My IUD Insertion Was More Painful Than Childbirth
I never particularly wanted an IUD. I believed in them, sure; I knew the research about efficacy—no user error, thank you—but even so, I was a Yaz girl. Give me my little pale pink pill each day, I never minded having to keep the habit. As a fiction writer who can easily get lost in my own mind and my own stories, I even loved how the blister pack helpfully noted the days of the week, something tactile to mark the passing of time besides my digital calendar. Hormonal birth control was my jam for 10 happy years. My skin was clear, my periods were light, and the door to my uterus remained locked, until my husband and I decided to have a child.
What you might not know if you haven’t had a kid is that most birth control pills, especially the easy ones—those that you don’t have to take at the same time every day and that make your skin glowy and your flow manageable—aren’t an option if you choose to breastfeed. Nursing is a natural contraceptive—well, kind of. As my midwife explained in my six-week follow-up: “Nursing works [to prevent pregnancy] if you do it every three hours around the clock and you never miss a session.” She paused, perhaps for dramatic emphasis (she’d probably had this conversation twice already that week). “We have people show up for their six-week follow-up to find they’re already pregnant again.” Suffice it to say, I scheduled my IUD insertion that day. I was told to return in a couple of weeks for the appointment and to “take Ibuprofen one hour before.”
Like all modern women, I have a group chat where just about everything is shared. Not just life drama but body stuff, too: itchy nipples, skin tags—God, not even hemorrhoids were off-limits. Two members of the chat who are IUD evangelists assured me it wasn’t painful at all. They loved theirs! Best decision ever! You don’t have to worry about pregnancy for seven years! (I love these women deeply, but no longer trust them for medical advice.)
Point is, I went into my insertion appointment largely without fear. After all, I had just been through childbirth—how bad could an IUD be? I walked into my OB/GYN’s office on the fourth floor of a light-filled loft in SoHo, as I’d done sometimes as frequently as once a week for the previous nine or so months. I felt happy to be taking control of my reproductive future with care from the same incredible women doctors who had first shown me that little blip of light on an ultrasound and who had saved my daughter’s life during an emergency C-section only weeks before. The receptionist had trouble finding me in the system, then told me, a little sharply, “You’re supposed to be downstairs.”
The practice I went to had two floors: upstairs for obstetrics, downstairs for gynecology. I’d love to tell you the vibes were no different, but that would be a lie. Upstairs was all ‘miracles of life’ shit—“Hey, mama, when can we set your next appointment?” Downstairs felt different—routine, impersonal. Even in a progressive office in Manhattan, it really did seem like women who’d chosen to give birth (or who were trying to) were elevated above those who were actively attempting to avoid it.
Soon, I was waved to a room I had trouble finding and given a gown. A practitioner I’d never met before (upstairs, I knew everyone!) came in after 15 minutes or so and got right to it. I’d never had a problem with gynecological exams. And also, I’d just given birth, meaning I’d been poked and prodded, had my cervix checked multiple times (by hand!), had an emergency C-section, and slapped extra-large maxi pads across the scar on my abdomen. Mentally, the recovery from birth was brutal. The experience had been traumatic, and I had PTSD and PPD as a result, but physically, I was in pretty good shape. I didn’t take a single OxyContin they insisted on giving me. Even though my stomach had been ripped open and my nipples were shredded from early nursing, the physical pain was tolerable.
Then came the IUD. The speculum went in, and at first, I was fine, until I felt what I can only describe as the most extreme discomfort I’ve ever experienced. “What are you doing?” I asked. “I’m just measuring your cervix.” I have no idea how she was measuring it or why it seemed to be taking so incredibly long. Was she counting, millimeter by millimeter? Was she doing some sort of advanced calculus to see how much volume the damn thing could hold? All I knew was I was biting my lip and squeezing my hands so hard that my nails left marks in my palms. Tears welled in my eyes. It felt endless; it felt unbearable. I wanted to tell her to stop. I almost did. But what were my options then? To fear another pregnancy when I could barely keep up with the newborn I had? To stop having sex altogether? In the moment, it honestly seemed like a viable option if it would make the pain go away. She looked up briefly, saying, “Now I’m going to insert the IUD.” Holy hell, we hadn’t even gotten to that part yet?
I didn’t stop her. I was too scared of having another baby. I was too scared of having to go through the IUD insertion again, of starting the whole thing over. Somehow I made it through. I left the appointment and immediately yelled to my group chat about how they were totally and completely wrong. My exact words were: “That was more painful than birth.” And it was.
This was back in 2020, before IUD pain was something we talked about publicly. It was something we were expected to just grin and bear. We don’t require that of other procedures. Did you know, for example, that you can actually get a sedation-free colonoscopy? It’s totally possible, and yet it’s not standard. Putting you under is run-of-the-mill. My guess is this is because it’s a procedure for both sexes. If only women were getting them, I think it might be a completely different situation. And while recently the American College of Obstetricians and Gynecologists updated its guidance around pain management with IUD insertion, encouraging counseling about pain-management options such as local anesthetics, including lidocaine spray, lidocaine-prilocaine cream, and paracervical block; that guidance has been adopted inconsistently. Women are still having to beg to even have these conversations.
Truly, the way women are treated by the medical establishment is enough to fill us all with fury. No stranger to the feeling myself, I wrote a novel centered on female rage. Marion is a modern twist on Hitchcock’s iconic Psycho in which the leading lady doesn’t die in the shower, but turns the knife on Norman instead, kicking off a crime spree that transforms her from victim to heroine. Marion mentions her IUD in an early chapter:
I had gotten an IUD inserted earlier in the week, and the doctor promised me all I’d need were a couple of Advil, but spoiler alert: I was still in pain,” and then calls back to it after she’s let her rage loose, when she’s listing the many ways patriarchy sets out to screw us: “It was late walks home alone, head always turning to look behind you, keys in your hand. It was stepping into an elevator with a person you knew could overpower you.…It was the doctor who’d insisted I didn’t really need any painkillers to get my IUD inserted. It was an innkeeper, sneaking into my room, a knife in his hand, ready to take my life. It was every woman’s dance with violence, a lifelong tango.
One early reader recently told me, “Watching Marion dispose of a dead body while complaining of IUD pain was chef’s kiss.”
Now, I’m not saying that of all the things that happen to women, lack of pain management is the worst of them. And I’m certainly not suggesting we should go on a murder rampage as a result (promise!). But there are other methods of pain management for IUD insertions, and it’s time they’re taken seriously and offered more commonly.
After the birth of my second daughter, I chose to get another IUD. My OB/GYN kindly walked me through it and made sure to schedule the appointment so she could do the insertion herself. She gave me a paracervical block, effectively numbing my cervix before the procedure. She encouraged me to play calming music on my phone. The experience was still no cakewalk, but it was a million times better.
It’s time to make this the standard: warm bedside manner. Counseling about options. Pain management beyond Ibuprofen. And above all else, a recognition that women are human, and even if we’ve become really good at tolerating excruciating pain, we certainly shouldn’t have to. Because if something doesn’t change, well, who’s to say one of us won’t snap one day and go on a little rage spree?