IUD Insertion: Tiny Device, Big Feelings
If you’re thinking about getting an intrauterine device (IUD), it’s normal to feel a mix of curiosity and nerves. This is one of the most common procedures in gynecologic care — but “common” doesn’t always mean well explained. Let’s walk through what an IUD is, how insertion works, what’s typical afterward, and what options exist to improve the experience.
What an IUD Is and Why It’s Used
An IUD is a small, T-shaped device placed inside the uterus to prevent pregnancy. There are hormonal IUDs, which release a low dose of progestin, and copper IUDs, which do not contain hormones. Both are among the most effective forms of reversible contraception and can last for several years.
Sometimes, hormonal IUDs are also used for reasons beyond birth control — such as treating heavy or abnormal uterine bleeding, or helping manage pelvic pain related to conditions like endometriosis or adenomyosis. Regardless of the reason it’s being placed, IUD insertion is done the same way.
IUDs prevent pregnancy, but they do not protect against sexually transmitted infections.
How the Procedure Works
IUD insertion is usually an in-office procedure performed by a gynecologist or trained clinician. In some situations, it can also be done in the operating room — more on that below.
The general flow looks like this:
· You’ll lie on the exam table in the same position used for a Pap smear.
· Sometimes, your provider will first perform a manual exam to assess the size, position, or direction of your uterus.
· A speculum is placed in the vagina so the cervix can be seen.
· The cervix is cleaned and then usually stabilized with a special device called a tenaculum.
· If any numbing medication is used — such as sprays, gels, or injections — this is typically done at this point.
· The uterus is then sounded, meaning an instrument is inserted into the uterus to measure its length, so the clinician knows how far the IUD should go inside.
· If the cervix is stenotic — meaning it is very closed or not open enough — cervical dilation may be required. This is done using small plastic or metal instruments that gradually open the cervix.
· The IUD is inserted through the cervix up to the top of the uterus using a thin applicator.
· The strings are trimmed so they rest just inside the vagina.
· Any bleeding from the cervix is controlled, and all instruments are removed.
The insertion itself usually only takes a few minutes, though the appointment may be longer depending on counseling, preparation, any complications or difficulties encountered during insertion, and pain-management steps.
What It Typically Feels Like
Experiences vary widely.
Some people feel brief, strong cramping. Others describe pressure or a sharp pinch that fades quickly. However, others report a much more intense experience — such as severe pain similar to labor contractions, or sharp pain that radiates to the back or upper abdomen.
It isn’t fully understood why people’s pain experiences differ so dramatically. Many factors play a role — anatomy, cervical tightness, prior experiences, anxiety, and pelvic muscle tension, among others.
Some patients also have a very sensitive cervix or reproductive tract, which can trigger a reaction called vasovagal — the nervous system’s reflexive response to cervical manipulation or something being placed inside the uterus. When this occurs, you may feel flushing, vision changes, sweating, nausea, a racing heart, or a sudden feeling of weakness, and sometimes even pass out. While it can feel very frightening — even like something is seriously wrong — it does not mean you are dying. It is important to tell your provider immediately if this is happening so the procedure can be paused and appropriately addressed.
Regardless, your individual experience is valid, no matter how well someone else tolerated theirs.
The worst discomfort is usually during placement itself. That said, it’s also common to feel lingering cramps for a few hours — and sometimes even a few days afterward.
What matters most is not comparing your experience to someone else’s, but knowing what’s possible and what support you’re entitled to.
Timing the Insertion
Some clinicians recommend scheduling IUD placement during your period. This can be helpful because the cervix may be slightly more open, which can make insertion easier for some people. In addition, being on your period often helps confirm that you are not pregnant at the time of insertion.
That said, it’s not required. IUDs can be placed safely at other points in the cycle as long as pregnancy has been reasonably ruled out. If you’re worried about pain or prior difficulty with pelvic exams, it’s reasonable to ask whether timing insertion with your period might be beneficial for you.
Making Sure You’re Not Pregnant
Before inserting an IUD, your clinician needs to be reasonably confident that you are not pregnant. This is typically determined by:
· confirming that you have not had unprotected intercourse since the start of your last period
· reviewing cycle timing and recent contraception use
· performing a pregnancy test on the day of insertion
If there is any uncertainty, insertion may be delayed. This isn’t punitive — it’s about safety. Inserting an IUD during an early, unrecognized pregnancy can increase the risk of miscarriage or other complications.
When Things Get Complicated
Most IUD insertions are straightforward. That said, there are situations where placement can be more technically challenging — and knowing about them ahead of time can make the experience less scary and more collaborative.
This doesn’t mean something is “wrong” with you. It just means bodies vary.
Cervical Stenosis (AKA a “Tight” Cervix)
Some people have a cervix that is narrower, less flexible, or more resistant to opening. This is often referred to clinically as cervical stenosis, and it’s more common if you’ve never been pregnant, are postmenopausal, or have had prior cervical procedures.
