Melissa Stewart is no stranger to pain. The Memphis-based attorney has lupus, and during flare-ups, feels radiating pain in their jaw and head. But some of the worst pain that Stewart has ever experienced was getting an IUD inserted in 2017.
An intrauterine device, or IUD, is one of the most effective types of birth control, though some like Stewart get one for the side effect that it can make periods less painful. The T-shaped implant is inserted into the uterus through the cervix; depending on the type, the Cleveland Clinic says an IUD can stay in place for up to 10 years.
Stewart’s doctor said the insertion might pinch, similar to getting your ears pierced and to take ibuprofen before the procedure. But for Stewart, the insertion felt like being stabbed.
“I screamed, crawled up the table, blacked out, and then when I woke up, I projectile-vomited,” says Stewart.
While recovering, Stewart asked their doctor why they hadn’t explained in advance that the procedure would hurt so much. The doctor replied that Stewart wouldn’t have gone through with the insertion if they had been warned, Stewart says.
Among women who used birth control from 2015 to 2017, 14% had an IUD, according to data analyzed by KFF. The level of pain this procedure causes varies, and some people find it’s not a big deal. One 2015 study found that among women who haven’t given birth, 42% said the pain was severe during an IUD placement, while 35% rated it moderately painful, and 23% reported it was mildly painful.
In the past several years, patients like Stewart have taken to social media to discuss how getting an IUD can be excruciating and traumatizing. Some have even filmed themselves during insertions, while others discussed their anger over the lack of pain management.
It seems the Centers for Disease Control and Prevention has listened because the public health agency has started telling clinicians to take a more person-centered approach to pain management when providing this gynecological care. The new recommendations, released in early August, guide doctors to counsel patients about the potential for pain and options for how to reduce that pain, and say that doctors should deliver this care in a “noncoercive manner.”
“This is critically important because of the context of historical and ongoing contraceptive coercion and reproductive mistreatment in the United States, especially among communities that have been marginalized,” wrote the authors of the CDC’s recommendations.
There is a long history of women’s pain being “dismissed and undervalued” by doctors, says Natali Valdez, a medical anthropologist at Fordham University who specializes in reproductive health care.
This goes back to the origins of modern gynecology when a physician performed experiments on enslaved Black women without anesthesia. This was justified by the belief that Black people didn’t experience as much pain as whites, and Valdez explains that context alongside the history of women not having authority over their bodies laid the foundation for why gynecological pain is sometimes deemed acceptable and even insignificant by clinicians.
“It's a kind of bias that gets enveloped into our science and medicine over time, it doesn't necessarily just go away,” says Valdez.
Black and brown women are particularly vulnerable in not having their medical pain taken seriously by clinicians because of this racist history, explains Valdez. Studies have shown that, in general, Black patients' pain is undertreated when compared to whites. Though, Valdez says, it’s hard to disentangle racism from sexism when it comes to reproductive health.
There are ways to make IUD insertions less painful. Clinicians can offer laughing gas or valium, and the CDC says a local anesthetic like lidocaine can also help.
Many people have had lidocaine when getting a cavity filled at the dentist as it numbs the area where it's applied. The CDC's 2016 guidelines said that injecting it might reduce pain during an IUD placement. The 2024 update retained this recommendation but added that a topical lidocaine gel, cream or spray might also help.
Administering a local anesthetic, such as lidocaine, before IUD insertions and other intrauterine procedures is standard practice at the Obstetrics, Midwifery and Gynecology Clinic at San Francisco General, where Dr. Karen Meckstroth sees patients.
"It's a very low risk, very easy to do intervention," says Meckstroth, who told NPR she is thrilled with the updated guidelines.
Some patients may fear that the lidocaine shots will be more painful than the actual IUD placement. In these instances, Meckstroth will opt for the topical treatment, or do a combination of the two. When giving the injections, she’ll use a small gauge needle, which helps her stimulate fewer nerves.
Adding this step to an IUD placement can take longer, which might discourage clinicians who are booked with back-to-back appointments. And the use of local anesthetic for IUDs has yet to be widely studied, which Meckstroth suggested is partly why more clinicians aren't trained to use it.
"If someone is not comfortable injecting things into the body regularly … adding it as a part of their practice can take some guidance," says Meckstroth.
Even with the option of lidocaine, the idea of getting another IUD was so terrifying for Melissa Stewart that when it was time to replace their IUD in 2022 they decided instead to get a hysterectomy. Stewart didn’t want to go back to having painful periods and also didn’t want to have kids, so they figured a major surgery that removes their uterus was better than suffering through future IUD insertions. Stewart found an OBGYN willing to do the surgery. But when the doctor learned why Stewart wanted the hysterectomy, she offered the alternative of putting Stewart under general anesthesia before switching out the old IUD for a new one.
They couldn’t believe that general anesthesia was an option for IUD insertion. "My jaw was on the floor," says Stewart.
Stewart chose to get the new IUD and says it went great.
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