The Future

The amount of pain management women receive before, during, or after an IUD procedure.
The Future

If men had to get IUDs, they’d get epidurals and a hospital stay

Insertions of the best method of birth control can be blindingly painful during and after, but all women get is a single over-the-counter painkiller. Why?

You hear that IUDs hurt, though accounts vary in a way that is extreme and will lead you, falsely, to hope for the best. Some people tell you you can go right back to work after. Some say you feel essentially nothing, maybe a pinch. Everyone I know LOVES theirs and said nothing of the insertion process. But a surprising number, as I discovered while trying to determine if my own acute suffering post-insertion was abnormal, describe it as the worst pain they've experienced in their life. The worst of it is blinding and minutes long, and then about 75 percent of that pain goes on for hours. And that’s if nothing goes wrong, like the device jams, and the doctor has to try again a second time.

When one gets one’s wisdom teeth out, you are numbed to all hell, and some people even get put under. I recall getting something like 24 shots of novacaine all around my mouth. People who get simple moles or cataracts removed, or receive biopsies, get local anesthesia, as do people receiving spinal taps. For colonoscopies, a bloodless procedure unless the doctor is taking a tissue sample, patients get either conscious sedation or full general anesthesia. During cystoscopies, a nonsurgical procedure used to check for bladder cancer, patients, particularly men, have the option of local or general anesthesia. That said, I’m not here to legislate who gets the birth control treatment, per se; I’d never trust a man to do his due diligence to make sure I don’t end up pregnant (it’s a worthwhile question, if not the one I’m asking).

If you’re unfamiliar with what an IUD insertion looks like, the internet delivers on this splendor (extremely NSFW). To give a sense of the pain, or at least how bad the pain can be, if a shot is a 3 on a pain scale, an IUD insertion is a 10, in three waves. For an IUD insertion, on average, women receive virtually zero pain management before, during, or after: maybe a little numbing gel, maybe a single over-the-counter-strength painkiller afterward, and that’s it.

Some people will snottily assert that perhaps your doctor just is bad at IUD insertions, and that’s why yours hurt. Perhaps, it but still leaves the question of why it’s such a vastly uneven experience to begin with, through no choice of the patient (maybe the most direct comparison point here for the kind of pain is pre-delivery pregnancy contractions, for which most women get a routine epidural, unless they decline).

Research shows doctors have historically had poor perception of how bad IUD insertion hurts, because women are socialized to downplay their pain. Some of this appears to vary based on things like cervix position — if it’s not pointed directly at the back of your uterus, the doctor has to steer it around and set it in position before they can put the IUD in place. Picture one of those plastic water bottles (this is a uterus) with one of those sport nozzles (this is a cervix) and now squish that nozzle in and crank it to one side. This is how a cervix can be, but it has to be set into a straight position temporarily in order to insert an IUD. It also depends how dilated your cervix might already be; some doctors will advise you to try and have your insertion during your period, when you might be ever so slightly dilated already, to save a couple millimeters of wrenching you open. Some doctors will give women a mifeprestone pill the day before, which dilates you a bit; some will tell you to take some Advil beforehand. Some will put numbing gel on your cervix. None of this is consistent at all. One doctor suggests there are three accepted pre-op pain mediation strategies for IUD insertion, of which doctors tend to pick just one, for reasons he couldn’t adequately explain. Even under ideal anatomical conditions, there is still likely to be pain but doctors provide no post-op pain medication other than one over-the-counter pill, no vicodin, no codeine. IUD insertion is at least as likely as not to be the worst pain you’ve ever felt, with virtually no options for recourse or relief. If men were routinely faced with this scenario they would riot in the streets.

My IUD insertion was not one big pain point, but at least three huge, blinding waves (there are a few steps to insertion, which I have not really seen communicated anywhere including from my own doctor, but “one pinch” does not seem to be the truth). Respect to the women who feel nothing, especially coming from someone who grits through everything and has 30 years’ experience repressing any and all pain (physical, emotional). But this felt like being torn open from the inside, again and again and again. But it’s not just the pain; it’s also the deep biological sense that something in your body that should not be messed with is being aggravated, activating what I can only describe as a fight-or-flight response where you can actually do neither, since the threat is inside of you, like Rosemary’s goddamn baby. I do not say this as a some kind of hippie who thinks medical advances are against nature, or anything, it’s just that the only way to describe the reaction is somewhere past “pain” and more in the realm of  “body horror.”

