IUD fear and pain

February 18, 2009 12:19 PM

It's time for the wife's new IUD. She's terrified of the pain, so what to do?

Condoms are tricky, because of her latex allergy and neither of us are excited about them anyway.

She can't get on the pill, due to hormone reasons.

She's suggested me getting a vasectomy, but I'm uneasy about making permanent changes to my body.

Other suggestions for birth control? Is there something that will help her through the pain? She's really terrified of the pain and is worried about it being worst due to having to take the old one out and put a new one in.

Surgery is currently scheduled for Friday of next week, but we have no problem postponing or switching methods.

If it matters, we're in the States.

Summary: The key issue here is the pain of getting a new IUD, so please focus your answers on that subject. If it didn't hurt so much last time, my wife would be totally fine with getting one again.

posted by anonymous to health & fitness (54 answers total)

Maybe she could take some Ibuprofen before hand and give her some valium to deal with the anxiety?
posted by greta simone at 12:21 PM on February 18, 2009

I meant the doctor could give her some valium. You know, like they do at the dentist.
posted by greta simone at 12:22 PM on February 18, 2009

Yup, she should ask her doctor about getting either something for anxiety or something for the pain. I've also heard of some women getting a drug that dilated their cervix before insertion. Seems like that might be worth discussing with her doctor, too.
posted by amarynth at 12:26 PM on February 18, 2009

Would her hormonal reasons rule out Depo Provera? It's a shot every three months, so it's not quite as convenient as an IUD but the pain is no worse than any other shot. If she's terrified of needles, this is of course no use to you.

In that case, Nthing some valium and a good talk with her doctor about managing the pain afterwards. Valium did wonders to keep me calm during Lasik surgery.
posted by peanut_mcgillicuty at 12:30 PM on February 18, 2009

Oh, the ladies at IUD Divas might have some good suggestions, too.

It's hard to say what you can do to help her through it without knowing exactly how it effects her. When I got mine inserted, it hurt like a bitch during the insertion and then I was fine -- I even went kickboxing that night. Some women have cramps for a few days afterward. I imagine anything good for menstrual cramps (heating pad, pain medicine, lots of TLC and laying on the couch watching bad tv) would help.
posted by amarynth at 12:32 PM on February 18, 2009

Affects her, not effects her. Ugh.
posted by amarynth at 12:36 PM on February 18, 2009

If I were you, I'd consider the vasectomy rather than put my wife through pain.
posted by M.C. Lo-Carb! at 12:38 PM on February 18, 2009 [10 favorites]

My doc prescribed Vicodin for me to take about an hour prior to the insertion of the IUD. She should definitely discuss her anxiety and concerns about pain with her doctor so that he can help her manage them, and prescribe something that might help.
posted by DrGirlfriend at 12:39 PM on February 18, 2009

What about Implanon? Her "hormone reasons" may rule out estrogen (which causes most side effects), but Implanon only has progestin. It is implanted in the upper arm in about 30 painless seconds, and lasts for 3 years with a better failure rate than any other method.
posted by booksandlibretti at 12:41 PM on February 18, 2009 [2 favorites]

I asked my gyno for a prescription painkiller. She balked at first but I told her it was non-negotiable. I was prescribed a non-fun painkiller because I had to drive myself to/from the app. It didn't work so well actually. Wish I'd had something stronger. A friend of mine got vicodin before her insertion and she said she felt absolutely nothing upon sounding/insertion.
It would have been GREAT if my SO had been able to drive me to/from so I could have stronger pain meds or valium. Getting dinner ready/favorite dvd's/heating pad/misc babying were the things he already had on board.

One of the issues with the IUD is the need to check the strings to make sure it's still there because it can come out without you knowing about it. That tells me removal must be *nothing* like insertion! I certainly knew it when it was going in!
posted by hecho de la basura at 12:44 PM on February 18, 2009

I had mine inserted not long ago--it hurt like a seriously bad cramp, but wasn't too bad. The worst part of it for me is imagining what's going on--visualizing the procedure made it seem more like a violation of my body than the actual pain, if that makes sense. To that end, on top of ibuprofen and maybe valium before hand, I would advise against calling it a "surgery"--it's not surgery, it's just a little insertion--just a tad more serious than a pap smear. And then during the procedure, see if you can go in with her and do some relaxation breathing and visualization with her, have focus on some good memory you can share (all the little details of the view from your hotel room on your last vacation, or something like that). Being relaxed will help it go much more smoothly.

