There is a moment, somewhere between the speculum and the tenaculum, when a woman lying on an exam table understands something quietly devastating: the people treating her did not plan for her pain.
IUD insertion is one of the most common gynecological procedures in the United States. Millions of women choose it every year for contraception, period management, and endometriosis relief. And for decades, the standard preparation for the procedure has been the same: take ibuprofen an hour before. Not because ibuprofen works particularly well. Because nobody studied anything better for long enough to change the recommendation.
Research has consistently shown that between 57 and 100 percent of women describe IUD insertion as moderately to severely painful. A 2025 analysis found that only 1 in 20 women received any pain medication on the day of their insertion, despite the majority reporting significant pain. The most recent guidelines recommending better options, including lidocaine spray, did not come from the CDC until 2024. Eight years after previous guidance that included no counseling on pain management whatsoever.
Eight years. In a procedure performed on millions of women annually.
The gap is not an oversight. It is the product of a medical culture that has historically treated women’s pain as exaggeration, as anxiety, as something to endure rather than prevent. Studies show that providers consistently underestimate their patients’ pain during IUD insertion by approximately half. They believe the procedure is tolerable. Their patients do not. And for a long time, the patients’ experience was not the data point being used to build the protocols.
Women have started filming their insertions and posting them to TikTok. They are crying on camera. Some pass out. The videos are not dramatizations. They are documentation. A record of what it looks like when a system never asked whether the people it was treating were comfortable, and the people finally started answering anyway.
A 2024 literature review published in PMC found that IUD insertions are still frequently performed with little or no analgesia, and that unconscious bias, absent gender-specific protocols, and cultural stereotypes all contribute to the undertreatment of women’s procedural pain. That last part is worth sitting with. It is not just that the research was slow. It is that the biases doing the slowing are still operating inside the rooms where the procedures happen.
Insurance compounds the problem. Even where effective pain management exists, including sedation at certain practices, coverage is inconsistent. Providers have reported patients declining IUDs entirely because they cannot afford anesthesia and do not trust that ibuprofen will be enough. The birth control method they wanted, made unavailable not by the procedure itself, but by what it costs to not be in agony.
There is also a racial dimension that rarely gets named. Research on IUD insertion pain has found that Black women report the highest levels of anticipated pain compared to other groups, and that race emerged as a significant factor in both pain anticipation and reported pain levels. Black women already face systemic dismissal of their pain throughout the healthcare system. The IUD room is not an exception to that pattern. It is an example of it.
The tenaculum, the cervical clamp responsible for much of the insertion pain, has not been meaningfully redesigned since it was introduced. Newer tools exist. They are not standard. The women holding still while the old one is used have been redesigning their expectations of care in its place.
The 2024 CDC update is progress. Lidocaine spray is now recommended alongside injection. Counseling before the procedure is now encouraged. But the update does not mandate anything specific. It suggests. A system that spent thirty years arriving at ibuprofen and a gentle tone decided, somewhere along the way, that women’s comfort was not a research priority. The update is a beginning. What would actually change care is requiring providers to offer what the research now shows works, making it coverable by insurance, and treating the reduction of pain during a routine gynecological procedure as a baseline expectation rather than a premium option.
The system built the procedure. It just never got around to building it for you.