Doctors explain this feeling as a “vasovagal reaction,” which is the body’s response to extreme emotional distress or pain or a few other triggers; symptoms are sudden hot or cold, dizziness, sweating, and often fainting, which many women report happening not just during IUD insertion, but in the hours after, sometimes as they trying to make their way home (some doctors will tell you to get someone to escort you home; others won’t).

Once the painful part started, I screamed and cried throughout the whole process. My doctor kept saying “I’m sorry, I’m sorry” over and over, but gave no indication that anything happening was out of the ordinary. For my trouble, the nurse handed me a single Motrin tablet and a teeny cup of water; this sounds as if she was being almost ironically cruel but it’s as much as any OBGYN’s office is allowed to do, apparently, other than let you sit a while afterward. The pain continued to roll through my body and all of my nerve endings were urging me to run somewhere safe. When I got up from the table, I had soaked through my shirt, and the paper covering was stained with sweat. I dragged myself out of the office, my whole body curling around my contracting uterus, trying to limp away from the pain that I couldn’t escape. The over-air-conditioned subway felt like a sauna. At first there was nowhere to sit, even though it was the middle of a Wednesday, and I must have looked like I was about to faint because people kept looking at me apprehensively, but there was no good reason to offer me a seat, being that I am not old and the whole point of this baroque torture is that I would not be pregnant.

When I got my wisdom teeth out, I was out of it and bleeding and a handful, practically speaking. But when it was done I was met with enough codeine to kill a horse to manage the pain for the next few days, and a few refills just in case. My mouth hurt the way cuts hurt, acutely but more annoying than dire; eating is annoying but you get through it.  

For the rest of the day after getting an IUD, I continued to get waves of acute pain that I’d seen others describe as “like menstrual cramps.” It is in the same place and feels like the same muscles as cramps, but the intensity is much greater. A couple of basically okay minutes, followed by several minutes where I was doubled over with pain from contractions. I’m sure women who have actually given birth are laughing at me right now, and I’m sure this has nothing on what they have been through, but to be fair, they get an epidural and a hospital stay for at least part of it. Again, I submit that if men had to have IUDs inserted like women do, it would be a hell of a lot more like getting one’s wisdom teeth out: substantial efforts to mitigate the pain during and after, where the option of going under general anesthesia is not unusual.

I suspect at least part of the reason everyone downplays how bad IUD insertions can hurt is that they don’t want to put women off what is, functionally, maybe the best birth control method out there. If you pay close attention, when you sign up, the description of what you are about to go through changes a lot from the day you make your appointment (“just a pinch for five years of no babies!”) to a few minutes before it happens (“one bad day, but still, five years of no babies!”) to after it’s done (“cramps and spotting for up to a month, but what will pull you through is remembering, five years of no babies!”). Being that neither the instructions nor the experience is consistent, even if the people for whom this operation is excruciatingly painful were a minority, it would be cruel to dismiss them as unfortunate outliers when we don’t do that for basically any other procedure.

If I’d known it was likely to have been as painful as it was, I might still have done it, but I would have begged my doctor on hands and knees for some real pain medication, which I have read some women have managed to get, and maybe that she perform all three pre-op pain mitigation procedures instead of one. I would have stacked Xanax, CBD, and probably three times as much Advil as I actually took beforehand, but I know now that that would have still not been even remotely enough, and I would have made someone come with me who would have forced me into a cab. As much as I’ve historically learned to love things that hurt me, and though I’m not due to get it removed or replaced for five years, I’m not sure I will ever stop dreading it.

Hey you! We want to know what you think about The Outline (and you can win some cool swag too). We know you love to answer questions, so take our 5 minute survey.