IUD insertion is a short in-office procedure that typically takes less than five minutes from start to finish. It involves a pelvic exam, measuring the depth of your uterus, and placing the device through your cervix. While the steps are straightforward, knowing exactly what happens at each stage can make the experience feel less intimidating.
Before the Procedure
Your provider will start with a few basics. A pregnancy test confirms you’re not pregnant, and a pelvic exam helps determine the position of your uterus, since it can tilt forward or backward. This positioning matters because it guides how the device is angled during placement.
Most people don’t need STI testing before insertion. If you have risk factors for sexually transmitted infections and haven’t been recently screened for gonorrhea and chlamydia, your provider can run those tests at the same appointment without delaying placement. The one exception: if there’s an active infection with visible signs like discharge from the cervix, insertion won’t happen until it’s treated.
Pain Relief Options
Pain management has improved significantly in recent years. Your provider may suggest taking an anti-inflammatory like naproxen before your appointment. Beyond that, there are several options that can be used during the procedure itself: a numbing cream applied to the cervix, a lidocaine spray, or an anesthetic injection into or around the cervix (similar to the numbing shots a dentist gives). A review of the evidence found that a specific numbing cream combining two anesthetics was the most effective at reducing pain during both the clamping step and the actual device placement, though it requires about seven minutes to take effect.
Not every clinic offers every option, so it’s worth asking ahead of time what’s available. If you have significant anxiety about the procedure, some providers will prescribe a mild anti-anxiety medication to take beforehand.
Step by Step: What Happens During Insertion
You’ll lie on an exam table with your feet in stirrups, just like a Pap smear. Here’s what follows:
Your provider inserts a speculum to hold the vaginal walls open and get a clear view of your cervix. They then use a small clamp called a tenaculum to gently hold the cervix steady. This is often described as the first pinch or cramp you’ll feel. If topical numbing was applied, this step is less noticeable.
Next comes a thin, flexible measuring rod called a uterine sound. It passes through the cervical opening and into the uterus to measure depth. The typical measurement falls between 6 and 9 centimeters. This number tells your provider how far to insert the IUD and confirms the uterus is the right size for the device. Many people feel a deep cramp during this step, similar to a strong period cramp.
With the measurement noted, your provider opens the sterile IUD package and loads the device into its insertion tube. A small marker on the tube is set to match your uterine depth so the IUD lands in the right spot. The tube is then guided through the cervix until it reaches the top of the uterus, and the IUD is released. The copper IUD has arms that spring open into a T-shape; hormonal IUDs work similarly.
Finally, the insertion tube is removed, and the two thin strings attached to the bottom of the IUD are trimmed to about 2 to 3 centimeters below the cervix. These strings curl up naturally and are what you (and your provider) use to confirm the IUD is still in place later on. The speculum comes out, and you’re done.
What It Actually Feels Like
Most people describe the sensation as intense cramping that comes in two or three waves: once when the cervix is clamped, once when the uterus is measured, and once when the device is placed. Each wave lasts only a few seconds. Some people feel lightheaded or nauseated briefly afterward, which is a normal response to the cervix being stimulated. Your provider will usually have you rest on the table for a few minutes before getting up.
Pain levels vary widely. People who have given birth vaginally often report milder discomfort because the cervix has been stretched before. For those who haven’t, the cramping can be more intense, which is one reason to ask about anesthetic options ahead of time.
When Protection Starts
This depends on which type you get. A copper IUD works immediately. There’s no waiting period, and no need for backup contraception.
A hormonal IUD is also effective right away if it’s placed within the first seven days of your period. If it’s placed at any other point in your cycle, you’ll need to use condoms or avoid intercourse for seven days while the hormones build up to effective levels.
What to Expect Afterward
Cramping and spotting are normal for the first few days. Some people have irregular bleeding or spotting for the first three to six months, particularly with hormonal IUDs. Over-the-counter pain relievers and a heating pad handle the cramping for most people.
Your provider will trim the IUD strings so they sit just inside the vaginal canal. You should check these strings regularly to make sure the device hasn’t shifted. The easiest way: wash your hands, insert a finger until you feel your cervix (it feels firm and rounded, like the tip of your nose), and feel for two thin strings, similar to fishing line. If you can feel them, the IUD is in place.
Check your strings every four weeks for the first three months, then once after each period going forward. The end of your period is the easiest time because the cervix sits slightly lower. If the strings suddenly feel longer, shorter, or disappear entirely, the IUD may have shifted, and you should contact your provider. Use backup contraception in the meantime.