Intrauterine devices (IUDs) are among the most effective forms of contraception, but they can create pain upon insertion. Reporting in Slate reveals that healthcare providers with a subspecialty in complex family planning are more likely to offer pain management––including paracervical blocks like lidocaine, or sedation––for IUD insertion. One insidious consequence of the closures of abortion clinics across the U.S. is that fewer clinics may end up offering pain management for IUDs.
According to a 2025 study published in the American Journal of Obstetrics & Gynecology, 79 percent of patients who received a local anesthetic for their IUDs were treated by physicians who were board-certified in complex family planning, a subspecialty that focuses on pregnancy prevention, pregnancy loss, and abortion. The American College of Obstetricians and Gynecologists has recommended that more cervical and uterine procedures, including IUD insertion, use pain management.
Health journalist Sarah Boden notes that as abortion clinics shutter, more patients who want an IUD “to manage periods, prevent pregnancy, or reduce pain caused by conditions like endometriosis might have to undergo painful procedures to receive one—if they’re able to receive one at all.”
SARAH BODEN; [email protected]
Boden is an independent health journalist.
Boden told the Institute for Public Accuracy: “For patients who need gynecological care, we tend to just accept that pain is part of the experience. But through my own reporting, I realized that the providers who approached pain management more thoughtfully were often those trained in abortion care and who regularly include it in their practice. These providers are more likely to offer options like paracervical blocks or sedation.”
To Boden, what stood out in the 2025 study, focused on pain management with IUD placement, was that abortion providers tended to offer more pain management. “It wasn’t the focus of the study, but it jumped out from the results. I realized I wasn’t imagining things. When friends asked me where to get an IUD, I would direct them to local abortion providers—places where they’re more likely to take pain seriously and offer better care.
“You can’t get an abortion in Texas in a healthcare facility anymore, unless it’s a very specific medical emergency. Clinics in Austin or New Orleans that used to do abortion care are now doing IUD placement. They are still practicing complex family planning, which is a fairly new subspeciality. But if you’re getting a first trimester procedural abortion, you’re going into a clinic for it and it’s standard to do lidocaine, or paracervical block injections, or if you’re further along in the pregnancy, you might want to be sedated. These providers are trained to provide this care, and the clinics that provide the care have the infrastructure to do so.
“As a journalist, I want to share information to help readers and listeners empower themselves. When it comes to healthcare, information is powerful because the system is so opaque. I want readers to know that they can ask for these interventions; they’re not rare… But there’s still a difference of opinion in the practice of gynecology, and a lot of [providers] still won’t provide this level of care. It can be hard to advocate for yourself, especially if you’re in an area of the country with fewer resources. But there are places where they will make this type of care much more comfortable for you.”