TikTok Is Outraged About the Lack of Anesthesia for IUD Insertion
A viral TikTok posted by @midwifemama has garnered more than 500,000 views. It showcases a metal tool with sharp hooks pinching a 3D-printed cervix. The video was created to inform individuals about the insertion process for intrauterine devices (IUDS), which are used by more than 150 million women worldwide—and TikTok users were quick to critique the procedure.
"I am not being slightly dramatic when I say this was the worst pain I've ever felt in my whole life and the most inhumane procedure during and after; petition to require anesthesia for IUD insertion!" posted @ellainaisinsane in a duet.
Commenters agreed and added personal experiences, including stories of doctors not informing patients of severe side effects. Some compared the IUD insertion procedure to colonoscopies and vasectomies, both of which commonly use anesthesia or sedatives.
"Why did I not know it included puncturing of the skin?" one commenter asked. "Why do colonoscopies require anesthesia or sedation but not IUD insertion?" another person commented.
Ellaina Sivo, a 22-year-old recent college graduate who commented on the post, shared her experience with Giddy about receiving a nonhormonal IUD, resulting in intense physical pain.
"I wasn't told much to prepare besides to take ibuprofen before and that it was OK if I wanted to scream and curse," Sivo said. "I was pretty confident that I could handle a few seconds of sharp pain, but I was wrong."
Sivo was asked to leave almost immediately after the procedure and was told it was safe to drive.
"The treatment from the nurse after included telling me I had to leave so she could clean the room," Sivo said. "Afterward, the cramps I was experiencing in my car were so severe. I called my mom screaming and crying, telling her she needed to come to pick me up, as I couldn't drive and could barely sit up straight."
Echoing Sivo's experience, many TikTokers shared similar incidents and questioned why the IUD insertion procedure hasn't evolved over the years to include better pain management, different tools and aftercare.
The current IUD insertion process
The IUD insertion procedure typically takes five to 10 minutes. IUDs are 99 percent effective at preventing pregnancy, and are considered significantly more effective than other forms of contraceptives, including the shot, pill, patch, vaginal ring and condoms.
Before the IUD procedure, doctors should discuss risks and side effects with patients, including irregular bleeding, infections, expulsion and more. Additionally, doctors will use patient counseling and experience to determine the best type of pain management for the patient.
Sam Rahman, M.D., a board-certified gynecologist and women's health specialist at the Center for Gynecology and Cosmetics (CGC) in Chicago, discussed the many different ways gynecologists may relieve pain and pressure during insertion.
"Many of us use misoprostol (a medication that protects the stomach lining) to soften up the cervix to ease the entry of the IUD," Rahman said. "Some of us utilize topical lidocaine gel at the top part of the cervix where we use a tenaculum to clamp. Topical meds and patient distraction are two methods to mitigate the pain from the tenaculum."
The first documentation of an IUD was in 1909, which was an insertion of a ring made from silkworm gut into the uterus. In the early 1960s, the ring was replaced by a plastic device, and in the late 1980s came the introduction of the copper IUD. Despite material changes, the procedure includes similar tools dating back 100 years. But a better understanding of anatomy has changed views regarding the insensitivity of the cervix.
IUD and the cervix
The tenaculum is a two-pronged instrument with hooks that allow the cervix to be stabilized and manipulated to align the cervical canal and uterine cavity. This stability is achieved by piercing holes into the cervix tissue with the hooks. The predecessor of the tenaculum was used on battlefields, including during the Civil War, to extract bullets.
The Kinsey Report, "Sexual Behavior in the Human Female," originally published in 1953, still impacts today's understanding of sexual behavior, anatomy and sexuality. Kinsey stated on page 584 of his eponymous report that, "All of the clinical and experimental data show that the surface of the cervix is the most completely insensitive part of the female genital anatomy."
"The misinformation around the cervix stated the cervical sensation was 'inconsequential,'" Rahman explained. However, "the truth is, the cervix is innervated by three different nerves: pelvic nerve, vagus nerve and hypogastric nerve."
This misunderstanding about the sensitivity of the cervix may have contributed to the lack of anesthesia and sedatives for people with uteruses.
The lack of anesthesia and sedatives
Research indicates that sedation allows patients to feel comfortable and little to no pain through conscious or deep sedation. So why aren't sedatives offered for IUD insertion?
Currently, pain management typically includes only over-the-counter medications, and patients have to ask for anything additional.
"Historically, only...NSAIDs, such as ibuprofen or Aleve, are administered one hour before the procedure," Rahman said. "IV sedation is not typically offered as it sometimes takes longer to administer sedation than it does to place the IUD. Nonetheless, it is, of course, a patient's prerogative to ask for pain options."
However, many patients aren't aware of the various pain management options for the procedure, including that they can ask for different forms of sedation. For example, with light sedation, you'll have little recollection of the insertion and minimal pain.
But asking for sedation may be costly.
"Most insurance companies will not pay for sedation for this procedure, which may become cost-prohibitive for patients," Rahman explained. "If we offer all premedications for the patient and the anxiety around the procedure cannot be mitigated with an oral anxiolytic, many of us will move toward sedation if it is possible and available."
Studies indicate that healthcare providers often underestimate the pain patients experience during IUD placement. Other factors include racial biases that influence the treatment of Black individuals, including the administration of pain medication. In general, 84 percent of women report feeling treated differently due to sex, and 90 percent believe that the healthcare system discriminates against women.
"The erasure of care and the depiction of the [IUD] procedure being for those who want to...have sex discredits the experience, emotions and side effects that come with these procedures," Sivo stated. "Men receive anesthesia and gentleness in their procedures as a result of their comfort and safety being prioritized in our society—it trickles down into all aspects of life."
The future of IUD insertion
Patient-provider communication before an IUD insertion may be effective for determining a treatment plan during and after the procedure, including pain management. Additionally, advancements in gynecological equipment and minimally invasive gynecologic surgeries can increase comfort and minimize pain.
"As we continue to raise awareness of bias in medicine, we will continue to work toward empowering women to take control over their health and be able to have open conversations around their concerns—whether it be pain, sexual health or reproductive health," Rahman said. "As patients, we have to advocate for our health but also hope these changes can spark more discussion around making health care easier and pain-free."