Pain-free IUD? Know your options for pain management with gynecologic procedures
July 22, 2025
For far too long, women have faced painful or uncomfortable in-office gynecologic procedures such as IUD insertion, colposcopy, endometrial biopsy, and hysteroscopy with nothing more than gritted teeth and ibuprofen.
Many people were never even told these procedures could be painful. I’ve even heard some say the cervix has no nerve endings. But anyone with a cervix knows that’s not true.
Fortunately, practices are changing. The American College of Obstetricians and Gynecologists (ACOG) released new recommendations this summer for pain-relief options – including an anesthetic cream, a spray, or an injected local anesthetic – during the insertion of intrauterine devices (IUDs) and other common gynecologic procedures.
ACOG noted that pain management has long been influenced by outdated beliefs about women’s tolerance for pain. The update recognizes the urgent need for health care professionals to better understand pain-management options and for patients to have the choice to receive pain control.
Pain is a very individualized experience. My 10 on the pain scale is likely not the same as yours. Not everyone needs pain management for an IUD insertion or endometrial biopsy. But everyone should be counseled on their options so they can make the best choice for themselves.
Pain control options for gynecologic procedures
Some gynecology offices offer a range of pain management options for each procedure. Others provide a combination of methods, such as a topical anesthetic and an injection for stronger pain relief. Most take seconds to administer and a few minutes to kick in, so they don’t add much time to the procedure. And those few minutes can make the whole process much more comfortable for the patient.
Using pain management is your choice. If you decide not to use it but change your mind once the procedure starts, we may be able to pause and give you something at that time. There are also nonmedical ways to feel more relaxed and help make in-office gynecologic procedures more comfortable. For example:
- Bring a friend or loved one for comfort and distraction
- Practice deep breathing or meditation
- Listen to music or a podcast or play a game on your phone
Your doctor may also recommend taking a non-steroidal anti-inflammatory drug (NSAID) such as ibuprofen right before your visit. While an NSAID will not significantly reduce pain during the procedure, it can help manage any cramping and soreness you might feel afterward.
Which procedures might have options for pain management?
Here are some common in-office procedures that can be uncomfortable, along with pain management options. Talk with your women’s health provider about what choices are available to you.
IUD insertion
An intrauterine device is a form of long-acting, reversible contraception. It’s a small, T-shaped device that is inserted by a physician through the vagina, past the cervix, and into the uterus to prevent sperm from fertilizing an egg.
Some women have mild discomfort or cramping during the five-minute procedure. Others have more intense pain. Every patient who is having an IUD placed should be counseled about the potential for pain and offered options such as:
- Paracervical lidocaine block: A local anesthetic is injected into the tissue around the cervix. It can make IUD insertion less painful, though some women report mild pain from the injection.
- Lidocaine-prilocaine cream or lidocaine spray: Local anesthetics are applied to the cervical canal for a numbing effect.
Endometrial biopsy
In an endometrial biopsy, a doctor removes a small piece of tissue from the lining of your uterus. It is used to investigate symptoms such as abnormal bleeding or to diagnose conditions such as cancer. The procedure takes about 15 minutes. Some people have mild discomfort or cramping during the procedure, while others may have more intense pain.
Pain management options for an endometrial biopsy may include:
- Lidocaine spray or gel: This local anesthetic is applied to the cervical canal and/or the area that will be touched by a tenaculum, which is a tool to stabilize the cervix.
- Paracervical block plus intrauterine lidocaine: This local anesthetic is administered by a catheter into the uterine area.
Colposcopy or cervical biopsy
A colposcopy is procedure to check your cervix, vaginal wall, and vulva for signs of cancer or pre-cancerous tissue. If an abnormality is spotted, your doctor may take a tissue sample to be tested in the lab. Colposcopies are often done after an abnormal Pap smear or positive HPV test.
A colposcopy takes 10-20 minutes. Some women feel discomfort similar to a pelvic exam; others feel pain, especially if a tissue sample is taken. Pain management options for a colposcopy may include:
- Anxiolytics: These are medications that reduce anxiety. Patients can request that their provider prescribe one before the procedure.
- Lidocaine spray or injection: This local anesthetic is applied to the outer area of the cervix or injected next to the biopsy site.
- Local anesthetic with vasoconstrictor: A local anesthetic is injected into the tissue surrounding the cervix. The vasoconstrictor makes the blood vessels contract to temporarily reduce blood flow to the area. This will curb swelling and inflammation.
- Nitrous oxide: Some clinics provide “laughing gas” to relieve anxiety during gynecologic procedures.
Hysteroscopy
In a hysteroscopy, a doctor examines the inside of your uterus to diagnose and treat conditions such as polyps, fibroids, and adhesions. The time this exam takes, and the potential for pain or discomfort, varies based on the suspected diagnosis and your symptoms.
Pain management options for a hysteroscopy may include:
- Misoprostol: This oral or vaginal medication is taken before the procedure to help widen and soften the cervix.
- Intracervical block: A local anesthetic is injected into the uterine area to temporarily block pain sensations.
Honest conversations between patient and doctor
Providers, as well as patients themselves, should not assume that a procedure won’t hurt or that pain control is not necessary. Misperceptions about pain tolerance still exist in some medical communities, despite being disproven repeatedly by modern medicine.
The new ACOG guidelines should encourage more health care professionals to talk with patients about the pain or discomfort they may experience during an in-office gynecologic procedure. Knowing that a procedure might be uncomfortable can help some women better prepare for it. This conversation should also cover what pain management options are available.
Patients should also bring up any concerns that could increase their pain or anxiety, such as past trauma or a previous unpleasant health care experience. Having this conversation up front can help the doctor customize your pain management and ease any anxiety you might have.
If your doctor doesn’t mention your options for pain control first, don’t hesitate to ask about what’s available. If your doctor doesn’t offer any options that work for you, you can ask if any of their colleagues do or look for another practice.
Some health care professionals have long offered pain management options for procedures such as IUD insertion. For example, I learned to give paracervical blocks during my training and have always offered them, along with other forms of pain management. I now help train medical students and colleagues to do the same.
The new ACOG guidelines and increased awareness of potential pain during gynecologic procedures are long overdue. No patient should be made to feel like they must “tough out” a procedure just because it only takes a few minutes. All women have the right to request and receive pain control during gynecologic procedures.
To talk with an expert about a gynecologic procedure, make an appointment by calling 214-645-3838 or request an appointment online.
