IUD insertion is a quick in-office procedure that typically takes less than five minutes from start to finish. A provider uses a speculum, measures your uterus, and slides the small T-shaped device through your cervix and into place. Most people leave the office shortly after and return to normal activities within a day or two.
What Happens Before Insertion
The only exam strictly required before placement is a pelvic exam, where your provider feels the position of your uterus with two fingers and visually inspects your cervix. You don’t need bloodwork, a Pap smear, blood pressure screening, or any lab tests specifically for the IUD. If you have risk factors for sexually transmitted infections and haven’t been recently tested for chlamydia and gonorrhea, your provider may run those tests at the same visit, but the results don’t need to come back before the IUD goes in. The one exception: if you currently have an active cervical infection, placement will be delayed until it’s treated.
An IUD can be inserted at any point in your menstrual cycle. Some providers prefer to place it during your period because the cervix is slightly more open, but this isn’t a medical requirement. You also don’t need to fast or arrange for someone to drive you home.
The Insertion Steps
You’ll lie on the exam table with your feet in stirrups, the same position as a standard pelvic exam. Here’s what happens next, in order:
- Speculum placement. Your provider inserts a speculum into your vagina to hold the walls apart and see your cervix clearly.
- Cleaning. The cervix and surrounding area are wiped with an antiseptic solution to reduce infection risk.
- Stabilizing the cervix. A narrow instrument called a tenaculum gently grips the cervix to hold your uterus steady. This is often the moment people feel a sharp pinch or cramp.
- Measuring uterine depth. A thin, flexible rod called a sound is passed through the cervical opening to measure how deep your uterus is and which direction it tilts. This helps the provider know exactly how far to insert the device. Expect a deep, achy cramp during this step.
- Loading and inserting the IUD. The IUD comes pre-loaded in a slim tube. Your provider guides this tube through the cervix, releases the IUD so its arms open into the T shape at the top of the uterus, and then withdraws the tube.
- Trimming the strings. Two thin threads attached to the IUD hang down through the cervix. The provider cuts them to about 3 centimeters so they’re long enough for you to check later but short enough to stay out of the way.
The actual insertion, from speculum to trimming the strings, usually takes about three to five minutes.
What It Feels Like
Pain during IUD insertion varies widely from person to person. In a study that asked women to rate their pain on a scale of 1 to 10, the median score was 4 out of 10, which was significantly lower than the 6 out of 10 most women expected beforehand. The biggest factor was whether you’ve had a vaginal delivery: people who had given birth vaginally reported a median pain score of 3, while those who hadn’t reported a median of 6.
The sensations typically come in two distinct waves. The first is a sharp pinch when the tenaculum grips the cervix. The second is a deeper, crampier pressure when the sound and then the IUD pass through the cervical canal. Both are brief, lasting only seconds, though the cramping can linger for several minutes afterward. Some people feel lightheaded or nauseated during or right after, so it’s worth eating something beforehand and taking your time getting up from the table.
Pain Relief Options
Multiple systematic reviews support using a local anesthetic, specifically lidocaine, to reduce insertion pain. Lidocaine can be delivered as a spray on the cervix, a gel applied to the area, or an injection (called a paracervical block) into the tissue around the cervix. One clinical trial found that lidocaine spray actually worked better than a lidocaine injection for IUD-related pain, with the added benefit of being less invasive.
Taking an over-the-counter anti-inflammatory like ibuprofen before your appointment is a common recommendation, though the strongest evidence for these medications is in reducing cramping after the procedure rather than during it. If pain management is a concern for you, ask your provider ahead of time what options they offer. Not every clinic routinely uses local anesthesia, but you can request it.
Timing After Pregnancy or Abortion
Both copper and hormonal IUDs can be placed immediately after a delivery or an abortion, and CDC guidelines confirm that postpartum and post-abortion placement is safe. However, timing affects how likely the device is to slip out of place. IUDs placed within the first three days after delivery have the highest five-year expulsion rate, around 10.7%. Waiting until six to fourteen weeks postpartum drops that rate to about 3.2%, the lowest of any postpartum window.
For people who aren’t postpartum, the five-year expulsion rate is roughly 4.9%. Your provider will factor in your access to follow-up appointments when recommending whether to place the IUD right away or wait for an interval visit.
Recovery and Aftercare
You should wait at least 24 hours after insertion before using tampons, taking a bath, or having vaginal sex. Cramping and light spotting are normal for the first few days, and irregular bleeding can continue for several weeks, especially with a hormonal IUD. Most people feel well enough to return to work or school the same day, though having a low-key afternoon planned is a good idea.
Your provider will likely schedule a follow-up visit about four to six weeks after placement to confirm the IUD is still in the right position. In the meantime, you can check the strings yourself by reaching into your vagina with clean fingers and feeling for the thin threads at your cervix. You should be able to feel the strings but not the hard plastic of the device itself. If you can’t find the strings or you feel the IUD poking through, contact your provider.
Risks and Complication Rates
Serious complications from IUD insertion are uncommon. In a large study of over 326,000 IUD placements, the rate of uterine perforation (where the device pushes through the uterine wall) was 0.21% at one year. For people who weren’t recently postpartum, the five-year perforation rate was just 0.29%. Postpartum placement carried higher risk, particularly when the IUD was placed between four days and six weeks after delivery (five-year rate of 1.98%). Breastfeeding also roughly doubled perforation risk compared to not breastfeeding among those with a postpartum insertion.
Expulsion, where the IUD partially or completely slips out, is more common but still affects a relatively small number of people. The overall five-year rate is about 4.6%. People with a history of heavy menstrual bleeding had the highest expulsion rates, reaching nearly 14% over five years.
Signs that something may be wrong after insertion include severe pelvic pain that doesn’t improve, a fever above 101°F (38.3°C), vomiting, or unusual discharge. A small increase in pelvic infection risk exists in the first few weeks after placement, but this is linked to pre-existing bacteria rather than the IUD itself.