Also, the doctor told me that the bleeding I had afterwards was mostly from the anesthetic needle used on my cervix, not from the insertion itself. It helped me to know that I hadn't been cut or anything like that, that the blood was just from a needle prick.
posted by stray at 12:47 PM on February 18, 2009

She's suggested me getting a vasectomy, but I'm uneasy about making permanent changes to my body.

You do realize that IUD´s have a non-trivial risk of complications? Unless you are planning on having children with someone other than your wife, rethink the vasectomy. Is your being uneasy worse than making your wife go through this painful experience repeatedly?
posted by yohko at 12:48 PM on February 18, 2009 [2 favorites]

Just got mine replaced a few months ago. The second time it hurt less than the first time.

Nthing Xanax/Vicodin/some kind of Rx that she can take beforehand. I didn't take anything before, just some ibuprofen after. It hurt, but not THAT much. I think relaxation is key.

It only takes a minute or two to put in, maybe she can focus on how soon it'll be over vs thinking about OMG pain.

Also -- getting the thing taken out is a snap, and does not hurt. I have Mirena, so I can't speak for other brands.
posted by rabbitrabbit at 12:50 PM on February 18, 2009

I took Advil before, but really I don't think it mattered. The pain upon insertion was bad, but the pain for the rest of the day/night was terrible. It'd be nice of you to pick her up after the appointment, (I ended up having to take an hour long bus ride afterwards - not a good idea!) and be ready with a heating pad/hot water bottle and pain killers. Since she already knows how bad the pain is for her, maybe the doctor can prescribe her something stronger.

Eventually I had to get my IUD taken out because I continued to have horrible pain while menstruating, and I was terrified of having it taken out, but was surprised when there was absolutely no pain when it was removed. Of course, this is probably different for everyone. Good luck to you both!
posted by legendarygirlfriend at 12:53 PM on February 18, 2009

What IUD? For me, the Mirena wasn't painless, but considering it was my first IUD, I haven't had kids, AND I had to have it inserted twice because it fell out the first time, it really wasn't that bad. Afterward I took a couple advil and slept the rest of the day, but I didn't really need to.

But I understand it's not the pain, it's the anxiety about the pain. Anxiety makes pain worse as well -- it's a vicious cycle. Halcion is a wonder drug that I was given before some serious dental work I was freaking out about. It's from the Valium family, but doesn't have the same side effects and gets out of your system faster. Plus, slight amnesia is a side-effect/benefit, so there's a chance afterwards she won't remember much at all. Which will make it a lot easier when it's time to get the next one put in.
posted by cgg at 12:55 PM on February 18, 2009

Is there a non-latex barrier method? For example, the cervical cap was a great buddy of mine. I don't know if there's a non-latex version. The same goes for condoms and the diaphragm--latex alternatives?
posted by PatoPata at 1:00 PM on February 18, 2009

If it feels like menstrual cramps and she's also suffering a lot of anxiety about it, then Mersyndol is a strong painkiller and it relaxes you, both physically and mentally. So if she's needing something for afterwards, then try this one.

Depo Provera does involve hormones, and fwiw I had a gradually worsening and traumatic reaction to this drug and wouldn't recommend it to anyone as a long-term solution to birth control.
posted by lizbunny at 1:02 PM on February 18, 2009

Since the idea of a vasectomy was discussed, I take it that you're either done having kids or do not plan to ever do so.

Have you considered tubal ligation? It's a (fairly) minor surgical procedure that could be done under either local or general anesthesia. The advantage is that it's a permanent thing, not something that's going to rear its ugly head every five years.

Since the old IUD has got to come out regardless, maybe you could have a "practice" run for your relaxation and pain management techniques (lots of good ones suggested in other answers) and then do the insertion later, using another method in between.
posted by charmcityblues at 1:03 PM on February 18, 2009

I was surprised to see you refer to it as Surgery. I've been through it twice, although it varies for everyone it's a very short and low risk procedure. No cutting or anasthetic but you probably knew that.

