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If IUD insertion becomes too painful, tell the clinician immediately and ask them to pause or stop. The American College of Obstetricians and Gynecologists (ACOG) says that, in most cases, the procedure can be paused while pain relief is reconsidered, or stopped when pain is significant. You do not have to endure an attempt that feels unacceptable.
After an incomplete attempt, arrange a follow-up conversation rather than assuming you must simply try again. Ask what made the insertion difficult, which pain and anxiety-support options this clinic can provide, and whether referral to a clinician or facility with additional options would make sense.
What to do during a painful insertion
Say clearly that you need a pause
Use direct words such as “Please stop,” “I need a pause,” or “This is more painful than I can tolerate.” ACOG patient guidance says the clinician should check how you are doing and, in most cases, pause the procedure to find an acceptable level of pain relief. If the pain remains significant, the procedure can be stopped.
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Ask what is happening before deciding on another step
Once the procedure is paused, ask the clinician to explain what they have done, what remains, and what they think is making the attempt difficult. The reviewed guidance does not identify the cause of any individual painful or unsuccessful insertion, so a failed attempt should not be used to diagnose your anatomy, anxiety, trauma history, or another condition.
If you are too uncomfortable to continue that day, it is reasonable to stop and arrange a separate consultation. A follow-up assessment may help the clinician decide whether a different plan, another clinician, or another setting is appropriate.
What to ask after an unsuccessful attempt
Bring these questions to a follow-up visit. They are prompts for a shared decision, not instructions to choose a particular medicine:
- “Can you explain what made the insertion difficult and whether you recommend any follow-up assessment?”
- “If I try again, can we agree in advance that I can ask you to pause or stop?”
- “Could topical lidocaine or a cervical or paracervical block be appropriate for me? What discomfort, side effects, and limits should I expect?”
- “Does this clinic offer additional pain or anxiety support, or should I be referred to a facility that does?”
- “Because the first attempt was unsuccessful, is there a reason to consider misoprostol in my case, and what are the trade-offs?”
- “If an IUD cannot be placed soon, what contraception plan should I use in the meantime?”
The last question matters because the available guidance reviewed here does not provide enough detail to recommend a specific alternative contraceptive method or pregnancy-prevention plan while placement is delayed. A qualified clinician can discuss choices that fit your health, preferences, and timing.
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Pain-relief options to discuss for a future attempt
ACOG’s 2025 clinical consensus states: “Options to manage pain should be discussed with and offered to all patients seeking in-office gynecologic procedures.” The same guidance emphasizes that there is no one-size-fits-all approach. The Centers for Disease Control and Prevention (CDC) recommends counseling before IUD placement and a person-centered plan based on the patient’s preferences.
The table shows how commonly discussed options differ. No option guarantees a painless procedure or guarantees that insertion will be completed.
| Option | When it is used | What to ask about | Limits and access |
|---|---|---|---|
| Topical lidocaine | Applied to the cervix or nearby tissue before the procedure | Whether the product and application used by the clinic are suitable, how long it needs to work, and what sensation may remain | ACOG notes that creams, gels, or sprays may not reach deeply enough to be completely effective. The CDC says lidocaine might be useful for reducing pain. Availability varies. |
| Cervical or paracervical block | Injected local anesthetic used before or during the procedure | Where injections would be made, how much discomfort the injection may cause, expected benefits, and possible adverse effects | ACOG and CDC describe local anesthetic as a reasonable pain-management topic, not a guarantee. An injection may itself be uncomfortable, and some clinics may refer you elsewhere. |
| Misoprostol | A clinician may consider it before a repeat attempt in selected circumstances | Why it might be appropriate after your recent failed placement, when it would be taken, expected effects, and alternatives | CDC does not recommend misoprostol routinely for IUD placement. It might be useful in selected circumstances, such as a recent failed placement. ACOG discusses possible benefits and adverse effects. Do not self-medicate. |
| Other pain or anxiety support | May address distress during the visit or comfort around the procedure | What the clinic can provide, whether a support person is permitted, and whether another facility offers options unavailable here | ACOG says options may not be available in every clinic and may require referral. The evidence reviewed does not promise that sedation or another support will eliminate pain or ensure insertion. |
| Non-drug comfort measures | Used during or after an office procedure | Whether a heating pad or another comfort measure is available and safe for you | ACOG lists a heating pad on the abdomen as an optional comfort measure. It does not treat the reason an insertion was painful or unsuccessful and does not replace a clinical plan. |
Some clinicians may also discuss an ordinary pain reliever, additional monitoring, or imaging support. Ask what is appropriate for you rather than taking a medicine or arranging a procedure on your own. The guidance does not say that an NSAID, sedation, ultrasound, a block, or topical anesthetic will make insertion painless or guarantee success.
