IUDs: healthcare experts answer the most important questions

IUDs: healthcare experts answer the most important questions

Should your IUD hurt? How can it affect your sex life? Stylist asks two healthcare experts the most important questions about the coil. 

“Having a coil fitted should not be traumatic or very painful,” medical experts have said, sparked by presenter Naga Munchetty sharing her harrowing IUD experience.

Munchetty shared her personal story of getting an IUD fitted on her BBC Radio 5 Live show this week, describing “excruciating” pain that left her feeling “violated, weak and angry,” prompting many to recount their own stories of painful coil fittings across social media.

“I had a coil fitted a few years ago and it was one of the most traumatic physical experiences I’ve had,” Munchetty told listeners, in a special segment on IUDs, women and pain.

While medics say that “most people encounter no problems, and no-one should be put off considering this safe and effective contraceptive,” more and more women are opening up about experiencing severe pain during and after the procedure.

The discussions have sparked an online petition for better pain relief for IUD insertions and removals, and claims that “several people have reported the pain as worse than childbirth or broken bones.”

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According to the NHS, an IUD (intrauterine device) also known as the “copper coil” is a small T-shaped plastic and copper device that’s put into your uterus to protect against pregnancy for between five and 10 years.

When inserted correctly, IUDs are more than 99% effective, and “it can be uncomfortable when the IUD is put in, but you can take painkillers after, if you need to.”

However, FemTech marketer Anna describes the experience of having the IUD fitted as “the worst pain I have ever experienced”. “I was told it would be quick and painless and that it had a quick recovery time, but I spent days in agony and I don’t think the pain or discomfort stopped for a couple of months,” she tells Stylist

Copywriter Gabby says that at first, she was optimistic about the coil, but it soon became a nightmare. “I’ve been constantly bleeding for nearly three months since I had it fitted. It’s ruined my sex life too. If I’m not bleeding, it always starts again after sex, no matter how gentle the intercourse is.”

“No woman should be expected to put up with this really and I wasn’t even warned that this could be an issue before having it fitted. Ultimately, I feel really disappointed and disillusioned at the state of contraceptive healthcare for people with uteruses,” she adds.

Stylist asked two healthcare experts the most important questions about IUDs, including pain, the insertion process and what it’s like to have sex afterwards.

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How does the IUD work?

“It’s important to know that there are two types of coils. They’re inserted in the same way, but work differently and can cause different side-effects and benefits. They’re both highly effective at preventing pregnancy and if a patient likes the method, they’re really convenient as you can largely forget about it,” says Dr Verity Sullivan, a sexual health doctor and health writer.

“IUD is short for Intrauterine Device, more commonly known as the copper coil. It contains copper, which is toxic to eggs and to sperm. This makes it really hard for an egg to get fertilised or to implant, thus preventing a pregnancy.”

“Lots of people opt for an IUD as it is completely hormone-free, however your periods may become heavier, more painful or last longer. As with all contraceptives this varies from person to person and some people experience little change. If you get an IUD fitted and the side effects are unacceptable, you can of course have it removed and consider other options.”

“IUS is short for Intrauterine System, commonly known as the hormonal or Mirena coil. This type of coil contains a hormone that works in a few different ways, including keeping the lining of the womb (the endometrium) really thin, making it hard for a fertilised egg to implant, before it becomes a pregnancy.”

“The IUS is a very good treatment for heavy, painful periods and can help some patients with endometriosis and adenomyosis. Like any hormonal contraceptive, side-effects are possible such as acne, mood changes and breast pain. These effects may be temporary and settle after a few months, but again, the IUS can be removed if it doesn’t suit you.”

Should IUD insertion hurt?

“To give a blanket statement telling people IUD insertion will not hurt creates an unrealistic expectation about the procedure,” says Dr Gabrielle Macaulay, a medical director and co-founder of MAHAAH. “The truth is that everyone’s experience is different. For some people having it fitted may feel uncomfortable, or a strange different sensation, but not true pain. A proportion of women do unfortunately find the procedure painful.”

What pain relief options are available?

“When I counsel women on copper coil insertion, I often advise them to take a simple over-the-counter painkiller like paracetamol one hour before their appointment, if no contraindication. People should also speak to their coil insertion provider about their options before attending for their appointment, as some people have some local anaesthetic applied to the area by their coil inserter which helps to numb the tissues and reduce sensation,” says Dr Macaulay. 

“We know that people who feel informed and relaxed have a better experience, highlighting the importance of taking plenty of time to chat through what the procedure involves, discussing concerns and making a plan for each patient. The truth is that there is no significant evidence to show taking painkillers before the procedure does much (though it may help with pain afterwards), nor does the use of local anaesthetic gel. There is some evidence to show the use of anaesthetic creams applied an hour before coil insertion can help and this is an area we need to look into more,” says Dr Sullivan.

“Injecting anaesthetic into the cervix can help, but some patients may prefer to give the fitting a go before having an injection into their cervix, which in itself can be painful. Sedation and general anaesthetic are reserved for difficult fittings as they carry their own risks, but absolutely should be considered for people wanting a coil but who have found it too much when fully conscious. However, it’s important to understand that many coils are fitted in sexual health clinics which are funded very differently to hospitals. We are not trained nor funded to provide sedation and general anaesthetic to our patients and for those needing this sort of care, they’ll need to be referred to a different service.”

Is it normal to bleed after IUD insertion? 

“Some cramping and light bleeding (’spotting’) is normal for a day or so after the insertion,” says Dr Sullivan. “Painkillers such as paracetamol and ibuprofen can help, alongside taking it easy. If you have any symptoms you’re not happy with you should contact the clinic where you had the coil fitted or seek medical attention elsewhere if it’s out of hours.”

“People may also experience period-like cramps after coil insertion but this should be mild and transient. Any prolonged pain, lower abdominal tenderness, fever, abnormal or smelly discharge indicates there could be a complication and people should seek immediate medical advice via their GP, coil provider or calling 111,” Dr Macaulay adds. 

How long does it take for your body to adjust to an IUD?

“This varies from person to person, but I advise my patients to wait three months for the body to adjust,” says Dr Sullivan. “Obviously, if you have unacceptable side effects before three months and want to have the coil removed, come to the clinic sooner. But remember that you should have no unprotected vaginal sex for seven days before a coil is removed, otherwise there is a risk of pregnancy once it’s taken out.”

Does an IUD affect your sex life?

“If you’re having pain during sex you should visit your local clinic, as this may be a sign of infection or that the coil is not in the right place,” advises Dr Sullivan.

“If your partner is able to feel the coil threads or the coil itself, again you must visit your clinic to check it’s in the right place.”

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“There is work to be done to support women’s experiences in healthcare,” Dr Macaulay says, from the average diagnosis for endometriosis taking eight years, to studies showing that many white medics harbour a racial bias when it comes to pain perception in Black patients. 

“There needs to be a focus on ensuring patients are fully informed about what a coil fitting involves, what effects the coil may have (good and bad) and ensure people know where to go if they’re having problems,” Dr Sullivan insists. 

“The gender pain gap is real and the inequalities in care for people with wombs needs to be addressed. But I implore you not to put the blame solely on your doctor or nurse about this. This is an issue that requires consistent, adequate funding and support from a government who have demolished the sexual health and contraception budget over the last few years, a sector that cares for some of the most vulnerable in society. Without proper resources, we’re stuck.”

Before taking any advice or making medical decisions, be sure to always consult your GPYou can call the national sexual health helpline free on 0300 123 7123 for support.

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