I would definitely talk to the doctor first, before getting it inserted. You will need time for any medication to take affect. Also you want to make sure the doctor is sensitive to your wife's concerns.

Additionally, while depo and associated options scare the heck out of me, the Mirena IUD is a bit different. It has hormones, but the hormones supposedly stay in and around the uterus. This may or may not be an option for you and I would suggest finding a doctor who knows a lot about it. It is like any other IUD in that it can be removed by any doctor, so if it isn't working it, no problem. The reason I suggest it is that getting my Mirena hurt significantly less than a copper IUD insertion and caused none in the following days. It also reduces menstruation and monthly pain.

My copper IUD insertion caused pain for days. I needed to take it easy. I needed to sleep extra, took lots of ibuprofen. (Next time, I would take it for days without waiting to see if I was still in pain. Once the pain catches up, it wears you out.) A hot water bottle is great.

Your job is to take over things like cooking and any caregiving (pets or kids). Pretend she's sick and offer to bring her nice things, like food and drinks!
posted by Gor-ella at 1:04 PM on February 18, 2009

My wife said it just felt like bad cramps. She took Advil and didn't need any prescription painkillers. I was worried like you, but as far as I could tell, it was fine.

Also, that was a few years ago and she's glad she got it.
posted by Stylus Happenstance at 1:05 PM on February 18, 2009

the question Other suggestions for birth control? seems to contradict the statement The key issue here is the pain of getting a new IUD, so please focus your answers on that subject, so I don't know if the OP will take kindly to my suggestion, but what about eschewing the IUD entirely and learning the Fertility Awareness Method? It takes a little time and commitment to learn (during which you'll have to use non-latex condoms and/or engage in non-vaginal intercourse sex), but once she gets the hang of it -- it took me a couple of months -- it's great.
posted by scody at 1:08 PM on February 18, 2009

One last thing: I'm guessing that she has a Paragard IUD based on what you said about hormones, but if she is does have a Mirena IUD (which has a very low dose of hormones), maybe you guys should consider Nuvaring as an alternative.
posted by amarynth at 1:09 PM on February 18, 2009

@milqman: Did you laugh at her?

Yeah, I'm sure that would have gone down well. 'Cause it's OK for his wife to go through repeated painful experiences for the sake of birth control but utterly unthinkable for him to even consider a single painful experience to the same end.

OTOH, though:

@yohko: Unless you are planning on having children with someone other than your wife, rethink the vasectomy.

No; rethink the vasectomy if you're not planning to have children with anyone, ever. It is, as the OP says, permanent -- don't count on reversal working! -- so it's not a good solution to a "we don't want children right now" problem.
posted by We had a deal, Kyle at 1:18 PM on February 18, 2009

It was pretty much a non-deal for me as well. I know your wife presently HAS an IUD, but I wouldn't minimize the extent to which histrionic people on teh interwebs can provoke anxiety. I consider myself someone with a high pain threshold and had done a significant amount of reading, yet when I got into the room I was actually sweating with nervousness.

There are a lot of IUD horror stories on the web, women saying the pain is worse than childbirth, major surgery, having arms/legs broken, etc, and that it made them pass out/faint/scream/have to be hospitalized.

Even though she has been through this before, reading about this might be amping her up and heightening her anxiety. I'd remind her (if I were you) that the first time it was fine and that it will likely be a non-deal this time as well.

Also, if this is such a major deal for her, maybe you should think more seriously about getting a vasectomy. Freeze some sperm and you'll be fine!
posted by arnicae at 1:24 PM on February 18, 2009

After I got my IUD, my boyfriend drove me home and we drank a bottle of really good wine (numbs the pain and is more fun than painkillers) and ate yummy cheese to go with it. Then I slept it off. Plan something fun and amazing (and not sex. that would be too painful) for post-insertion and it will go by less agonizingly because she'll think about the fun thing rather than the painful thing.

And get her one of those foam stress relief balls to grip during the whole thing. That helps. Also, the pain is really only for a few seconds so if she can get a mental trick to distract herself it works. Usually for painful things, I imagine the pain being in a different part of my body and that somehow makes it easier for me. I don't really know how I get this to work but it's just my way.
posted by mustcatchmooseandsquirrel at 1:24 PM on February 18, 2009

It sounds like she currently has an IUD, so she's been through this before? She should call her doctor and explain. Normally they just advise you to take a double dose of Advil, but I'm sure they would prescribe something stronger if she had a difficult experience last time. Doctors really don't want you to be in pain.

