In general, gynecology appointments can be terrifying for a variety of reasons: Your first pelvic exam, pap smear, or an intrauterine device (IUD) insertion. Going to your gynecologist isn’t fun by any means, and it usually feels completely unnatural just being there.
It certainly doesn’t help that 37.8% of TikToks about IUDs depict negative experiences relating to pain, according to a December 2022 study by Duke Health. Most patients in the videos discussed negative experiences with pain control, felt they didn’t have adequate anesthesia, and experienced side effects.
These videos have naturally left me terrified (team birth control pills 5ever), but what does that say about doctors taking women’s concerns seriously? I spoke with three healthcare experts — Dr. Monte Swarup, Dr. Fanny Leboulanger, and Mahmoud Abdelaziz — about everything to expect when getting an IUD inserted. From side effects to pain management, here’s what you should know before your appointment.
What should you know before the appointment?
It’s okay to be nervous — women’s health is kind of considered a taboo topic, so it’s normal to be scared of the unknown.
The amount of pain someone experiences depends on the patient, but there generally is a cramping feeling, says Dr. Monte Swarup, a board-certified ob-gyn and founder of the vaginal health information site Vaginal Health Hub.
The amount of pain someone experiences may be determined by other conditions they have, like vaginismus, which is characterized by involuntary vaginal muscle spasms and tightness, or a tilted uterus, which is when the uterus is tipped backward instead of forward, Self reported.
“There are usually three cramps that are quick – when the instrument is placed on their cervix, measuring the uterus depth, and finally when the IUD is inserted,” Dr. Swarup says.
You may also want to bring a friend to your appointment as moral support before your insertion time, but it’s even better to have a ride secured afterward because there’s a small risk of fainting, says Dr. Fanny Leboulanger, a physician and sex coach.
“People need to be aware there is a small risk of fainting,” says Dr. Leboulanger. “It is rare, especially if the professional is thoughtful, giving you time before sitting up for example, and takes time. It’s not ‘serious’ but it’s always a good idea to take your time.”
What side effects are considered normal and which ones aren’t?
At the end of the day, your uterus is adjusting to the fresh IUD that’s just been inserted, so you’re bound to have some side effects, but some are red flags.
For example, it’s normal to experience cramps that feel similar to those during your menstrual cycle for a few days as your uterus adjusts, says Mahmoud Abdelaziz, a pharmacist who specializes in women’s health.
“In the days following IUD insertion, it is common to experience some side effects, which are usually temporary,” Abdelaziz says. “These can include light spotting or irregular bleeding, mild cramping, and a feeling of fullness or pressure in the lower abdomen.”
It’s also normal for the cervix to slightly bleed after insertion, but there shouldn’t be much blood, Dr. Leboulanger added.
So, what are the red flags you should be looking out for? While normal symptoms like irregular bleeding vary for each patient, abnormal side effects include heavy or prolonged bleeding, foul-smelling discharge, or pain during intercourse, Abdelaziz added.
There are also important signs to look for if you think something is wrong with the IUD itself. The three main things you should look for, according to Abdelaziz, include expulsion, when the IUD partially or completely comes out of the uterus, perforation, when the IUD perforates or pierces a uterine wall, and lastly infection with symptoms like fever or abnormal discharge.
If you experience any of the red flag symptoms, it’s important to call your gynecologist’s office as soon as possible.
What should I do if my ob-gyn doesn’t listen to my concerns?
There is actual evidence that caregivers and doctors can underestimate women’s pain. In a Journal of Pain study published in March 2021, participants in the study had to rate the level of pain they felt male and female patients were having. Researchers identified a “bias of underestimation of pain in female patients,” which could seriously hurt a woman’s access to pain care.
If you feel your doctor is ignoring your concerns, “first change practitioner if possible, or have your IUD by someone you feel safe with,” Dr. Leboulanger says. If you’re unable to change your practitioner, it may be beneficial to ask the doctor to look at your cervix or inquire about an ultrasound.
During follow-ups, you should also “emphasize what’s important to you so your doctor knows to address” and “write down and bring a list of questions you want answered,” Dr. Swarup says.
Your concerns should always be validated by your doctor, even if you feel ridiculous while asking them! IUDs aren’t permanent, and if you don’t like them or if you’re experiencing extreme side effects, then they might not be the best birth control method for you — and that’s perfectly alright, too.