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Understanding lidocaine and local anesthesia
Topical products
Topical lidocaine can be applied without an injection, which may be attractive if needle discomfort is a concern. However, ACOG’s patient information warns that a cream, gel, or spray may not reach deeply enough to be completely effective. You may still feel pressure, cramping, or discomfort from the procedure. Ask the clinician how the product is applied and what level of relief is realistic.
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Cervical or paracervical blocks
A block involves injections of local anesthetic near the cervix. ACOG says local anesthetic agents may reduce IUD insertion pain, and the CDC says lidocaine, either as a paracervical block or topically, might be useful. A block can involve brief injection pain and does not promise a pain-free insertion or a successful placement. Discuss the expected benefit, side effects, and whether the clinician has experience providing it.
When misoprostol may enter the conversation
Misoprostol is not a routine preparation for every IUD insertion. The CDC says it might be useful in selected circumstances, including a recent failed placement. That wording is important: a previous unsuccessful attempt is a reason to ask whether it belongs in your plan, not a reason to take it automatically.
ACOG describes possible trade-offs and adverse effects. Your clinician should review why the medicine might help, how it would be used, what effects to expect, and what other plans are available. Do not use leftover tablets, someone else’s prescription, or an internet dosing schedule. The decision depends on your individual circumstances and the clinic’s protocol.
Finding a clinic with more options
Not every office can provide every pain-relief or anxiety-support option. ACOG’s patient guidance says some options may require referral. The NHS likewise notes that additional relief, including local anesthesia, may be available in some settings.
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When you call a clinic, describe the previous attempt plainly: it was too painful, could not be completed, or both. Ask these practical questions before booking:
- Which local anesthetic options are provided on site?
- Can the clinician pause or stop the procedure whenever I ask?
- Is a clinician with experience in difficult or previously unsuccessful insertions available?
- Are additional pain or anxiety supports offered, and do they require a referral or separate appointment?
- What should I do if the office cannot provide the option we discuss?
Getting answers in advance can prevent another visit in which the only plan is to repeat the same approach. A referral is not a sign that you have failed; it may simply be the way to reach equipment, staffing, or pain-management services that this office does not have.
Making a repeat-attempt plan
Before the appointment
- Write down what you remember: where the pain began, whether it continued after the attempt, what was tried, and what made you ask to stop.
- Tell the scheduling staff that a previous insertion was unsuccessful and ask how the clinician prepares for repeat attempts.
- Request a conversation about pain management before instruments are placed, rather than trying to negotiate while you are already distressed.
- Agree on a simple stop signal or phrase and confirm that everyone in the room understands it.
- Ask how long the visit is expected to take and whether a separate consultation is needed for a block, medication, or referral.
During the appointment
- Confirm the plan and the stop signal before the procedure starts.
- Ask the clinician to explain each major step in the amount of detail you want.
- Report pain as it changes. Do not wait until it becomes intolerable.
- If the agreed plan is not working, ask for a pause and reassess whether to continue, change pain relief, or stop.
- Before leaving, make sure you know whether an IUD was placed, whether another attempt is planned, and whom to contact with questions.
After the visit
Follow the clinician’s individualized aftercare instructions. If the IUD was not placed, ask when and how to discuss contraception while you decide on the next step. If the IUD was placed but you remain concerned about pain, contact the inserting clinician for advice rather than assuming that severe or persistent symptoms are something you must tolerate.
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What the evidence does—and does not—promise
ACOG’s 2025 consensus notes that studies use varying research protocols and that no single intervention works for everyone. Its conclusion that local anesthetics may reduce pain is not a promise of complete numbness. The CDC’s statement that lidocaine might be useful is similarly cautious.
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The same caution applies to blocks, topical products, oral pain medicines, sedation, ultrasound, and other interventions a clinician may discuss. They can be considered as part of an individualized plan, but none should be presented as certain to make insertion painless or to ensure that it can be completed.
Comprehensive counseling is central to choosing among these options. ACOG coauthor Kimberly Hoover, MD, FACOG, said in the organization’s May 15, 2025 announcement: “Comprehensive counseling is key because patients must be able to decide for themselves what interventions, if any, they would like to try.”
When you are not ready to try again
You can decline another insertion attempt or take time to consider the choices. Ask the clinician to explain alternatives for pregnancy prevention during the delay, since the appropriate option depends on your circumstances and is not determined by the failed attempt alone. You can also request your records or a summary of what was attempted so that a different clinician does not have to guess what happened.
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