However, I'm wondering if she's been satisfied with the IUD itself, especially if she's suggesting a vasectomy. The pain from an IUD insertion, after all, is normally only at unbearable levels for a few seconds or so. If she's experienced any problematic side effects, she should really talk to the doctor, since there are two very different types of IUDs.
posted by susanvance at 1:35 PM on February 18, 2009

My mom taught me a trick for shots and dental work, because I get really tense about the pain. She told me that, instead of trying to distract myself, I should think about the pain and try to make it more painful (if that makes any sense)... somehow it kinda works though, and when you're done you're like, oh? That's it?

I should note though that I have never tried it on anything more serious than dental surgery and from the way you describe your wife as acting, it may be much, much more painful.
posted by SputnikSweetheart at 1:40 PM on February 18, 2009

I drove myself home from my last IUD insertion. It did not feel awesome but I didn't want to die. She may or may not have the same pain tolerance as I do, though, so YMMV. The most important thing about IUD insertion is that your doctor knows what s/he is doing. If the Dr. is hesitant, then it's going to be worse.

If she's *that* freaked, she needs to take some ibuprofen before she goes, maybe try to get a valium, and then you need to drive her there and back. Heating pads helped me, and staying off my feet the rest of the day, and lots of DVDs of TV shows.
posted by Medieval Maven at 1:41 PM on February 18, 2009

The varying pain experiences being reported, even here, have a lot to do with the variations in anatomy from woman to woman. I very recently had a ParaGuard inserted, and yeah, it was probably one of the most painful experiences of my life. Brief, but excruciating. And I was calm and had taken a very large dose of ibuprofen. Vicodin got me through the afternoon and the next day.

Definitely have your wife talk to her doctor beforehand about getting a more serious painkiller to take prior to the insertion, and more for after. Drive her to and from the appointment, and let her hold your hand during the insertion if she wants to (I certainly wouldn't want my partner there, but it can't hurt to offer). Have plenty of movies, comfort food, and a heating pad waiting for her when she gets home, and just be ready to wait on her.

And of course, if she gets the good drugs, don't add that good wine into the mix.
posted by amelioration at 1:50 PM on February 18, 2009

I'm kind of amazed at the differing levels of pain/recovery here, too. I just had my second one inserted on my lunch break -- it didn't even occur to me that I might want to even take the rest of the day off or whatever. I wonder if it didn't hurt that much because I didn't expect it to hurt that much. Maybe I'm glad I didn't do any research into people's experiences with IUD insertion.
posted by rabbitrabbit at 1:58 PM on February 18, 2009 [1 favorite]

Agreeing with everyone to talk to the doctor about the anxiety, and to not be shy about asking for medication for it.

It sounds like this is already scheduled, but common practice in many places is to schedule this during the menstrual period when the cervix is already opened, reducing the potential pain of cervical dilation. If that's not how it is scheduled now, your wife may want to reschedule it for a better time. That's assuming that she's still having periods with her current IUD.
posted by gingerbeer at 2:02 PM on February 18, 2009

My doctor gave me, I believe, a shot of lidocaine to the cervix to help control the pain- which felt like a bit of an unpleasant pinch, but was not unbearable. All I experienced was some cramping during insertion and milder cramping afterwards.

I am definitely one to get flipped out by gyno-related procedures- but this one was not that bad.

Seconding a valium prior to your appointment- and discuss lidocaine option w/ doc.
posted by hellboundforcheddar at 2:10 PM on February 18, 2009

The removal will likely be very easy and the second insertion should be easier than the first. First and foremost, she should go to a very experienced provider. The more insertions they've done, the easier it will be on her. She should definitely have it done during her period--if she schedules it for then and her period is late, delay if it all possible. It really does help because the cervix is naturally more dilated then. There are several medications available that can dilate the cervix; have her speak to her doctor beforehand because they may require some time to work. She may also be able to get prescription painkillers by speaking to her doctor. At a minimum she should take 800 mg of Advil. Drinking raspberry leaf tea beforehand might help, as it's definitely soothing for menstrual cramps.

