What to Expect When You’re Expecting… an IUD (Awake)

Content note: This article describes a medical procedure in detail and mentions pain and discomfort.

If you’ve ever found yourself on the bathroom floor Googling “how bad does an IUD insertion actually hurt?”, you’re not alone. As a nurse, I hear it all the time: “I was so stressed about getting it done because of what I saw on TikTok.” Between Reddit horror stories and intense Instagram reels, it can sound like getting an IUD while awake is a guaranteed nightmare.

And to be fair some people do have rough experiences. Pain, dismissal, or feeling unprepared can leave a real mark, and that’s valid. Many people however find it quick, manageable, and absolutely worth it. With the right prep and a clinician who cares about your comfort, it can be a less stressful experience even though everyone’s body reacts differently, and that’s okay.

As a nurse who helps with several IUD insertions a week, I’ve seen it all. Here’s an honest look at what the process looks like when you’re awake: from paperwork to cramps and everything in between.

First, the vibe check

Before anything goes near your cervix, there’s a chat. Your clinician (whether a doctor or nurse) should go through your medical history, sexual health, and what kind of IUD you’re considering hormonal (like Mirena or Kyleena ) or copper (non-hormonal, and sperm’s worst nightmare).

Expect a rundown of:

• How each type works

• Potential side effects (hello, spotting and cramps)

• How long it lasts (3–10 years)

• What removal looks like down the track

It’s also a great time to ask questions: like whether you can bring a friend for moral support, or if you’ll need pain relief (spoiler: you can and you probably should).

In a perfect world, every clinician would be gentle, trauma-informed, and up to date. But some are still quoting research written by men who’ve never met a uterus. So check the vibes, ask the questions, and don’t be afraid to advocate for yourself! You deserve care that actually cares.

Pre-game rituals

You might be asked to take a painkiller like ibuprofen an hour before your appointment. Some clinics even offer a local anaesthetic (Panichyawat et al., 2020) or numbing sprays (e.g., 10% lidocaine spray) for your cervix, so if you’re worried, ask!

Timing can help. Getting a hormonal IUD within the first 7 days of your period means your cervix is already a bit more open for business and your risk of pregnancy is low. But if that doesn’t line up, don’t panic. Your clinician can usually insert it at any point in your cycle, depending on things like your contraception, pregnancy risk, and medical history (MSI Australia, 2024). Just be honest about where you’re at; most clinicians get that timing an appointment around one elusive day that may or may not show up on time? That’s basically a full-time job.

And yes, you can absolutely eat beforehand. Please do. Fainting on an empty stomach isn’t a cute look for anyone. A nurse like me will usually be around with juice and biscuits if you start feeling faint, but trust me, we’d much rather you arrive with something solid in your stomach to lower your chances of having a bad experience.

You might need a urine pregnancy test to make sure there are no surprises before your appointment. So check in with your clinician before you hit the bathroom, or start chugging water like a champ so you’re ready when they call your name.

The main event

You’ll undress from the waist down (hopefully behind a curtain) and lie back in the exam chair (the one with the stirrups). Your clinician will use a speculum (like during a CST) with a little lube to see your cervix. From my experience assisting with procedures, many patients say this the most uncomfortable part. We try our best to be gentle and use the smallest speculum practical, however studies show that if you've never delivered a baby vaginally or are new to front-penetrative sex, you are more likely to experience discomfort during this part (Bayer et al., 2025).

Here’s the play-by-play:

1. A quick clean: Your cervix gets wiped with an antiseptic swab (cold and weird, not painful).

2. Measuring up: A thin instrument called a sound checks the length and position of your uterus. You might feel a cramp here. Occasionally, your clinician may need to try a smaller sound first and gently work up to get a proper measurement however it’s quick, and we’ll always tell you what’s happening.

3. Insertion: The IUD, folded up in a small plastic tube, is guided through your cervix and into your uterus. This part lasts about 10–20 seconds. For some people, it’s mild discomfort; for others, it’s a strong cramp that makes your toes curl.

4. Strings attached: The clinician trims the threads so they sit just past your cervix. You’ll be able to feel them if you reach up, but they shouldn’t poke or bother you.

And that’s it. The speculum comes out, you take a deep breath, and it’s over. One patient described the feeling to me as similar to taking a bra off after a long day. The whole thing usually takes less than 10 minutes. Depending on your clinic, you may spend a little time in a recovery area, being observed and offered juice, water, or biscuits.

Aftercare: cramps, cuddles, and care

You might feel period-like cramps for a few hours or even a couple of days. Your cervix isn’t thrilled about the new resident and may cramp a bit as it adjusts. A heat pack, gentle movement, ice-cream, and rest can help. Spotting or irregular bleeding is common for the first few weeks (sometimes months) after insertion. With hormonal IUDs, periods often get lighter or disappear altogether. With copper IUDs, they can get heavier and crampier, especially at first.

Your clinician might book a follow-up check in about six weeks to make sure everything’s sitting right. But if you notice:

• Severe pain

• Fever or chills

• Foul discharge

• You can’t feel the strings (or feel the plastic part itself)

…go back to your clinic or a sexual health service right away. These could be signs of infection or a rare expulsion.

Honesty Time (from Your Nurse)

Okay, real talk. Most of the patients I’ve supported through an IUD insertion walk out smiling, cracking jokes, and texting their friends within minutes. For many, it’s over before they’ve even processed the weird cramp. But here’s the honest bit. We can’t promise it won’t hurt. Everyone’s body is different, and the cervix has a mind of its own. Some people feel mild pressure, others feel sharper pain, and there’s no reliable way to predict how your body will react until we get started. Pain isn’t a reflection of strength or tolerance, it’s just how your body reacts in the moment.

