Due to a few different comments/requests around, I’ve decided to do a small tweetorial for both #MedEd and people who are getting IUD’s put in, in the chair. Pls avoid if you find this traumatic. I know many have had bad experiences.

The first thing to note is that many, many women find this procedure intensely painful. Amount of pain seems to correlate with vaginal birth, but not exclusively. Having had kids vaginally does not ensure a low pain procedure.

Likewise, not having had kids/vaginal birth does not mean you cannot have an IUD placed as an office procedure. You do not HAVE to undergo general anaesthetic.

Ultimately I would hope the choice was yours but health care differs vastly across the world.

For #MedEd - providers - DO NOT LIE TO YOUR PATIENTS - don’t say it’s just a little pinch. All lying achieves is a loss of trust. It doesn’t make it hurt any less.

The pain is akin to very bad period cramping at its worst.

If your patient is experiencing pain, then how much you handle the cervix and how long you take to complete the procedure will both prolong the discomfort. Become efficient. Safe - but efficient.

For people who want to know what will happen during an IUD insertion:
First you will be asked to undress. If you are not given privacy to do so, remember you may ASK. You do not have to have someone watch you disrobe.
You should be offered a sheet/towel/blanket as cover

You will likely be in a bed that has the end off, with foot plates or stirrups. This may seem intimidating. These beds help position you for maximal access in minimum time. This will reduce your discomfort. Still intimidating and exposed I know - but I promise it’s beneficial

A speculum will be inserted. Counterintuitively, if you can get yourself to relax, it will be less uncomfortable. Concentrate on your buttocks and relaxing them to the bed, keeping your legs open as you can. If someone is pushing at you, tell them to back off and give you time

I cannot stress this enough - you are in charge. You absolutely may not feel it, but maybe at that time you’ll hear my little voice in the back of your head and remember it. You ARE in charge.

At this point, some cleaning solution will be used to reduce infection. Usually either chlorhexidine or betadine. Make sure they know if you’re allergic to either.
Then some form of anaesthetic may be used. I going into more detail below about what’s out there.