The reason is pretty simple: Unlike the birth control pill, IUDs are a set-it-an-forget-it method, and they’re one of the most effective birth control methods you can use.

Back up. What’s an IUD?

An IUD is a small device that’s inserted into the uterus and is more than 99% effective at preventing pregnancy long-term—anywhere from 3 years to 12 years, depending on the brand and the type. An IUD doesn’t prevent pregnancy permanently, and can be removed any time. Five IUD brands are approved in the United States, and they’re divided into two types: hormonal (Mirena, Kyleena, Skyla, and Liletta) and copper (ParaGard). Both types prevent pregnancy by making it impossible for sperm cells to reach an egg in the uterus.

What to expect during an IUD insertion

You’ve probably heard that IUD insertion isn’t exactly fun. When you get an IUD inserted, your doctor will likely do a pelvic exam first, says Brett Worly, MD, an ob/gyn at The Ohio State University Wexner Medical Center. Then, a speculum is inserted into your vagina to find your cervix. From there, cervix is cleaned with antiseptic solution and grasped with an instrument to help manipulate your uterus, so that the insertion should be safer and easier, Dr. Worly says. The inside of your uterus is then measured with a thin plastic measuring device. The IUD is then inserted, the strings are cut, everything is removed, and you’re all set.
People can expect “mild to moderate discomfort” at different points during the procedure, sometimes with cramps or sharp pains, Dr. Worly says. Given that more information is always better, we consulted real women who have been through this to see what IUD insertion really feels like. The experience was different for every woman, but they all say it was worth it.

“My cervix wouldn’t open up.”

“I’m in college and figured an IUD would be a good idea given that I don’t want to have a baby right now. So, I made an appointment and thought it would be pretty simple. But for some reason, my cervix wouldn’t open up, so my doctor gave me medication to take, and asked me to return the next day. I did and, while I like to think that I have a high pain tolerance, it was pretty painful. Like, I started crying. I also had cramping and bleeding for eight weeks afterward, which isn’t fun.” —Sarah E.

“There was no pain, just pressure.”

“I decided to use an IUD because I don’t want to have kids and I have horrible painful periods, so the Mirena seemed to be a perfect solution to deal with both issues. I was very uncomfortable the day of the procedure because I was on my period (doctor’s orders!) and the doctor started the procedure by saying that if I felt as if I was going to faint to let her know. I am very tolerant to pain so I dismissed her comments and then she inserted it. I got very hot and felt like the walls and ceiling were collapsing on me, but there was no pain, just pressure. The doctor told me to use my yoga breathing in the moment. I rested for the rest of the day and was perfect the next day. It was the best decision I’ve made.” —Mariel B.

“It is like getting your ears pierced on your cervix.”

“I thought the copper IUD was the way to go after three kids. The pain was excruciating—a hard cramp, pressure, and a clamp. The best way I can describe it is like getting your ears pierced on your cervix.” —Kelley K.

“The insertion process is definitely not fun.”

“I absolutely love my IUD but the insertion process is definitely not fun in any way, shape, or form. I chose Mirena after all forms of the Pill did not work for me/my body. It’s been the best choice for me and my lifestyle, hands down, and I recommend it to anyone I know/who asks. That being said, it’s a 5 to 10 minute procedure, which can feel like much longer when it’s happening. The cervix measurement just before IUD insertion was actually more painful (like being stabbed in my vaginal wall/cervix with a knife). I’m actually on my second IUD now. The first one was more mild in my opinion—only about 5 minutes of very intense cramping, and some minor cramping during the following day or two. The second time, I had to get my cervix measured before insertion and I nearly jumped off the table. I thought I might pass out, it was so painful. It lasted maybe five to seven minutes. Then the IUD went in and it was painful and I had cramping for another five to seven minutes. I was sweating, shaking, and had nausea—the whole she-bang. It took me 10 to 15 minutes to lay on the table to not feel light-headed anymore. Then I was on my way, cramping for about two days. After that, I was totally fine. Even with how painful the insertion process is, I tell people it’s a short amount of time, and incredibly worth it for not ever having to worry about taking a pill.” —Amelia S.

“It was honestly one of the most painful experiences.”

“It was honestly one of the most painful experiences both before and after. Every woman’s body is different but I was in excruciating pain screaming and then hemorrhaged without being able to move for three full days. I was not prepared for that reaction and neither were the doctors. A year later though, I am very happy with it but wish I had known.” —Elyse K.