Pain during IUD insertion has long been a deterrent for patients considering this highly effective contraceptive — and two new studies published in JAMA are bringing fresh evidence to the table. A Swedish randomized trial of 370 nulliparous patients found that intrauterine instillation of mepivacaine, a local anesthetic, significantly reduced pain compared to a saline placebo. Patients in the mepivacaine group were also about half as likely to experience severe pain and more likely to say they'd choose an IUD again.

A separate U.S. study looked at a different angle: when IV moderate sedation (fentanyl + midazolam) was routinely offered at family planning clinics in Massachusetts, 1 in 5 patients chose it. Those who opted for sedation were more likely to be nulliparous, have anxiety or depression, or have a history of pelvic pain — suggesting that demand for stronger pain control may be higher than previously assumed.

By the Numbers

• Mean pain score: 43.8 mm (mepivacaine) vs. 58.6 mm (placebo) on a 100-point scale
• Severe pain: 18% (mepivacaine) vs. 35% (placebo)
• 98.3% of mepivacaine patients said pain was tolerable vs. 91.4% in the placebo group
• 79% of mepivacaine patients would recommend the method to others vs. 69% in the placebo group
• 20.3% of patients chose IV sedation when universally offered

Why it matters: IUD insertion pain isn't just a discomfort issue — it's a contraceptive access issue. Fear of pain can prevent patients from choosing one of the most effective long-term birth control options available. These findings push clinicians toward offering a broader, individualized menu of pain management options before and during the procedure.