After I advised my physician, she mentioned swapping the capsule for an additional type of contraception referred to as an intrauterine gadget (IUD) would possibly doubtlessly assist scale back my newfound ache. However the thought of somebody (even a medical skilled) placing the plastic, T-shaped gadget into my uterus scared me—despite the fact that it is solely concerning the measurement of 1 / 4. I’ve additionally had a number of destructive experiences with gynecological exams prior to now, so between these reminiscences and pals’ tales of painful IUD insertions, it is secure to say I used to be hesitant.

However the advantages of IUDs are exhausting to disregard. Whereas you must bear in mind to take contraception capsules on daily basis, an IUD may be positioned and left alone to do its job. IUDs are additionally 99 p.c efficient at stopping being pregnant, per Deliberate Parenthood, they usually could scale back the quantity you bleed each month or cease your intervals altogether, which may be useful for individuals coping with situations like endometriosis, per the American School of Obstetricians and Gynecologists.

After I discovered a pal of mine with endometriosis was capable of get an IUD underneath sedation, blissfully unaware whereas hooked as much as an IV with sedative medicine, I jumped on the alternative myself. I shortly booked my appointment at her OB/GYN’s workplace in New York Metropolis and efficiently acquired my IUD this spring.

Associated Tales

Most OB/GYNs that supply IUD insertion underneath sedation do not typically promote that they do. There are various doable the explanation why, from value and insurance coverage protection points to lack of sources and employees accessible in-office (like anesthesiologists). And whereas reproductive care has come a great distance, the medical group has traditionally underestimated ladies’s ache¹—particularly the ache of ladies of shade². These misconceptions imply sufferers are sometimes denied enough ache administration, per a March 2024 paper in eClinical Drugs from The Lancet.

However sedation is slowly changing into extra accessible—even at native well being clinics. And you recognize your physique (and your ache tolerance ranges) greatest. If you happen to’ve been contemplating getting an IUD, however are not sure due to the ache and anxiousness related to it, you can advocate to get one this manner. This is how I did it, and ideas for how one can, too.

First, what occurs throughout a typical IUD insertion?

Getting an IUD often solely take a couple of minutes. Your OB/GYN will use a speculum to carry the vagina open, and use a instrument to place the IUD by way of the opening of your cervix and into your uterus (the place it’ll keep), in accordance with Deliberate Parenthood.

Whereas it is fairly regular to really feel cramping just a few days to weeks after insertion, the severity of ache felt in the course of the precise appointment can fluctuate from individual to individual. The truth is, some medical doctors recommend taking 600 to 800 milligrams of ibuprofen previous to your appointment to assist reduce down on ache, per UNC Chapel Hill.

“I might say in my expertise, there’s a very, very huge variation when it comes to individuals’s ache,” says Julia Cron, MD, FACOG, a board-certified OB/GYN at Weill Cornell Drugs/NewYork-Presbyterian. “Some individuals do superb; some individuals have numerous ache.”

A February 2019 evaluation within the American Journal of Obstetrics and Gynecology displays this, discovering the median ache rating for over 1,000 ladies who obtained hormonal IUDs was 5 on a scale of 10. The research additionally discovered ladies who’ve by no means given delivery vaginally or have already got painful intervals usually tend to really feel IUD insertion ache.

And sadly, the worry and anticipation of ache could make issues worse. A February 2015 research in Open Entry Journal of Contraception discovered that anticipated ache was typically greater than ache in the course of the precise process. These expectations, and the quite a few IUD tales I might seen on social media, are what stored me ready on getting one. Although Dr. Cron warns these tales typically exist in a vacuum: “Generally, it is similar to a restaurant: If you happen to had a traditional expertise and every little thing was positive, you are much less prone to put that on social media.”

Having a pleasant physician who will discuss you thru the process is one other vital piece. Throughout insertions for her sufferers, Dr. Cron will typically ask, “would you like me to speak you thru what I am doing, or simply distract you?” As soon as full, the physician can provide you time to relaxation on the examination desk, or a nurse could keep within the room with you to ensure you’re feeling okay.

What pain-management choices are at present accessible for IUD insertion?

Apart from the beneficial 600 to 800 milligrams of ibuprofen (or different over-the-counter ache relievers like Tylenol), medical doctors would possibly put lidocaine numbing gel on the vagina and cervix for additional ache aid, says Alyssa Dweck, MD, FACOG, a board-certified gynecologist in New York.

However regardless of pain-relief capsules⁶ and lidocaine gel⁷ being the principle choices, the analysis is combined⁸ on how effectively these strategies truly work to mitigate ache in the course of the process. A simpler methodology is likely to be lidocaine paracervical block—an area anesthetic typically used throughout labor to numb the world across the cervix, per Johns Hopkins Drugs. However that is often solely used if requested prematurely, or for those who require a second try at insertion (as a result of your OB/GYN was unsuccessful at inserting the IUD at your first appointment attributable to ache).

Then there’s IV sedation—the even lesser-known methodology which relaxes you and typically makes you go to sleep. This sort of sedation, referred to as “twilight” or “aware sedation,” is used for minor, much less complicated procedures that do not essentially require whole anesthesia, like knowledge tooth elimination for instance, per the American Society for Anesthesiologists (ASA).

As demand grows, increasingly more suppliers, and even some Deliberate Parenthood clinics, have began to supply IV sedation for IUD insertion and different related gynecological procedures. Not solely is it very best for people who find themselves delicate to ache, but in addition for “these with a historical past of previous abuse or trauma,” says Dr. Dweck. “Some ladies with cognitive or bodily disabilities may additionally profit.”

