CDC updates guidance on IUD insertion pain management amid outcry

The Centers for Disease Control and Prevention (CDC) issued updated recommendations earlier this week for physicians about how to counsel patients on pain management before placing an intrauterine device, otherwise known as an IUD. 

IUD use is on the rise in the U.S., and so are the number of complaints from women on the lack of pain relief offered to them during the insertion process.  

The CDC guideline changes came amid outcry from women, particularly on social media, about the pain associated with having the t-shaped contraceptive device inserted into the uterus.  

Some women have said the pain from the procedure is so intense that they have vomited or passed out during the insertion process.  

Doctors have been accused of minimizing women’s pain during IUD insertions, with one study showing that while most women reported a pain score of about 65 out of 100 when receiving an IUD, providers rated women’s pain at about 35. 

The updated guidelines feature more patient-centered language regarding IUD use and pain management.  

“Before IUD placement, all patients should be counseled on potential pain during placement as well as the risks, benefits, and alternatives of different options for pain management,” the guidelines read.

“A person-centered plan for IUD placement and pain management should be made based on patient preference … when considering patient pain, it is important to recognize that the experience of pain is individualized and might be influenced by previous experiences including trauma and mental health conditions like depression or anxiety.” 

The CDC’s 2016 guidelines recommended lidocaine shots as a possible medication to help ease pain during an IUD insertion. Now, the recommendations state women can request the anesthetic in gel, cream or spray form.  

Michael Belmonte, a Darney-Landy fellow at the American College of Obstetrics and Gynecology, called changes like these to the CDC’s guidelines “critically important.” 

“These updated documents will help guide our shared decision making conversations to ensure our patients are best prepared to choose the form of contraception that meets their individual needs and goals,” Belmonte said.