“I remember leaving in tears.” Why women are still struggling through “horrifying” IUD fittings
A campaign for better pain relief was launched in 2021. Our investigation revealed that many fixable barriers continue to prevent change.
By Alina Jaffer
Five years ago, accountant Lucy Cohen went to her GP to get a coil intrauterine device (IUD) fitted. She left utterly traumatised.
The fitter who inserted Cohen’s IUD seemed completely unfazed by her “horrendous” pain, offering two paracetamol and little compassion. “They acted like, ‘oh most people are fine with this. It seems to be a you problem’.”
Afterwards, she drove herself home in a daze, her stomach still cramping and her mind replaying the agonising procedure. Today, she chalks up the experience to medical misogyny – the dismissing and normalising of female pain in healthcare settings.
“We'll look back at this in 20 years and think
it was absolutely barbaric.”
The NHS website provides a brief play-by-play of IUD insertions. It tells patients that a nurse will gently put a smooth tool – a speculum – into their vagina, open it and insert the IUD into the womb through the cervix, to prevent pregnancy. It does not mention that a scissor-like tenaculum is used to grasp and stabilise the cervix, often causing intense discomfort.
After her dreadful experience, Cohen distributed a survey to see if other UK women suffered serious pain during the insertion. 93 per cent did. Out of 1,505 respondents, 73 per cent felt poorly informed about how the fitting would feel; and 95 per cent said better pain relief should be offered for the procedure.
Their suffering was preventable. The College of Sexual and Reproductive Healthcare (CoSRH) says local anaesthesia – the type of pain relief used for dental work – can be effective during IUD fittings. Options include injectables, sprays and gels made from numbing agents like lidocaine and prilocaine.
After Cohen’s story went viral in 2021, the CoSRH launched a campaign called Pain Shouldn’t Be Part of the Plan. Their updated guidelines demanded that IUD patients should receive information about all their pain management options before a fitting. But Dr Cindy Farmer, senior vice president of the CoSRH, says that training materials for IUD-fitters weren’t updated to reflect that guidance until 2023.
“I sent [another survey] out more recently, last year, to see if the change in guidelines was being implemented,” says Cohen, discussing her ongoing activism. “I had about 500 responses and 70 per cent of women still reported that they weren't even offered pain relief.”
Such was the case for Jane, 24, a Londoner who had her IUD fitted in February 2026 and whose name has been changed for privacy. She tensed up instantly when the procedure started and was shocked when the tenaculum clamped her cervix. “It was like something I’d never felt before,” says Jane. “It wasn’t like cramps. It was like something inside you, pinching you.”
“We're not toddlers. You’re not tricking us to eat vegetables,
this is an informed consent thing.”
After the fitting, a nurse told Jane to lie on her side for a few minutes, to help with the pain. “I remember leaving in tears,” she says.
She did not expect the appointment to be so intense. In terms of pain control, Jane’s doctors only mentioned paracetamol. She read up about insertions before her appointment, but saw mixed results online. “People were saying ‘oh it’s fine’ and ‘oh my god, it’s the worst thing I’ve ever felt’. I guess it's everything to do with your own body,” she says.
Jane’s research is in line with a December 2024 report by the Women and Equalities Committee (WEC), which said that many women use online spaces to seek help in the face of medical misogyny. Accordingly, the report said that the NHS website should prevent misinformation.
However, the site currently features questionable advice. It recommends taking paracetamol or ibuprofen an hour before IUD fittings and notes that “extra pain relief”, such as local anaesthesia, is available upon request. While over-the-counter painkillers might help with cramping after a fitting, Farmer says that they aren’t much help during the procedure.
“I said ‘it doesn't even work on period pain. I’m quite certain it won’t when shoving something up my cervix’,” says Cohen, who challenged the fitter who told her to take paracetamol. “It was actually a male doctor who told me that. Like, when was the last time you had something up your cervix?”
Despite the painkiller’s ineffectiveness during insertions, FoIs have revealed that, for some London patients, it’s their only option. The Central London Community Healthcare NHS Trust – which typically does 350 coil IUD insertions per year – does not offer anaesthesia for the procedure.