Regardless of ache aid capsules and lidocaine gel being the principle choices, the analysis is combined on how effectively these strategies truly work to mitigate ache in the course of the process.

My expertise getting an IUD underneath sedation

As quickly as I discovered that IV sedation for IUD insertion was an choice, I talked to my pal’s OB/GYN and made an appointment. Some individuals could have to undergo extra preliminary steps, however I used to be fortunate sufficient to discover a supplier who took my insurance coverage and had availability pretty simply. Whereas the workplace solely supplied sedation as soon as a month, they conveniently had an in-house working room, which isn’t the case for some practices (you’d should go to the hospital or a surgical procedure middle as an alternative).

A couple of days earlier than my appointment, I acquired directions on methods to put together. I used to be advised to quick (no meals or water for at the least eight hours beforehand) and to deliver somebody to drive me dwelling after my appointment. I used to be fairly anxious the night time earlier than; I hadn’t been sedated since my early teenagers.

At my appointment, I used to be led to an examination room, the place I became a robe and talked with my OB/GYN. She eased my anxiousness with an encouraging however detailed overview of what was to come back. Then she launched me to the anesthesiologist, who defined he’d be giving me a really low dose of propofol (a standard anesthetic) by way of an IV, which might lull me into a light-weight sleep. One other step towards ease: My physician launched me to everybody within the working room and even performed some music. I shortly felt the results of the IV, and earlier than I may hear the refrain of the track that was enjoying, I used to be quick asleep.

I awoke a bit disoriented, however had solely been underneath for round 20 minutes, which simply felt like a protracted nap. I used to be escorted to a different room to get well, the place my cousin (who’d accompanied me to the appointment) was ready. My physician was capable of give me some ibuprofen by way of the IV to assist with any post-procedure ache. After resting for about 45 minutes to let the anesthesia put on off, I used to be capable of safely stroll out with my cousin. The one proof I might had of the IUD was the acquainted heavy feeling in my stomach that often comes with my interval cramps, however nothing too intense.

From begin to end, the entire course of took about an hour and a half—and I might do it time and again if I needed to. It was such a aid to bypass any ache or anxiousness in the course of the precise process, and I did not have any negative effects from the anesthesia. I did have some cramping and light-weight recognizing for the remainder of the week, which is regular post-IUD insertion, and was capable of take OTC ache relievers such as you would after a typical insertion.

Suggestions for getting an IUD underneath sedation

Getting an IUD this manner is just not at all times marketed or available. Listed here are some ideas I’ve discovered from the specialists and my very own expertise.

Name round

Among the finest issues to do is name round and ask concerning the choices completely different OB/GYN places of work present. Be ready to reply questions on why you are in search of IV sedation. The entrance desk could have to name you again after checking with suppliers on whether or not sedation is an accessible choice. If they do not provide it, you’ll be able to ask for suggestions for close by practices which may.

Ask your insurance coverage firm about your protection

My insertion and sedation itself had been each lined by insurance coverage—because the anesthesiologist was in-network with my insurance coverage supplier. However value and protection can definitely be a problem. “Going to the working room is very extra expensive than having it executed within the workplace,” notes Dr. Cron.

“For sufferers which have good insurance coverage that may cowl it, they may not see that out-of-pocket value. However for sufferers that perhaps do not have insurance coverage or have a big out-of-pocket value, then it is considerably cost-prohibitive,” she provides.

Test in together with your particular person insurance coverage firm about your protection. Chances are you’ll even have the ability to discover a suitable OB/GYN this manner, too.

Carry it up in case your physician does not (i.e., advocate for your self)

It is vital to advocate for your self: Even throughout my first appointment with my pal’s physician, she did not point out the choice of sedation till I introduced it up.

That is typically the case. “Generally, I do not provide it proper off the bat,” says Dr. Cron, except somebody has a incapacity or historical past of sexual assault, for instance. If sufferers request it, she says she has a dialogue about the advantages, particular dangers, and different elements related to sedation.

How your physician reacts to you talking up, sharing about your ache tolerance and fears, and making requests is typically all it is advisable find out about whether or not or not they’re the suitable supplier for you. You may in the end need somebody who listens to and validates your wants. Do not be afraid to face agency in your requests and selections, particularly for those who’re getting pushback.

Weigh out the advantages and dangers

I did not really feel negative effects from the anesthesia, however that is one thing you must think about for those who’ve had a nasty response to sedation prior to now. In response to the ASA, the most typical negative effects of IV sedation embrace complications, nausea, and drowsiness. And with regards to the IUD itself, you should still really feel ache and cramping within the days after the process—like I did—although that is just like ho you might really feel after insertion with out sedation. Getting sedated additionally takes longer and requires extra prep earlier than your appointment.

The advantages could outweigh the dangers for you, or vice versa. Everyone seems to be completely different, however you recognize your physique and your wants greatest.

The underside line

As somebody who’s had uncomfortable experiences on the OB/GYN prior to now, and has threat elements for elevated ache throughout IUD insertion (i.e., painful intervals and no historical past of vaginal delivery), I am so glad sedation was an choice for me. However I acknowledge this can be a privileged take—not everybody is ready to get an IUD this manner.

This should not deter you, nonetheless, from getting an IUD if you need one; they’re not at all times intensely painful and are an extremely efficient contraception methodology—one thing to bear in mind as sure reproductive rights are rolled again in some states.

In an excellent world, we would have higher methods to handle ladies’s ache. Fortunately, extra medical doctors and clinics are recognizing that ache administration is an integral half in making certain ladies proceed to get the care they want. For now, realizing sedation for an IUD is an choice, and advocating in your consolation, is an effective place to begin.