I hear cohash (not sure if blue or black) can also be effective. She should speak to an herbalist to find out dosage, etc, or look at the IUD Divas community on LiveJournal.

You should go with her to hold her hand during the procedure and drive her home.
posted by min at 2:20 PM on February 18, 2009

Nthing the valium beforehand and the painkillers after. I had mine inserted (Mirena) after a LEEP procedure, so I suspect it hurt more than normal, but my doctor was open to prescribing the valium and painkillers. I also had the lidocaine shot. I was on the pill, depo, and the nuva ring prior to the IUD, and had problems with the hormones from those, so the IUD is the only birth cotrol that I've been able to use.
posted by ahdeeda at 2:27 PM on February 18, 2009

@yohko: Unless you are planning on having children with someone other than your wife, rethink the vasectomy.

No; rethink the vasectomy if you're not planning to have children with anyone, ever. It is, as the OP says, permanent -- don't count on reversal working! -- so it's not a good solution to a "we don't want children right now" problem.

His wife suggested the vasectomy, so I´m assuming that she does not want to have children, ever. insert ´children with the OP´ for compatibility with different marriage types, etc, etc.
posted by yohko at 2:28 PM on February 18, 2009

You can request a local anesthetic for IUD insertion. It is not uncommon at all. My sister is in the process of becoming a women's health nurse practitioner, and says that she would definitely insist on one (she's considering that method).
posted by unknowncommand at 2:47 PM on February 18, 2009

nthing Nuvaring.
posted by charlesv at 2:52 PM on February 18, 2009

I expelled my first IUD and then had a second inserted. The pain was significantly less than the first time -- we're talking a couple hours of cramps managed with a single Aleve vs. a whole weekend of off-and-on cramping, backaches and general grumpy malaise.
posted by Madamina at 3:03 PM on February 18, 2009

If she was sensitive to the birth control pill, she REALLY needs to think twice about DP. With the pill, you can just go off it if you don't like it. DP is with you for a few months.
posted by barnone at 3:08 PM on February 18, 2009

Seconding min's suggestions — she should ask her doctor for a dose of misoprostol to take before the removal/insertion and that would probably help a lot with one dimension of the pain. Also, maybe you might be able to find a gyno who offers twlight sedation. It's not general anesthesia, but it knocks your out far more that just some Valium would.

Also, if she doesn't want children ever, and she's not okay with something as invasive as getting her tubes tied, have you guys thought about Essure? The insertion procedure is done in the doctor's office and is about as uncomfortable as getting an IUD, but she only has to do it once rather than every several years.

yokho: realistically, IUDs today aren't risky, especially for women who aren't going to be exposed to STIs in the first couple weeks after insertion. The worst that can reasonably happen is expulsion, which is probably unlikely for the OP's wife because she's had an IUD for several years now.
posted by thisjax at 3:15 PM on February 18, 2009

Also, Depo's pretty notorious for weight gain, both anecdotally and as shown by clinical trials, so that might change how she feels about using it.
posted by thisjax at 3:20 PM on February 18, 2009

She should definitely request local anesthetic during the procedure (as others have said, it's definitely not surgery); this is something my doctor provided as a matter of course.

If she can get prescription painkillers for afterwards, perfect. If not (or even if so), rent some really engaging movies that will keep her mind off it, and make sure you have plenty of tylenol or ibuprofen around, tylenol PM if she wants to sleep it off. It's amazing how much simple distraction can help with pain.
posted by dizziest at 4:47 PM on February 18, 2009

"Also, Depo's pretty notorious for weight gain,"

Just to counteract that, I have used the Depo shot in the past, and did not gain any extra weight. Neither did a friend of mine. YMMV greatly, it's an amazingly convenient form of contraception. 1 shot, lasts for at least 3 months, so it's fairly easy to switch for another if you don't like it. I stopped taking it because I am under 25 and it can impact your bone density while you're young - I'll use it again in the future without hesitancy and FWIW - I am overweight. My doctor responded to the question of weight gain with "only if you eat more".
posted by saturnine at 5:59 PM on February 18, 2009

Stay away from Depo Provera as if it were a swarm of bees. I'd go into more details but it's personal. Mefi Mail me if you want to know.
posted by Brainy at 7:29 PM on February 18, 2009 [2 favorites]

Just wanted to add that the removal was nothing, IME-in fact, I didn't realize the doctor had done it already. To be honest, though, I didn't have problems with the insertion, either-but I had it inserted 6 weeks post-partum, which may very well make a difference.

