The IUD is one of the most effective contraceptive methods available: long-term protection and you don't have to think about it every day as with, say, the pill. Nevertheless, there is a major concern: the pain that some women experience when placing an IUD. Recently, this perception of pain has come under increasing scrutiny, and rightly so. But how do we ensure that the fear is not an obstacle, while at the same time improving the care surrounding IUD insertion?

"One in two women experience severe to unbearable pain when having an IUD placed," a recent questionnaire (584 participants) by Ipsos I&O commissioned by Stichting Ava¹. The figures provoke debate and healthcare providers argue for nuance. But GP Valentine Endtz puts it aptly: "The question should be: shit, IUDs are more painful than we thought. What are we going to do about it?"².

The numbers don't lie: pain management and better counselling are not a luxury, but a necessity. Some women even abandon an IUD for fear of the pain. The discussion is needed, but the tone of the reporting may be scrutinised. Headlines like "We need to talk about IUD insertion and the hellish pain involved"³ arouse fear, and thus miss the mark. Should we inform women? Absolutely. But should we scare them away? Certainly not.

Pain or discomfort during IUD insertion play a part in choosing a contraceptive method, but for many women, the benefits outweigh the advantages: long-term protection, not having to think about it daily and the option for a hormone-free variant. Fortunately, Ava's research also includes optimistic voices. Statements like, "Focus on the positives: long-term contraception, easy and fewer to no periods!" or "The insertion was relatively painful, but it was totally worth it given the results." show that experiences differ¹.

And pain? The experience of pain can be experienced differently by different people at different times. As was expressed in the Radbode: 'Stubbing your big toe on a day when you are in a great mood and getting good news will hurt less than stubbing the same toe when you have just had an argument with your partner.''⁴  Pain perception is complex and influenced by emotion and expectation⁵. This does not mean that we should downplay pain, but it does mean that we should not ignore the context.

Interest group Ava calls for better pain management and for women to be taken seriously in their pain experience. The Dutch College of General Practitioners (NHG) is considering changing the guideline and healthcare providers are looking for ways to make the procedure less painful⁶. What can already be done?

• Communicate about pain experiences; Make pain and pain relief discussable preferably before the consultation, not only during placement.
• Offer pain management options; there is no perfect solution yet but research shows positive results for Emla cream and Lidocaine injections. Discuss the options and their pros and cons^3,7.
• Handle another tool to place spirals.*
• More research on pain reduction - New techniques and methods also both pharmacological and non-pharmacological.

Healthcare is moving, but not overnight. Time, research and implementation of a multi-faceted approach are needed.

It is vital that the perception of pain during IUD insertion is taken seriously and steps are taken to minimise it. At the same time, we must avoid this leading to a culture of fear that scares women away. The balance between realistic education and unnecessary panic is delicate. There are already a number of ways to reduce pain, and the coming period will see more focus on concrete solutions. Women should be able to choose IUD placement with less pain and without fear.

*Titus Health Care remains committed to innovative solutions that can make the experience more comfortable. For example, a gentler and more woman-friendly alternative to hook-up forceps will soon be available*. With this, women will experience significantly less pain and blood loss during an IUD placement. We will keep you posted on the latest developments!

1. Ipsos & Ava (2025). Pain at IUD insertion: Survey of women's experiences and perceptions. Ipsos. https://206.wpcdnnode.com/ipsos-publiek.nl/wp-content/uploads/2025/01/24066175-ava-spiraalpijn-rapport-v3.0-voor-publicatie.pdf

2. Valentina Endtz (2025, 20 February) LinkedIn post, Linkedin

3. Oerman, A. (2023, March 28). We need to talk about IUD insertion and the hellish pain involved. ELLE. https://www.elle.com

4. Radboudumc. (2025). Wanted: pain differences M/F. Radbode. https://www.radboudumc.nl/nieuws/2025/gezocht-pijnverschillen-m-v0

5. Gemzell-Danielsson, K., Jensen, J. T., Monteiro, I., Peers, T., Rodriguez, M., Di Spiezio Sardo, A., & Bahamondes, L. (2019). Interventions for the prevention of pain associated with the placement of intrauterine contraceptives: An updated review. Acta obstetricia et gynecologica Scandinavica, 98(12), 1500-1513. https://doi.org/10.1111/aogs.13662

6. Dutch College of General Practitioners (NHG). (s.d.). NHG to update guidelines. NHG. https://www.nhg.org/actueel/media-aandacht-voor-pijnbestrijding-bij-plaatsing-spiraal/0 Source 6: Input on what can already be done now

7. NH News (2024, Feb 22). This GP wants IUD placement to hurt less. NH News. https://www.nhnieuws.nl/nieuws/345448/deze-huisarts-wil-dat-het-plaatsen-van-een-spiraal-minder-pijn-doet