When the cervix is tighter, passing instruments through it can be more uncomfortable — and sometimes technically difficult. In these cases, your clinician may need to take extra time or use additional techniques to place the IUD safely.
That might include:
· moving more slowly
· using smaller instruments
· applying local anesthetic
· gently dilating the cervix rather than forcing entry
· prescribing a medication (misoprostol) beforehand to soften the cervix
Needing dilation does not mean the insertion is unsafe or “going badly.” In many cases, it actually makes the procedure more controlled and less traumatic than trying to push through resistance.
Importantly, cervical stenosis and dilation should be explained before they happen. You’re allowed to know what’s being done and why.
Uterine Position or Anatomy
Some uteruses tilt forward or backward, and some have subtle shape differences. These variations are common and normal, but they can affect how insertion feels and how easily the IUD passes into position.
An experienced clinician adjusts technique based on anatomy rather than forcing placement.
Pelvic Floor Tension or Anxiety
Pelvic muscles respond to stress like any other muscle group. If you’re anxious, bracing, or have a history of painful exams, your pelvic floor may tighten — which can increase discomfort during insertion.
This isn’t psychological weakness. It’s physiology.
Slowing down, breathing techniques, verbal check-ins, and feeling in control can meaningfully change how the procedure feels.
Prior Painful or Traumatic Experiences
If you’ve had a difficult Pap smear, biopsy, pelvic exam, or prior IUD attempt, that history matters. Prior pain — especially if it felt unexpected or dismissive — can amplify sensation during future procedures.
Some people carry real procedural trauma into the exam room, even if they wouldn’t label it that way.
You are allowed to say, “I’ve had a rough experience before — I need us to go slowly.”
Pain Management Options
Pain is often the biggest fear surrounding IUD insertion — and for good reason. Discomfort is a common experience, and it’s important to know what options exist so you can advocate for yourself. Availability of pain-control methods varies by clinic, but the options below are more than reasonable to ask about.
Before the Appointment
· Over-the-counter anti-inflammatory medications may help with cramping afterward.
· Some providers can prescribe stronger pain medications or short-acting anti-anxiety medications to take beforehand. These often require that you bring someone with you, since you may not be able to drive afterward, but can be very helpful for taking the edge off.
During the Procedure
· Local anesthetic applied to or injected into the cervix
· Slower pacing with verbal check-ins
· Ultrasound guidance for difficult anatomy or prior failed attempts
Sedation or Anesthesia
For people with severe anxiety, prior trauma, cervical stenosis, previous unsuccessful insertions, or based on personal preference (this is your body we’re talking about), IUD placement under sedation or in the operating room is always an option. This is appropriate care — not an overreaction.
Risks of IUD Insertion
Like all medical procedures, IUD insertion carries risks — though serious complications are uncommon.
One of the most feared risks is uterine perforation, where the IUD passes through the wall of the uterus during insertion. This is estimated to occur in roughly 1 out of 1,000 insertions.
While rare, perforation is important to know about. If it occurs, the IUD is no longer effective and typically requires surgical removal. This is why careful technique, appropriate patient selection, and stopping when something doesn’t feel right all matter.
Other risks include:
· infection
· expulsion of the IUD
· migration of the IUD
· missing strings (which can make removal more complicated later)
· ongoing pain or abnormal bleeding
Your clinician should review these risks with you before the procedure and help you decide what feels right for your body.
Aftercare and What’s Normal
After insertion, it’s common to experience:
· cramping for hours to days
· spotting or irregular bleeding in the first weeks
· changes in menstrual flow, depending on the type of IUD
Hormonal IUDs often lead to lighter periods over time. Copper IUDs may cause heavier or more crampy periods, especially early on.
When to Call Your Clinician
Reach out if you experience:
· severe or worsening pain
· heavy bleeding
· fever or chills
· foul-smelling discharge
· inability to feel the strings or feeling part of the device itself
When to Stop and Reschedule
An IUD insertion should never feel like something you have to endure at all costs.
It’s okay to stop or reschedule if:
· pain becomes overwhelming
· your body isn’t relaxing despite time and support
· anxiety escalates
· the cervix won’t safely open
Stopping is not failure. Sometimes the best next step is returning with a different plan — more pain control, ultrasound guidance, or sedation.
The Bottom Line
IUD insertion has become a much more openly discussed experience in recent years - largely because many patients have spoken up about the pain, fear, or lack of preparation they felt going into it. That conversation matters. Our goal with this article is not to scare you, but to demystify what actually happens, explain why experiences can differ so much, and remind you that you have options. You deserve clear information, thoughtful care, and the ability to ask for what you need to make the experience as safe and comfortable as possible.
Tell us how you really feel
Share the knowledge with your friends!
The post contains affiliate links (because we gotta pay the light bill). As an Amazon Associate, we earn from qualifying purchases at no extra cost to you - but don’t worry: we only recommend products we truly believe in. 