And I now swear by the distraction technique my dentist gave me-concentrate on wiggling your toes during painful short procedures like novocaine injections and pap smears. It takes your mind away from the center of activity and can be very distracting. That, coupled with some good painkillers and an iPod full of fabulous music, made all the difference to me during gum surgery I was really anxious about.
posted by purenitrous at 8:21 PM on February 18, 2009

It has hormones, but the hormones supposedly stay in and around the uterus.

This is what I was told about the Nuvaring and it affected me horribly - I turned into a raging bitch which cleared up as soon as I stopped using it. But then, I guess I am particularly sensitive to hormones, and ymmv of course. I didn't want to risk it with the Mirena, because then I'd have to get it taken out and the other one inserted.

I wanted to get the paragard but it was contraindicated, so I actually use a diaphragm now. It can be rather messy, though, so if she has a low tolerance for dealing with gushy fluids maybe it's not something she would want to consider. The one I use is natural rubber, not latex. I had to be fitted for it, which wasn't difficult or painful in the slightest.

We used to use the sponge, but they disappeared off the market again. I guess the company went bankrupt.

I'd probably get a tubal ligation if I could but I don't think my insurance would cover it.
posted by marble at 8:26 PM on February 18, 2009

I understand your concerns, but if she's terrified about this procedure, maybe you really should think some more about getting the snip.

Several of my friends have done it (I haven't had kids yet) and reported that it was pretty trivial, if you're already in your forties it seems unlikely that you're going to have any (more?) kids, but you can get it reversed if that comes up somewhere down the track.

If she can use Depo, then that would be a great choice - an ex of mine had a very good experience with it. Same girl had a pretty good experience with a Mirena as well, though I didn't like it so much as the string annoyed my penis.
posted by The Monkey at 8:45 PM on February 18, 2009

I also have issues with hormonal birth control and can't consider the Nuva ring or Depo Provera. If you are sensitive to hormonal birth control it does not matter how it gets in your body (skin, pill, injection..) the hormones will still cause all sorts of awful problems.
posted by sadtomato at 9:00 PM on February 18, 2009

Again, please check to make sure she has issues with all hormones, not just estrogen (which is most common). There are several kinds of hormonal birth control without estrogen, and progestin is fine even for people with clotting issues.
posted by booksandlibretti at 11:03 PM on February 18, 2009

Hated Depo. Made Birth control unnecessary as I did not want to have any sex ever the entire time I was on it. EVER.
posted by artychoke at 11:56 PM on February 18, 2009 [1 favorite]

Of the six surgeries I've endured as an adult, by far the best was my vasectomy, in terms of ease of recovery, lack of pain/discomfort and payoff: the delightful no-condom, no-IUD, no-pill fun my wife and I were able to have within mere weeks of the procedure. I totally understand your concerns about permanence and irreversibility, but I can truthfully say that getting a vasectomy is one of the best decisions I've ever made. Please do consider it.
posted by cheapskatebay at 5:27 AM on February 19, 2009

Since she's been ok with the Mirena IUD, which is progestin-only, she might look into trying the mini-pill, which is also progestin-only.
posted by amarynth at 8:34 AM on February 19, 2009

If she doesn't feel happy with the Pill, I would be very wary of Depo. I put on two stone in six months on it, and that wasn't from eating more. I also found it affected my mood very heavily. On the other hand, I haveproblems managing medication so found the IUD to be a great solution.

Mine was the worst pain I've ever had when I had mine in, and afterwards my boyfriend took me for coffee and ice-cream and saw me home safely to bed. I think just having someone there with her will really help a lot. I would have felt much worse if I'd had it inserted when I was alone, as I almost did.
posted by mippy at 8:36 AM on February 19, 2009

I have been told it's more painful for women who have never given birth too, so if she has never had children that'll probably make it more owie.
posted by mippy at 8:38 AM on February 19, 2009