Disclaimer: This is a personal recounting of my experience of having an IUD inserted. This is in no way representative of the general population.
This morning, after months of planning and deliberating, I had a Paragard (copper) IUD inserted.
A few facts you should know about me:
- I’m nineteen years old
- I’m nulliparous (have never had children/been pregnant)
- I had a previously poor experience with hormonal birth control pills
- I have a history of low-level depression/anxiety
- I am in a committed, monogamous relationship
- I have good health insurance through my university
- I have a history of fainting during relatively routine, painless medical procedures (getting my blood drawn, glaucoma checks in eye exams)
If you’ve done any research into IUDs, you will know that many of the seemingly mundane facts I listed above can play a great role in your decision to get an IUD. Some factors affected my general decision to get one and others affected my choice between the Mirena/Skyla (hormonal) and the Paragard (copper) IUD. My personal weighing of the pros and cons of each will be saved for another post.
Because I am nulliparous, I anticipated the insertion process to be extraordinarily painful. I have never had a pap smear due to my age, and I was becoming so fed up with my doctor describing the process as being “no more painful than a pap smear” that I turned to the internet for answers. I was unprepared for the horror stories that some women shared. From my rather in-depth research on the subject (via nearly ever blog/chatroom/article I could find), I finally realized that each woman’s experience with the insertion process was different. The pain descriptors ranged from “just a slight pinch” to “worse than my unmedicated labor pains.” Naturally, I was nervous for my own insertion.
At the end of my consultation, my gynecologist instructed me to take 800mg of ibuprofen (i.e. Advil, Motrin) the night before my procedure and another 800mg in the morning with a substantial breakfast. She also asked me to try to schedule the insertion appointment to coincide with my menstrual period because that is the point at which the cervix is already slightly open. I have highly irregular periods, so it was something of a shot in the dark. Unfortunately, I have pretty bad aim, and I didn’t get the slight benefit of my period mitigating the pain.
Last night I was horribly anxious. Suddenly I couldn’t remember what dosage and which type of NSAID my doctor had suggested. Was it aspirin? Acetaminophen? Would Aleve do the trick? In the end, I let Google guide me in the right direction, and thankfully she did not lead me astray. I only had 7 Advil pills (200mg each) left, so I took 600mg last night and 800mg this morning. After a restless night, the last thing I wanted to do was wake up at 8am to drive myself to this appointment.
I arrived at the office, the nurse took my weight and blood pressure, asked me which IUD I had decided on, and instructed me to bring her a urine sample (I learned later this was for a pregnancy test — can’t be too careful!). After that, the nurse left me to undress from the waist down and cover my lower body with a large paper sheet. Soon the gynecologist arrived and spoke with me about the process, asking me about the factors that led me to choose the Paragard.
Once she had confirmed my reasoning seemed sound, she began the process, talking me through each step. I was beyond nervous; my hands were shaking and I had tears in my eyes. The nurse – an older lady with a great sense of humor and a comforting smile – held my hand for the entirety of the procedure. Do NOT underestimate how much this simple gesture can affect your experience; ask for a nurse or bring a loved one to be there with you.
Slightly more graphic details about the specifics of the process are below the line.
First, the doctor had me place my feet in the stirrups, and she performed a quick manual pelvic examination confirming that my uterus was in the normal position and orientation and of average size. Next, she inserted the speculum, which created a rather strange sensation. There was slight pain, but it was more uncomfortable because of the unfamiliarity than the actual sensations. Above all, it felt as though I needed to pass gas. Based on my previous research, this is pretty standard.
Next, the gynecologist took quick swabs of the area around my cervix as she includes an STI screening with the procedure and used Betadine to disinfect the area. At this point, she warned me that this was the part that would become more painful. First, she used a tool to hold my cervix steady. It felt like a strong pinch, and I gripped the nurse’s hand tighter. The doctor told me to keep breathing and continued to remind me of this throughout the procedure.
Next a sound (a probe-like instrument) was inserted into my cervix to gauge the depth of my uterus in order to assure proper placement. I would be lying if I said this was not painful. It felt like a terrible (but brief) period cramp.
Finally, the moment of truth: It was time to insert the IUD itself. It felt about the same as the sound, and really, the pain was essentially continuous between the two insertions. I groaned and shut my eyes and grabbed the nurse’s hand tight, but she kept reassuring me with reminders such as “ten years, one time for ten years” and “slow breaths.” A
And then, suddenly, it was over. The pain and discomfort of the speculum and the cervix-holder-thinga-mabob (woo, medicine) were still there, but the pain had subsided to the level of a strong cramp. The gynecologist trimmed the strings, removed the pinch from my cervix, and finally removed the speculum. She advised me to remain lying down and talked to me about scheduling a follow-up appointment. Once I had sat myself up and knew I was not going to faint, the gynecologist left the room, and the nurse remained, chatting with me about my major and future plans.
Throughout the day today I have had minor cramping (at least compared to the pain of the second day of my typical period) that has only occasionally become anything close to unmanageable. Initially I was worried because I was maxed out on the amount of ibuprofen I could take for the next eight hours, but I turned out to not really need it.
Overall, I can tell you I had an extremely positive experience, especially given the extreme fear I had going into the procedure. While I obviously cannot claim that everyone’s experience will (or should) be like mine, I do believe in offering a sense of hope and realism to those who are suffering anxiety over the process.
So, for what it’s worth, here are my bits of advice (based solely on anecdotal evidence):
- Take ibuprofen. 800mg the night before, 800 mg the morning of (with a solid meal). Ibuprofen-based NSAIDs include Motrin and Advil. Medications such as Aleve (naproxen), Tylenol (acetaminophen), and Pamprin (acetaminophen) are all acceptable painkillers, but according to my gynecologist do little to ease the cramping that is at the heart of the pain.
- Have a consultation visit before insertion. Many doctors will not do insertions without prior consultation, but ask for one if it is not offered. The internet cannot take the place of a trained medical professional.
- If possible, have your IUD inserted by someone who has done this many times before. My gynecologist personally does all insertions for her patients at the clinic and has extensive experience with the process.
- Do not stress yourself out (or try not to!). It’s only going to make the entire experience much more unpleasant than it needs to be.
- Ask your doctor about any questions or concerns you have before you begin the process. If he or she is unwilling to be patient with you and do some (figurative or literal) hand-holding, you should find another practitioner (if possible).
- Bring a pad (or your doctor may provide one) because there can be slight bleeding as a result. Even if you do not bleed, the gel used by your gynecologist and other fluids may leak. Better safe than sorry!
As a side note, I was not offered (nor did I ask about) an injectable local anesthetic being administered to ease pain, so I do not have any direct knowledge of that part of the process that some doctors use.
Finally, here are some informative links which may help you to get a better understanding of the process:
- An extremely NSFW video of an actual IUD insertion and removal instructional video. Do not watch if you think that observing an actual medical procedure will make you more uncomfortable. (I only found the video after my procedure. It’s unclear whether it would have calmed or alarmed me.) Additionally, if the NSFW warning wasn’t clear enough, there is nudity in this video. (Note: the blood is probably the result of a period, not the procedure itself.)
- A step by step walkthrough of the process. It’s similar to my article, but less based on personal experience.
- A rather long and somewhat chaotic aggregation of one woman’s decision to live-tweet her IUD insertion experience.
- And a short Mayo Clinic overview, mainly for official medical cred.
I hope this explanation of my experience was helpful to you. Please feel free to reach out to me in the comments or by email if you’d like to know more or just talk about your experience or concerns!