Intrauterine devices, or IUDs, are an increasingly popular form of birth control, but getting one placed is often a painful experience. According to one recent study, 78 percent of patients who had an IUD inserted described the pain during the procedure as either moderate or severe. On social media, 97 percent of the TikTok videos tagged with #IUD include complaints about pain.

Those complaints led the Centers for Disease Control and Prevention to update their guidelines on pain management during IUD placement procedures earlier this month.

"There has been increasing awareness about the pain patients experience during the procedure, and there is a history of women's pain not being taken seriously," says Dr. Robyn Schickler, the chief medical officer of Planned Parenthood of Southwest and Central Florida. "We're seeing a cultural shift thanks to social media, where more people are sharing their experiences. The research is confirming what many women with IUDs already knew—the discomfort during placement can be much more than just 'a little cramping.'"

While IUDs have been available since the 1800s, they gained popularity in the 1960s and have remained a trusted contraceptive, especially after the Supreme Court overturned Roe v. Wade. That decision led to a spike in patients choosing them as a long-acting, reversible birth control option. In July and August 2022, Planned Parenthood of Southwest and Central Florida reported twice the usual number of IUD placements, with an average of 150 to 200 devices being inserted each month.

"As abortion bans, like Florida's near-total ban, become more common, it's not surprising that people are increasingly interested in highly effective birth control options like IUDs," says Schickler.

Despite the rising demand for IUDs, the issue of pain management during placement has been long overlooked. Planned Parenthood of Southwest and Central Florida chief executive officer Barbara Zdravecky acknowledges that there was a delay in addressing the issue.

"It's been a long time coming," she says. "Women haven't always been counseled on pain management during medical procedures. But now, more voices are being heard and amplified. We started looking into this even before the new guidance was released. It's important for us to increase birth control access and ensure that people have options to control their reproductive health."

Zdravecky emphasizes the importance of long-term contraception in the current political climate. "Given the policies we're living under, it's crucial to have effective and reversible options like IUDs," she says. "[Our] voices are being heard in a more poignant way, and the medical establishment needs to respond to that. We need to ensure that patients feel comfortable and in control when making decisions about their treatment, and not be afraid."

The CDC's new guidelines specifically mention the use of lidocaine, both topically and injected directly into the cervix, as a pain management option during IUD placement, although studies have shown mixed results on its effectiveness. The key takeaway from the updated guidelines is the emphasis on counseling all patients about their pain management options.

Sedation for IUD placement is available at Planned Parenthood for $50 for self-pay patients, but depending on the patient's insurance coverage plan, it may be fully covered.

Schickler says that patients who choose the moderate sedation option remain awake and breathing on their own, but are resting comfortably. "We give patients the medication through an I.V. immediately before we start the insertion," she says. "The exam is performed and the IUD is placed once sedation begins to take effect. Patients feel drowsy and sleepy for about 30 minutes but can walk independently out of the recovery room after that time."

The introduction of sedation services is seen as a crucial step in making IUD placement more accessible and comfortable. "Sedation services break down barriers, allowing patients to receive care in a way that's more comfortable and empowering for them," says Schickler. "When everyone can access the care they need, our entire community is healthier."

The release of the new guidelines is part of a movement toward implementing trauma-informed care in many different areas. "This approach shifts our thinking from 'What's wrong with you?' to 'What happened to you?'" says Schickler. "It gives us a more comprehensive view of the patient's life, potentially improving patient engagement, treatment adherence and overall health outcomes."