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IUDs have been a promising breakthrough in birth control, offering both convenience and effectiveness, and their use has exploded over the past few decades. But that progress has often come with some (painful) trade-offs. Vox senior reporter Allie Volpe has been digging into why medicine has been slow to catch up to the pain that IUD insertions can cause and doctors’ plans to make the process for more palatable for patients in the future.

It is a big reproductive rights story, at a time when those rights are increasingly under threat. I sat down and chatted with Allie about it.

Allie, are IUDs becoming more popular? What do people like about them?

They’re definitely more popular. Just over 6 million people, or 8.4 percent of contraceptive users between the ages of 15 and 49, use IUDs. It’s actually the fourth most popular form of birth control. No. 1 is tubal ligation or, as people refer to it, getting your tubes tied. The pill is No. 2, condoms are No. 3, and IUDs are No. 4. That’s a huge increase from the mid-‘90s when just 1 percent of birth control users used IUDs.

People really like the IUD. It’s a set-it-and-forget-it kind of thing. Once you get past the act of placing it, you have it for anywhere from three to 10 years, depending on the type you have. Both do the same thing: They prevent the sperm and egg from meeting.

A lot of people report less cramping on their periods, lighter periods, or even no periods in general. That’s a huge draw for people who often have painful periods or endometriosis. It’s a good way to treat those things.

I think a lot of people have the perception of IUDs as a quick, painless insertion that’s not really a big deal. Is that accurate?

It depends on who you talk to, right? It is quick. It is all over within a matter of minutes unless you’re getting anesthesia, which would make the process longer.

And for some people, it’s historically not been all that uncomfortable. But for others, it’s really uncomfortable. Pain is very personal, and it’s hard to pinpoint what pain actually is. Some people are like, “Yup, didn’t really feel it.” Others are like, “I’ve had multiple children, and this is more painful than childbirth.”

What we’ve been seeing over the last couple of years is those people coming on social media talking about their experiences with painful IUD insertions.

Why do you think that misconception persists? Why do even doctors misunderstand the pain that their patients are going through?

Women’s pain in medicine has long been minimized. There’s been reporting over the last couple of years about medical gaslighting, not just in gynecological procedures but across the board. Women will come in with a problem. And for decades, centuries, they’ve just been written off as being hysterical.

Specifically, when it comes to IUDs, as more people got them, you started to hear more stories about these being very painful. It’s a numbers game — more people get them, more people are going to have problems — but also a medical history game.

You’re writing about this now because things do seem to be changing. What’s going on?

One of the OB-GYNs I talked to said, “I’ve been placing IUDs for like 37 years. It’s not like I didn’t mention that it would be painful, but I just tried not to bring it up. Because if a patient expects something’s going to be painful, it’s going to be more painful than they really thought.” These conversations about pain were not really happening until recently.

Within the last year, the CDC and the American College of Obstetricians and Gynecologists both released recommendations telling doctors to talk to their patients about pain management during IUD placement.

For a while, there just wasn’t really good research that pointed to methods that might help during this procedure because the pain can come at multiple points. But these groups are urging doctors to talk to their patients about not only taking ibuprofen to manage the pain after the procedure but also using topical creams or an anesthetic shot during the procedure to reduce discomfort.

What questions should patients be asking their doctor?

All of the OB-GYNs I talked to really stressed this: Talk to your doctor before your appointment. Because if you walk in the day of, there’s not really a lot they can do. So, as you’re making this appointment, discuss your concerns with your doctor. Tell them if you’re concerned about pain or if you have any past history that might make this procedure more difficult for you. Ask, “What can you offer me?” Ask as many questions as you want.

If you don’t feel satisfied with the options they have — like if you really want a paracervical block but your doctor doesn’t offer it — ask if they have recommendations for another provider that will. Then start to talk through a plan with your provider. What medications will they give you pre-appointment? Some doctors now are giving people Xanax to chill out before the IUD insertion. They will probably often tell you to take ibuprofen beforehand. Ask what they will use during the procedure. Make sure you have that clear plan written out ahead of time.

If your doctor isn’t taking your concerns seriously, they’re blowing you off, or they don’t offer pain management that meets your standards. Some of the experts I talked to recommended reaching out to a hospital affiliated with a university. They have a higher chance of having a provider that uses some of these pain management methods. Others recommended searching for someone who’s trained in complex family planning. That means they have received additional training in abortion and contraceptive care, so they might also have more pain management options.

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