“It Felt Like I Was Being Stabbed”: Why IUD Pain Can No Longer Be Ignored

These quotes aren’t rare. They’re everywhere—on Reddit threads, TikTok videos, and more. For years, patients have described intense, unmedicated pain during in-office gynecologic procedures like IUD insertions—only to be told it’s “quick,” “routine,” or “nothing to worry about.”

Now, two major health authorities—the American College of Obstetricians and Gynecologists (ACOG) and the Centers for Disease Control and Prevention (CDC)—have said what patients have known all along: Yes, these procedures can hurt. And no, pain should not be ignored.

But acknowledging pain is just the first step. Whether anything changes in the exam room depends on more than guidelines. It depends on a combination of factors including:

• Clinician awareness of updated guidelines and willingness to adapt

• Clinician capacity given the demand for their time especially with the rise of OB GYN shortages,

• Patient experiences with already long wait times and short appointments

• Reimbursement rates for pain alleviation

• Effective patient (self) advocacy

🔍 What the New Guidelines Say: ACOG and CDC Finally Align

In May 2025, ACOG released its Clinical Consensus on Pain Management for In-Office Uterine and Cervical Procedures. In August 2024, the CDC updated its U.S. Selected Practice Recommendations (SPR) on IUD placement and bleeding management. Together, they send a clear message:

✅ Lidocaine should be offered

• Paracervical blocks (lidocaine injection near the cervix)

• Topical lidocaine (spray or cream)

Both are recognized as effective pain relief for IUD placement and similar procedures.

❌ Misoprostol is not recommended for routine use

Despite past use, the guidelines suggest it causes more side effects than benefits unless you’ve had a prior failed IUD insertion or have cervical stenosis.

📢 Patients must be counseled

ACOG urges providers to use trauma-informed, culturally competent, and shared decision-making approaches to pain management—tailoring care to each patient.

⚠️ But If These Are the Guidelines... Why Are Patients Still in Pain?

Here’s where reimbursement enters the picture—and often, derails the care patients deserve.

💸 Insurance Doesn’t Always Pay for Pain Relief

Many in-office procedures are coded and billed as “simple”—leaving little room for add-ons like:

• Paracervical block billing (not always reimbursed separately)

• Sedation or anesthesia (often only covered in hospital or surgical settings) - see page 72 if you’re interested in getting really nerdy about this

• Pre-procedure counseling time (rarely reimbursed adequately)

Even when clinicians want to do better, they may not be able to offer what's recommended—not because they don’t believe you, but because the system won’t support it.

🧠 What This Reveals About Women's Health

This is why patients - whether it relates to IUDs, pelvic pain, other other factors - often feel gaslit, not because their clinicians are heartless, but because:

• The workflow doesn’t allow for personalized care

• The billing structure rewards speed, not support

This gap between what’s ideal and what’s real is where so much harm happens.

👩‍⚕️ What You Can Do as a Patient

If you’re preparing for an IUD insertion, biopsy, or hysteroscopy:

📄 Print or link to the guidelines: Bring the ACOG and CDC documents. Frame it as collaboration, not confrontation.

🗣️ Use specific language: Be succinct and clear with your clinician. Speak the language they can understand. For example, you can say, “I saw that ACOG now recommends offering lidocaine. Can we talk about what pain relief options you offer?”

🧾 Ask about coverage: If your clinician can’t offer a paracervical block or sedation, ask: “Is this because insurance won’t cover it, or are there other limitations in this setting?” Be sure to ask about this with the billing department prior to the appointment.

🩺 Don’t be afraid to reschedule: It’s okay to say: “I’d rather come back when pain relief options are available.” You deserve a plan—not a panic.

🙌 Credit Where It’s Due

ACOG’s acknowledgment of systemic racism, trauma, and the historic dismissal of women’s pain is commendable. It’s rare to see a clinical body name these truths.

But guidelines alone don’t guarantee change regardless of whether we are talking about IUD insertion or another topic. Unless insurance companies, health systems, and providers commit to implementation, patients will continue to suffer needlessly.

💬 Final Thought

Reddit posts from patients blindsided by IUD pain still exist. Patients continue to hear, “it only lasts a few seconds.” But now you have something to point to: guidelines by both the CDC and ACOG!

And hopefully, one day soon, the table won’t be where pain is dismissed—but where it’s prevented.

📚 Sources

• American College of Obstetricians and Gynecologists News Release ACOG Releases New Recommendations on Pain Management for IUD Insertions, Other In-Office Gynecologic Procedures, 15 May 2015.

• Curtis KM, Nguyen AT, Tepper NK, et al. U.S. Selected Practice Recommendations for Contraceptive Use, 2024. MMWR Recomm Rep 2024;73(No. RR-3):1–77. DOI: http://dx.doi.org/10.15585/mmwr.rr7303a1

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