What to Expect During an IUD Insertion

The Steps for Intrauterine Device Placement

If you've chosen an intrauterine device (IUD) for birth control, preparation is similar for the insertion of each type. See what to expect and understand more about this form of birth control.

An IUD is a small T-shaped flexible device that is inserted into the uterus. The Mirena, Kyleena, Liletta, and Skyla continuously are types that release a small amount of the progestin levonorgestrel and are effective for five to seven, five, four, and three years respectively.

ParaGard is the only non-medicated IUD available in the United States and can be left in place for up to 12 years. This IUD has copper (which acts as a spermicide) coiled around it.

Dispelling IUD Myths

One of the greatest hurdles facing IUD use is that many people have been lead to believe inaccurate information about it, such as:

Before an IUD insertion, it's important to first dispel these myths in order to alleviate any worries and feel more confident during insertion.


Preparing for IUD Insertion

Prior to insertion, some healthcare professionals advise taking an over-the-counter pain management medication, like non-steroidal anti-inflammatory drugs (such as 600 to 800 milligrams of ibuprofen—Motrin or Advil) an hour before the IUD is inserted. This may help to minimize the cramps and discomfort that may be caused during the insertion.

Also, check to see if your healthcare provider’s office has sanitary pads. If not, make sure to bring one from home to use after the insertion in case some bleeding occurs.


Once in the Exam Room

what to expect during IUD insertion

Illustration by Emily Roberts, Verywell

Your healthcare professional will have all the equipment prepared to insert the IUD. Before starting, he or she should explain the procedure to you and respond to any of your questions and concerns. This can help you to become more relaxed, which makes the insertion easier and less painful.

Your healthcare provider will likely perform a pregnancy test to rule out the possibility of a pregnancy.

Then, a healthcare provider will usually perform a bimanual examination (this is where your healthcare professional inserts two fingers into the vagina and uses the other hand on the abdomen to be able to feel the internal pelvic organs). This is done to accurately determine the position, consistency, size, and mobility of the uterus and identify any tenderness, which might indicate infection.


Stabilizing the Cervix

At this point, your healthcare professional will hold open the vagina by using a speculum, which resembles a metal beak of a duck. The instrument is inserted into the vagina, then its sides are separated and held open by a special action device on the handle.

Once this is accomplished, due to the importance of having a completely sterile environment to reduce the likelihood of infections, the cervix and the adjacent anterior (front) and posterior (back) recesses in the vagina will be cleansed with an antiseptic solution.

Some healthcare providers may apply a local anesthesia, such as 5% lidocaine gel, into the cervical canal to reduce discomfort.

Your healthcare provider will then use a tenaculum to help stabilize the cervix and keep it steady. The tenaculum is a long-handled, slender instrument that is attached to the cervix to steady the uterus.


Measuring Uterus and Cervical Canal

Your healthcare provider will now insert a sterile instrument called a sound to measure the length and direction of the cervical canal and uterus. This procedure reduces the risk of perforating the uterus (having the IUD puncture through), which usually occurs because the IUD is inserted too deeply or at the wrong angle.

Your healthcare provider will make sure to avoid any contact with the vagina or speculum blades. The uterine sound has a round tip at the end to help prevent perforation (puncturing the uterus).

Some healthcare providers may use an endometrial aspirator as an alternative to the uterine sound, which does the same thing. It is important that the healthcare provider determines that your uterine depth is between 6 and 9 centimeters as an IUD should not be inserted if the depth of the uterus is less than 6 centimeters.


Insertion of the IUD

After the sound is withdrawn, the healthcare provider will prepare the IUD for insertion by removing it from its sterile packaging. Then, the arms of the IUD are bent back, and a tube (or slider) containing the IUD is inserted.

The IUD is pushed into place, to the depth indicated by the sound, by a plunger in the tube. Once out of the tube and when the IUD is in the proper position in the uterus, the arms open into the "T" shape.

The insertion of an IUD is usually uncomplicated. Although there may be some discomfort, the whole procedure only takes a few minutes.

A woman may experience cramping and pinching sensations while IUD insertion is taking place. Some women may feel a bit dizzy. It may be helpful to take deep breaths.

While many women may experience some discomfort, less than 5% of women will experience moderate to severe pain. Reactions such as perspiring, vomiting, and fainting rarely are generally brief and rarely require immediate IUD removal. Additionally, these reactions do not affect later IUD performance.

Women who have never given birth, have had few births, or have had a long interval since last giving birth are most likely to experience these problems.


Finishing the Insertion Procedure

Once the IUD is in place, the tube, plunger, tenaculum, and speculum are removed from the vagina. The intrauterine device will stay in place.