The Greater London NHS trusts that do offer anaesthesia do not thoroughly track its use. The Homerton-based trust, for example, does around 1,000 IUD fittings per year and does not electronically record how many were performed with anaesthesia. Out of the eleven trusts that perform fittings, only three systematically record administered painkillers.
“Not tracking these things means that you’re not going to actually spot a trend that is impacting people,” says Cohen. “We don’t see if guidance has been implemented.”
Cohen adds that at the time of her 2021 survey, there was no other research on patients’ desires for better pain management during IUD procedures. “As fun as it is to be cited in the British Medical Journal, it should not have been on me to do it,” she says. “Just because it’s not fatal doesn’t mean it shouldn’t be tracked.”
If the NHS better tracked anaesthesia use in IUD procedures, the CoSRH could potentially build a case for improved fitter training. As it stands, Farmer says that trainees must master seven steps – including discussing pain management – but aren’t expected to learn how to administer common anaesthetics. The focus is on talking patients through their options, not providing those options.
“If you learn a skill, you have to be using it a certain number of times a year in order to remain competent and safe,” says Farmer, explaining why many fitters are not trained to use anaesthetic sprays. “If you’re not doing that number, then it’s almost pointless learning something.”
On 2 March 2026, the CoSRH hosted a panel to introduce more IUD-fitters to an anaesthetic called lidocaine spray. During the webinar, Farmer explained that fitters must prep the bottle, spray onto the cervix and wait three minutes before continuing the fitting.
Many of the 400 attendees expressed concern with that three-minute waiting period. Though Farmer explained that lidocaine spray reduces pain during the insertion, one attendee called the waiting time “tedious”.
We asked Farmer to explain this pushback from fitters. “The temptation is to just crack on, not waste any time,” she says, adding that prolonging procedures – even by a few minutes – can be logistically tricky for already-burdened primary care facilities.
Farmer also says that letting the spray sit for a few minutes can make patients anxious. Others disagree. “I would happily have laid there for an extra however many minutes, but that wasn't even an option,” says Jane.
Some fitters on the call did not wish to discuss lidocaine spray at all, steering the conversation towards non-pharmaceutical interventions. These natural tactics – like using calming words, creating a comfortable environment and having a third-party present – are meant to relax patients during fittings.
“It’s as if silly women can just be distracted from pain by talking,” says Cohen, who finds the strategy insulting.
Farmer admits that if a fitter only offers non-pharmaceutical pain relief, it is “not enough and almost a little bit patronising”. She considers it valuable only when combined with clinical pain management options.
The informed consent problem
Some IUD-fitters also knowingly downplay the possibility of painfulness to their patients.
“We actually know that if they're anticipating it to be a painful procedure and they're more anxious, then that procedure will be more painful,” says Farmer. For example, a 2025 report from the American College of Obstetricians and Gynecologists (ACOG) notes that patients who hear, “You’re going to feel a lot of pressure,” during a speculum exam typically report higher pain scores than those who hear, “I am going to introduce the speculum.”
“Yes, it can be horrible and agonising and I don't in any way wish to minimise those experiences, but it can also be actually absolutely fine,” says Farmer.
To inform patients without raising their anticipation, Farmer says that fitters should discuss all pain-management options while also emphasising that the majority of people only experience mild pain scores. But Cohen says that this method fails to warn and protect patients who will experience serious pain.
“When you buy a packet of paracetamol, it tells you all the weird and random things that will never happen,” says Cohen. “But yet, we're not telling women that this might really, really hurt.”
Since the start of her journey, Cohen has received a bizarre response from the medical community. “[They say] ‘well if we told women it was going to hurt, they wouldn't have it done’,” she says. “Like, are you fucking stupid? We're not toddlers. You’re not tricking us to eat vegetables, this is an informed consent thing.”
Currently, the CoSRH says it will continue sharing resources about IUD pain relief to both patients and providers.
“We'll look back at this in 20 years and think it was absolutely barbaric,” says Cohen. “Either that or The Handmaid’s Tale will have fully happened and no one will care anymore.”
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