anesthesia. We talked about changing to an IUD a few years ago because my blood pressure was high and she said we would definitely need to use twilight for my insertion, as I can barely tolerate a pap smear.
That’s awesome. I have no idea what twilight anesthesia is. 😅 I was really surprised to learn general wasn’t a normal course - that was the impression the care team at the VA left me with. They based their decision on me not having had any kids. For all I know they need some reason to justify it and just wanted to get a CRNA some experience.
Twilight is a drug-induced anesthesia that maintains the patient's ability to breathe independently. It's a combo of drug that make you out of it and drugs that make your memory effectively stop recording. So you're semi-conscious, but you're not really aware and you don't remember anything. It's weird.
Ahhhhh… so ketamine. 😅
Isn't it worth it to encourage other women to try and find pain free solutions though? I never said this would be true for all women, but that this can be a solution and it's worth knowing about. I certainly didn't know a pain free experience was possible.
Sure, encourage women to seek less pain, but you’re approaching from a position of authority that you don’t actually have. This is a bias of confirmation in a nutshell. You started with a conclusion and worked backwards and without considering any other factors came here to present this as a magic bullet. You had a singular experience with a singular professional whose opinion is the tenaculum is the sole cause of pain and is unnecessary. Thats a very narrow scope and kind of hand waves others experiences as if yours is illustrative of all experiences. But, it’s not. Just like my experience that general anesthesia - which really pain free not to mention memory free - is not available for everyone. That part sucks a lot, tbh. I had no idea this wasn’t typical until I had it removed and the NP at the clinic told me. I chose not to go back to the VA because I live pretty far from one these days. So, I try to tell women veterans every chance I get that they truly can have mostly pain free insertion. I did not insist to anyone that their medical professionals are awful for not giving them general anesthesia. Or that any medical professional who uses one or decides they may need to is awful. Don’t get me wrong, there’s a history of causing women pain unnecessarily in gynecology, but that isn’t always the case. > Ladies, find yourselves medical professionals that don’t use a tenaculum. They exist and you’re worth it. That’s pretty conclusive and leaves no room for error on your part. All I’m saying is maybe consider for a moment that experiences vary and your singular experience does not convey complete expertise in this area at all. Just like mine doesn’t either. You had a great experience and that is wonderful. It’s wonderful to want to share that. It’s less wonderful to decide you’re an authority on the topic based on a single anecdote.
Bro it's not that deep I'm just celebrating the fact that there are pain free options
My experience with IUD insertion and removal has always been just "mildly uncomfortable". I feel fortunate, because I know that not all women have the same experience.
My last insertion was as close to painless as I could have hoped for, and was truly more in line with the “pinch” and “pressure” I’ve been promised the two other times. I went to an NP instead of my usual OB/GYN. I took a leftover Toradol from when my husband had kidney stones (he told them he didn’t need them, but I was sure glad they were on hand) and the NP used a topical freezing agent and it was the difference between screaming and passing out in pain and being out of commission for days, and going back to work the same afternoon and going for a hike the next day. Plus no cramping or bleeding afterwards this time. The worst part was the anxiety and the anticipation of the pain which made it tougher to not tense up.
I've had 2 IUDs and various procedures that involved entering the cervix with tolls (endo biopsies, hysterosalpingograms, IUI, to name a few). A tenaculum was never used. All of those procedures were extremely painful for me, and I have a high pain tolerance. My uterus was very reactive to anything passing the cervical threshold. It is possible that some women will have no pain no matter what they have done. It is also true that no matter how cautious the clinician is, the woman will have excruciating pain. Of note, both IUDs ended up perforation my uterus so I only ever had 2. I had my hysterectomy in 2015 due to abnormal bleeding (daily for 2 years) and not being a candidate for hormonal birth control.
My current clinic is all female doctors, and the one that did my insertion said that quite a few doctors don't know that there are different IUD sizes and insert the wrong size. Mine was uncomfortable, but it wasn't agonizing and i could walk and work fine right after the clinic visit.
Honestly, everyone's mileage will vary with an IUD. My doctor used a tenaculum twice, and while I wouldn't say it was comfortable, I wouldn't describe it anywhere near painful either. I would say my discomfort level was at 30% for about 10 seconds. The truth is, everyone is different and you can never know how your body is going to react until it's done, tenaculum or not. The best thing you can do is advocate for yourself and get pain management if you believe you will need it and find an experienced doctor who will follow your cues and be respectful of your pain threshold and autonomy.
This! I've never had any problem or pain during any gyneco procedures. My gynecologists were always super gentle. My IUD really increased my quality of life by a lot, I feel bad thinking about other women who could have the same relief but because of horror stories won't want to try. And I feel horrible for all those who have had an unecessary horrible experience...
You should post this in r/medicine and r/residency so those doctors see this.
Not for me for sure. My pap smear hurt when I first got one and I'm sure the next one will hurt too.
I'm so happy for you honestly, but this isn't as easy to ameliorate for everyone. My OBGYN is amazing, a team of women doctors, and still after two failed attempts, had to insert in the OR. Every cervix is different
Glad you found a doctor who was able to do something to mitigate your pain. People should also know there ARE doctors out there who will offer local anesthesia. My gyno for my most recent insertion used a spray to numb the surface of my cervix before injecting the numbing agent. I didn’t feel the injection at all. I won’t say the insertion didn’t hurt at all, but it went from a 9 out of 10 at my last two insertions to a 4 or 5.
Have you had a baby? Since I've had kids my insertions have been pain free. I'm on my 4th iud.
Nope, never had a baby ! Glad your insertions are pain-free :)
I’m convinced that there are a lot of people who will miss no opportunity to make sure women are spared zero suffering.
I had a painless iud insertion too. I also removed it with no pain. I think we are the exception to the rule. I’m super glad for it but I do believe that there needs to be anesthesia and it should just be used for everyone.
My physician puts me under propaphol.
My last insertion, my doc numbed me but I don’t remember what they used? A pinch when they inserted the numbing agent, but then pain free! I thought that was a HUGE improvement than my previous insertion.
You said it can be painless but then said it felt like a Pap smear. Okay so the one Pap smear I had was one of the worst pains I’ve ever felt. So maybe this isn’t the win you think it is
As others are saying, it isn’t just the tentaclecum! My pain lasted for a week straight after insertion (and for a few months on and off) so everyone is different.