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Obstetric nurse Stephanie Edwards-Latchu has inserted over 450 intrauterine devices. Some women barely notice the device being inserted, she says, but others report experiencing the worst pain of their lives.

The devices, which are inserted into the uterus to prevent pregnancy, are the third most common form of birth control in the United States. Yet some patients come to her after being turned away by other doctors – told to “calm down,” their pain is “not that bad,” or even “you’re exaggerating.”

In new birth control guidance released this week, the U.S. Centers for Disease Control and Prevention (CDC) has given doctors updated recommendations on how to ease the pain some people feel when inserting the devices, known as IUDs. Lidocaine “may be useful for reducing pain in patients” when injected as a local anesthetic or applied topically as a numbing gel, cream or spray, the CDC said in the update, the first since 2016.

The CDC also recommends that doctors inform all patients about potential pain and tailor IUD placement and pain management plans to each patient.

The individualized and patient-centered language represents a major change from the 2016 guidelines, which were less specific and detailed, according to Dr. Tessa Madden, professor of obstetrics, gynecology and reproductive sciences at the Yale School of Medicine.

Madden’s research on the use of lidocaine was mentioned in the updated guidelines, but she pointed out that her research is nearly 12 years old – highlighting the long-standing challenge in improving pain management during the procedure.

In a 2019 survey of about 1,000 family planning providers, fewer than 5% reported using a lidocaine injection during IUD insertion. Instead, they more often suggested ibuprofen, which research shows does not relieve insertion pain.

“Prescribing ibuprofen is the bare minimum and not enough,” said Edwards-Latchu, whose campus health clinic at the University of North Carolina Chapel Hill offers lidocaine gel and injections, heating pads, Valium and the option to bring a support person. The clinic is also experimenting with navel vibration devices that could ease discomfort during the procedure.

Inserting an IUD takes no more than 15 minutes. The doctor performs a pelvic examination and then uses a speculum to dilate the vagina to insert the device into the uterus.

“Each of these steps – from the pelvic exam to the insertion of the IUD – can be uncomfortable for those affected. However, the insertion is usually the most uncomfortable and the most painful phase,” says Dr. Beverly Gray, associate professor of gynecology and obstetrics at Duke University and an OB-GYN at Duke Health.

Cramping and other uncomfortable or painful sensations may occur during and after insertion because the procedure involves the use of pointed forceps (called a tenaculum) to stabilize the cervix and insert the IUD through the narrow cervical canal.

“Patients have spoken clearly about their traumatic or painful experiences,” Gray added. “These guidelines underscore the importance of discussing pain management and being open about the range of experiences people might be having.”

For a long time, pain in women was not adequately recognized and treated.

“Women have been saying for decades, ‘My pain is not taken seriously,'” Edwards-Latchu said. “It feels like screaming into the void.”

A 2021 study found that pain is consistently underestimated in female patients due to gender stereotypes and that women benefit less from painkillers than men, despite being equally likely to seek treatment.

“In medicine, we have not been particularly good at taking women’s pain seriously in the past,” Madden added.

Edwards-Latchu described a patient whose appendix ruptured after her abdominal pain was dismissed as menstrual cramps. This suggests a more general problem, namely the mistreatment of pain in women. Research confirms this, showing that women in emergency departments with similar abdominal pain to men had to wait longer and were less likely to receive pain relief.

This problem also affects the insertion of an intrauterine device (IUD). Studies have shown that patients report significantly more pain than the treating staff perceive.

There is no guaranteed way to predict a person’s reaction to having an IUD inserted, Madden said. She said some of her patients experience severe pain, while others feel “very little.”

However, increased pain during the procedure is more likely if the patient has not had a vaginal birth, has suffered from painful periods in the past, or has experienced trauma.

Some research also suggests that anxiety is associated with greater pain during various medical procedures.

“People’s experiences vary greatly. Sometimes it’s hard to predict who will have no problems with insertion and who will have a greater challenge,” Gray added. “Understanding that is important.”

A 2014 study of 109 IUD patients found that 78% of them reported moderate to severe pain during the implantation process. This range is evident on TikTok, where numerous women have shared live videos from the exam table as their IUD is inserted.

“Having an IUD put in is the worst pain imaginable,” wrote one user, showing herself doubled over in pain.

“It was the worst pain I’ve ever experienced,” said another.

In both videos, you can hear the medical staff telling the patients that they should expect pressure or a “pinching” sensation when inserting the IUDs.

“It’s heartbreaking,” Edwards-Latchu said of the videos on her social media feed. “My first thought is, ‘I doubt they got anything for their pain,’ and that’s disturbing to me.”

The videos would raise awareness of the potential pain, she said, adding that it was important to “know about the negative experiences so that something changes.”

However, according to Madden, the videos can also discourage viewers from considering a birth control method that might be a viable option for them.

“Patients come into the office and talk about videos they’ve seen on TikTok or Instagram. That’s often where patients get their information from,” she said. “Seeing a video like that could have a significant deterrent effect.”

Intrauterine IUDs have a troubled history. In particular, the Dalkon Shield in the 1970s led to serious infections and other complications, casting a shadow over the safety of IUDs. However, modern IUDs have been proven safe and effective and are used by over 10% of women ages 15 to 49, according to CDC data from 2017 to 2019.

Their effectiveness lasts up to ten years or more and they prevent unwanted pregnancies twenty times better than birth control pills and other short-term contraceptive methods, according to a 2012 study.

“(An IUD) is a highly effective method that many patients are very happy with,” Madden added. “For some patients, concern about pain during insertion is the reason they don’t use (it).”

“If patients feel that we are addressing their concerns about pain and taking them seriously, this can increase their willingness to use the method.”

The updated guidelines come amid rising demand for contraceptives following the overturning of the Roe v. Wade ruling in 2022.

Edwards-Latchu explained that every year around graduation, her campus health clinic sees a rush of students seeking IUD placement. Many of these students are preparing to move to areas with restrictive reproductive health laws and are unsure if they will have access to reproductive care in the future.

“They’re looking for long-acting, reversible contraceptives like the IUD, and if they already have one, they want a newer one so they’re protected longer,” she said. “It’s something you can hide and nobody can take away from you, especially if you go to a state where contraceptives might be a target.”

Against this background, comprehensive and individualized discussions about pain management during insertion are more important than ever, she added.

Gray, Madden and Edwards-Latchu say the increasing attention on insertion pain, long-term contraceptives and the new guidelines presents an opportunity for providers to listen to their patients to provide them with a better personalized experience.

To make this possible, patients should actively ask questions during their consultations, particularly about pain management options and anxiety support, they said.

Edwards-Latchu suggests asking about lidocaine blocks, gels, sprays and other pain control methods as described in the new CDC guidelines.

“If a patient feels that the doctor is not taking her concerns seriously or is unwilling to offer her some of these possible procedures, then she may not want to have an IUD inserted by that doctor,” Madden added.

“We have to take this pain seriously.”

CNN’s Jacqueline Howard contributed to this report.