IUD Insertion Is Often Painful—Can a New Tool Help?

IUD Insertion Is Often Painful—Can a New Tool Help?

Intrauterine devices have become a popular form of birth control, but it’s common for women to report pain during the placement procedure, and many people still avoid them out of fear. Now, a company called Aspivix has manufactured a new device designed to make IUD insertion less painful. 

Before an IUD is inserted, healthcare providers typically grasp the cervix with a long scissor-like tool called a tenaculum, which experts say can puncture the cervix and spur painful uterine contractions. The new device, called Carevix, provides an alternative to the tenaculum by using suction to grasp the cervix. This “eliminates unnecessary pain and bleeding,” according to Aspivix. 

The device was cleared by the Food and Drug Administration last year, and Aspivix says it will be “available for commercialization in … the United States of America very soon.” 

“Pain during IUD insertion is primarily caused by several factors associated with the manipulation of the cervix and the uterus,” said Michal Yaron, MD, a gynecologist at Geneva University Hospitals who led a study on Carevix presented at the American College of Obstetricians and Gynecologists (ACOG) Annual Clinical and Scientific Meeting in May.

By potentially reducing pain during IUD insertion, Carevix “addresses critical barriers to IUD adoption,” Yaron told Health.

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The new tool is still being tested. Still, some studies have shown positive results.

For the study presented in May, which hasn’t yet been peer-reviewed, Yaron and her colleagues collected data from nearly 300 procedures performed across 11 healthcare centers in Europe and the U.S., 88% of which were IUD insertions. 

About 76% of healthcare providers reported successfully using Carevix at first, and 89% said they succeeded after using it in 10 procedures.

As for pain, most patients surveyed said it was manageable, and the procedure was “easy.” 

For another study published last July, led by Yaron and funded by Aspivix, researchers randomly assigned a hundred women eligible for IUD insertion to have the procedure using either the suction device or a tenaculum. Overall, participants whose procedures included suction reported less pain than those in the other group.

The team saw the most significant difference in pain reduction reported by patients who had never given birth, a group that tends to experience more pain during an IUD insertion because their cervixes have never been dilated. (One study found that 80% of women who had never given birth reported severe pain during their IUD insertion.)

Yaron said that using suction rather than a clamp could reduce the risk of uterine contractions that result from manipulation of the cervix.

Carevix may also help to minimize puncture wounds, Katrina Heyrana, MD, PhD, an OB-GYN at Cedars-Sinai in Los Angeles who is not involved with the studies, told Health. “In my experience, most patients feel pain most intensely at the point of time that the tenaculum punctures the cervix,” she said.

The device does have some limitations, Lisa Bayer, MD, an associate professor of obstetrics and gynecology at the Oregon Health & Science University School of Medicine who is not involved with Carevix research, told Health.

It doesn’t address the pain that occurs when doctors measure the length of the cervix, which requires stretching the cervix and inserting a measuring device that touches the bottom of the uterus. “Anytime something goes through the cervix, it can be painful,” she said. “Then you’re touching the top of the uterus, and there are a bunch of nerves there, which can cause pain.”

That’s often the most significant source of pain for patients, Heyrana added.

It’s also possible that some patients won’t be able to use it—about 5% of participants were excluded from the published study because the tool was too big to be used on their cervix. 

Carevix is also a disposable device, which would contribute to the already sizable problem of healthcare waste, Bayer added.

“It doesn’t look like it’s a total replacement” of a tenaculum, she said.

According to a report issued by the Centers for Disease Control and Prevention in 2023, about a quarter of U.S. women aged 15 to 49 who have ever had sex with men use long-acting reversible birth control, which doesn’t include condoms or surgical sterilization such as a hysterectomy. Of those, more than 80% have used an IUD.

Bayer said more people are likely reporting pain from insertion because IUDs are becoming more popular among women who’ve never given birth.

“IUD users have changed over the last one to two decades,” Bayer said. “Traditionally it was women who got them after they had babies. But that has changed; we see them commonly in younger women and people who have never been pregnant.”

A key issue contributing to the problem is that there “is a dismissal of women’s pain during gynecological procedures,” Bayer said. The American College of Obstetricians and Gynecologists, the governing organization for OB/GYNs, does not have guidance on the best way to manage pain during an IUD insertion, she added. 

“They acknowledge that studies haven’t demonstrated an effective strategy to mitigate this discomfort, but they don’t tell people what to do instead,” she said. “That has left a lot of people thinking there aren’t interventions that are effective.”

Bayer said that many women aren’t given anything to reduce pain during the procedure, despite the availability of options.

“Research has shown that ibuprofen isn’t the best medication for this, but other NSAIDs have been shown to be effective,” she said.

A paracervical block—local anesthesia administered to the cervix and uterus—can also be helpful, Bayer added.

Getting an IUD placed while under full anesthesia can also be necessary for some people. “A lot of people haven’t thought about that because the traditional thinking is this is just going to be a little cramp,” she said.

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