The IUD will have strings attached to it that the healthcare provider will leave intact. They hang down through the cervix into the vagina. At this point, the healthcare provider will cut the ends of the strings but will allow about 1 to 2 inches to hang out of the cervix.

The strings are not able to be seen from outside of the vagina but are long enough to be felt by a finger inserted into the vagina (this is how you can check if your IUD is still in place). Your healthcare provider should then instruct you on how to feel for the strings.

Additionally, be sure that your healthcare provider informs you of the type of IUD that was inserted (ParaGard, Skyla, Kyleena, Liletta, or Mirena) and when it needs to be replaced. Most healthcare providers should give you a little card that you can put in your wallet with all of this information.

If not, it is a smart idea to write down this information and keep it in a reliable place or put it in your electronic calendar or reminder app. This information is important should you switch healthcare providers later on, as a healthcare professional cannot tell, just by looking, which IUD you have and when it was inserted (and, therefore, when it should be removed).


After IUD Insertion

Since most women only feel slight discomfort during the procedure, they are usually fine to drive themselves afterward and resume their daily activities. Since you may not know how you will react to your insertion procedure, you may wish to arrange for somebody to drive you home.

Some women may still feel some cramping afterward as the uterus adjusts to the placement of the IUD. If this is the case, the cramps should lessen with some time and, perhaps, some rest or pain medication.


Once You Are Home

You may have some bleeding and spotting during the first few days after your IUD insertion. This is normal, so there is no reason to worry. If the bleeding is constant or heavy, it may be a good idea to call your healthcare provider just to make sure that there is not an infection.

Also, be prepared that your first period after the insertion could very well be heavier than normal. It may also come a few days earlier than expected.

Try to schedule a follow-up appointment after your first period (sometime within four to six weeks of the IUD insertion) just to make sure that the IUD is still in place.


Sex and Pregnancy Protection

It is OK to have sexual intercourse as soon as you feel comfortable after your IUD is inserted (unless your IUD has been inserted within 48 hours after giving birth). But when pregnancy protection can be expected varies:

  • ParaGard IUD provides pregnancy prevention immediately after it is inserted.
  • Mirena, Kyleena, Liletta, and Skyla IUDs are effective immediately only if inserted within five days after the start of your period.
  • If you have Mirena inserted at any other time during your menstrual cycle, you should use another method of birth control (like a male condom, female condom, today sponge, or spermicide) during the first week after insertion. Pregnancy protection will begin after seven days.

Some healthcare professionals recommend using a condom as a backup method during the first month after your insertion to reduce your risk of infection.


IUD Maintenance

It may be helpful to check the IUD strings every few days for the first few weeks and to feel for the string ends between periods to make sure that the IUD is still properly in place.

After your first period (or at least no longer than three months after insertion), schedule a checkup to make sure your IUD is still where it is supposed to be.

Some women may ask their healthcare provider to have the strings cut shorter (during this checkup) if they are felt by the woman’s sexual partner. If this is the case, sometimes the strings are cut so short that the woman cannot actually check for the strings anymore.

After this healthcare provider’s visit, regular IUD checkups can be done at the same time as a woman’s periodic gynecological exam. That being said, one of the greatest advantages of both the IUD is that a woman doesn’t really have to do anything once it is inserted.

Frequently Asked Questions

How painful is getting an IUD? 

IUD insertion can cause discomfort and cramping, but is not painful for most women. Studies suggest 5% of women find IUD insertion painful.

How can I ease the pain of IUD placement?

Taking 600 mg to 800 mg of ibuprofen an hour before your scheduled IUD placement can help to make the procedure less painful. In addition, your healthcare provider can use lidocaine to numb your cervix prior to inserting the IUD.

How long does it take to heal after IUD insertion?

IUD placement is a minor procedure and most women are able to drive themselves home after the appointment. As the uterus adjusts to the IUD, you may feel some cramping that can be managed with over-the-counter pain relievers and shouldn’t last longer than a few hours to a few days. If you experience pain, call your healthcare provider.

Does IUD placement cause bleeding?

Light bleeding or spotting can occur for a few days after having an IUD inserted. However, the bleeding should not be constant or heavy. If it is, call your healthcare provider.

How soon after placement does an IUD work?

It depends on the type of IUD and when during your cycle it was placed. ParaGard prevents pregnancy as soon as it is inserted. If Mirena, Kyleena, Liletta, or Skyla was placed within the first five days after the start of your period, it is also effective immediately. However, if your IUD was placed after that, you should use another birth control method for the first week.

Can a guy feel an IUD?

An IUD is placed in the uterus, so it can’t be felt during intercourse. The IUD’s strings thread through the cervix and can be felt in the vagina, but most men do not feel it during intercourse. If it is a problem, your healthcare provider can shorten the strings. 

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