This isn’t about scaring you; it’s about setting real expectations. That’s why it’s so important to find a clinician who genuinely cares about your comfort. Someone who’ll remind you to eat beforehand, offer a heat pack, let you bring a support person, use local anaesthetic if needed, and maybe even Penthrox (the green whistle) for extra pain relief. You deserve care that prioritises your body and your experience.

Sex, strings, and safety

You can technically have sex as soon as you feel comfortable, but to reduce the risk of infection and give your body a little time to settle, most clinicians recommend waiting about 48 hours (Sexual Health Victoria, 2023). During this time, avoid placing anything in your vagina, including:

• Vaginal sex of any kind

• Tampons (pads are fine if you’re bleeding)

• Baths, swimming, or spas (showers are perfectly fine)

If you have a hormonal IUD, it’s effective immediately if inserted within the first seven days of your period. Otherwise, you’ll need backup contraception, like condoms, for seven days. Copper IUDs work immediately and can even act as emergency contraception if inserted within five days of unprotected sex.

Your partner shouldn’t feel the strings during sex, but if they do, your clinician can trim them a little shorter (without pulling the whole IUD out, promise). If you're not keen to get back in the stirrups any time soon, they’ll just have to suck it up. After all, you’ve been through enough! It’s a tiny trade-off for years of worry-free contraception.

So… was it worth it?

Most people who get an IUD say yes. After the first day or two of cramps, you’ve got years of contraception that doesn’t rely on remembering a pill or patch. For anyone with heavy or painful periods, a hormonal IUD can be a total game-changer if it works as hoped. And if your body isn’t loving it? No worries! You can have it removed anytime. Many patients are surprised at how easy removal is, and fertility usually returns right away.

On sedation:

It’s a whole other ball game. Sedation means you’re given medication to help you relax or lightly sleep through the procedure, so you won’t feel or remember much of it. Some people choose it for medical reasons, some because of trauma, and some just because they’d rather not be awake for it. All totally valid. It can be quite involved (not to mention pricey), often requiring a team of nurses, a proceduralist, and an anaesthesiologist, so it’s important to chat with your clinician about whether it’s right for you, the risks involved with going under sedation, and what’s available where you are.

For trans and non-binary folks

If you’re a trans masc or non-binary person with a uterus, you can absolutely get an IUD. Some people find the process brings up dysphoria or anxiety about pelvic exams, and that’s completely valid. You deserve a clinician who respects your identity, uses the right language, and explains each step before doing anything. You can also ask about options like smaller speculums, trauma-informed care, or even sedation if that makes the experience more manageable.

Does testosterone change things?

If you’re on testosterone, you can still use an IUD safely. Testosterone doesn’t protect against pregnancy, so contraception is still important if you have a uterus and are having sex that could lead to pregnancy. Some people notice that being on testosterone can make vaginal tissue thinner or more sensitive (Land & Obedin-Maliver, 2019), which might make the insertion feel a bit different, but your clinician can use extra care, lubrication, or a smaller speculum to help with comfort. In some cases, they might prescribe a short course of topical estrogen beforehand to make the tissue less fragile and reduce discomfort during insertion. Hormonal IUDs can also help reduce bleeding if your period hasn’t fully stopped on T.

In Conclusion

Getting an IUD can feel daunting, but it’s also empowering. It’s about taking ownership of your reproductive health, your way, whether that’s preventing pregnancy, managing heavy periods, or just saying, “I’m done stressing about birth control for the next five years.”

And if you need a hand to hold, bring one. Because honestly, that’s what good sex (and good healthcare) is all about. Support, communication, and a bit of lube when you need it most.

References

Bayer, L. L., Ahuja, S., Allen, R. H., Gold, M. A., Levine, J. P., Ngo, L. L., & Mody, S. (2025). Best practices for reducing pain associated with intrauterine device placement. American Journal of Obstetrics and Gynecology, 232(5), 409–421. https://doi.org/10.1016/j.ajog.2025.01.039

Harper, C. C., Speidel, J. J., Drey, E. A., Trussell, J., Blum, M., & Darney, P. D. (2012). Copper intrauterine device for emergency contraception. Obstetrics & Gynecology, 119(2, Part 1), 220–226. https://doi.org/10.1097/aog.0b013e3182429e0d

Land, E., & Obedin-Maliver, J. (2019, July). Q&A: Gynecologic and vaginal care for trans men. San Francisco AIDS Foundation. https://www.sfaf.org/collections/beta/qa-gynecologic-and-vaginal-care-for-trans-men/

MSI Australia. (June, 2024). INFORMATION SHEET - Hormonal IUD. MSI Australia.

Panichyawat, N., Mongkornthong, T., Wongwananuruk, T., & Sirimai, K. (2020). 10% lidocaine spray for pain control during intrauterine device insertion: A randomised, double-blind, placebo-controlled trial. BMJ Sexual & Reproductive Health, 47(3), 159–165. https://doi.org/10.1136/bmjsrh-2020-200670

Sexual Health Victoria. (2023). IUD post insertion information . Sexual Health Victoria.

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The information provided in this blog post is intended for general educational purposes only and does not constitute professional medical advice, diagnosis, or treatment. While I am a registered health practitioner, this content is not a substitute for consultation with a qualified healthcare professional who can consider your individual circumstances.

This blog reflects my personal views and professional experiences and does not represent the views of my employer or any affiliated organisations.

In line with AHPRA guidelines, no testimonials are included, and this blog post is not intended to advertise or promote specific services or treatments.