Anticipation and Experience of Pain During Intrauterine Device Placement

To characterize pain during intrauterine device (IUD) placement, expectations for pain, and patient experiences with clinician counseling regarding pain with IUD placement.

This was a single-site qualitative study of reproductive-aged patients who underwent recent IUD placement at three outpatient ambulatory settings at a large academic institution in the Southeast between February and July 2025. Semi-structured in-depth interviews explored information sources surrounding IUD placement, decision making regarding IUD placement, experience with clinician counseling regarding pain expectations, and perception of pain during placement. We used qualitative analysis to identify key themes and subthemes, followed by thematic content analysis of patient expectations and experiences of pain during IUD placement.

We interviewed 20 participants who had an IUD placed in the previous 30 days. The median age of participants was 29.5 years, and 75.0% of the participants were nulliparous. We identified three key themes around participant perceptions of pain during IUD placement. Expectations for pain were guided by information from friends, family, online sources, and prior personal placement experiences. Descriptions of pain during placement ranged widely from mild cramping to severe and traumatic feelings of pain, with a range of experiences regardless of parity or age. Lastly, participants felt misled when they did not receive adequate counseling on pain expectations and pain management options.

Clinicians should offer clear expectations and comprehensive counseling using shared decision making to all patients on anticipated pain during IUD placement.