Pain may have been systematically underreported in earlier records.
81% of women experienced moderate to intense IUD insertion pain, with over half reporting severe discomfort—far exceeding official estimates of 5%. Pain management during IUD insertion lacks standardization in Brazil, with inconsistent use of analgesics and anti-inflammatories contributing to negative experiences.
- 81% of women reported moderate to intense pain during IUD insertion, versus 5% in official health records
- Study analyzed over 7,000 IUD insertions at a major Brazilian family planning clinic between 2022 and 2024
- IUDs account for only 4% of contraceptive methods used in Brazil, while oral contraceptives dominate
- Pain management protocols lack standardization, with inconsistent use of analgesics and anti-inflammatory medications
A Unicamp study of over 7,000 IUD insertions found 81% of women reported moderate to intense pain, vastly exceeding the 5% documented in official health guidelines, revealing a critical gap between clinical reality and medical records.
Researchers at Unicamp have documented a striking gap between what medical guidelines say about IUD insertion pain and what women actually experience. A study of more than 7,000 intrauterine device placements conducted between 2022 and 2024 at one of Brazil's largest family planning clinics found that 81 percent of women reported moderate to intense discomfort during the procedure. More than half described the pain as severe. These numbers stand in sharp contrast to the roughly 5 percent figure cited in official health records—a discrepancy so large it raises fundamental questions about how pain has been measured, reported, and managed in clinical practice.
The research matters because it exposes a gap between what happens in the examination room and what gets written down in medical literature. When official guidelines underestimate pain by this magnitude, they shape everything downstream: how doctors prepare patients, what information women receive beforehand, whether they consent to the procedure with realistic expectations, and ultimately whether they choose this highly effective contraceptive method at all. The Unicamp team suggests several explanations for the gap. Pain may have been systematically underreported in earlier records. Individual women experience and describe discomfort differently. There is no consistent protocol for how clinicians assess or manage pain during insertion. And the information patients receive before the procedure—or fail to receive—influences both their anxiety and their perception of what they feel.
The practical consequences are substantial. The IUD remains underutilized in Brazil, accounting for only about 4 percent of contraceptive methods in use, while oral contraceptives dominate. Specialists point to three main barriers: inadequate information about what the procedure involves, fear of insertion pain, and limited access to trained providers. When women are not told what to expect, anxiety rises. When pain arrives and exceeds what they were told to anticipate, the experience becomes traumatic. Some then discourage others from choosing the method, and adoption stalls.
The study also reveals that tools exist to reduce discomfort—analgesics, anti-inflammatory medications, antispasmodics—but they are not applied consistently across clinics or even within the same clinic. This absence of standardization means that a woman's experience depends partly on chance: which provider inserts the device, what that provider was trained to do, whether pain management is part of their routine. It should not work this way. A procedure this common, this effective, and this painful deserves a unified approach.
Broader structural problems compound the issue. Brazil lacks unified family planning guidelines. Professional training varies widely. The distribution of supplies is uneven. There is no systematic monitoring of clinical practices to ensure quality or consistency. Women navigate these gaps with their bodies and their trust. Many face preventable barriers to accessing a safe, long-acting contraceptive method.
The Unicamp findings point toward what needs to change. Health providers and patients need better communication about what insertion involves and what pain management options exist. Clinics need standardized protocols for pain assessment and relief. Training programs need to make pain management routine, not optional. And the gap between official estimates and lived experience needs to be closed—not by pretending the pain is less than it is, but by acknowledging it fully and preparing to address it.
The study does not solve these problems. It documents them with precision. What happens next depends on whether the medical system treats this as a data point to file away or as a call to redesign how one of the most effective contraceptive methods in the world is actually delivered to the women who need it.
Notable Quotes
The contrast between observed data and earlier estimates suggests pain perception may have been underestimated over time, directly impacting how patients are prepared and what strategies health professionals adopt.— Unicamp study findings
The Hearth Conversation Another angle on the story
Why does this gap exist? If 81 percent of women report intense pain, how did official records stay at 5 percent for so long?
The study suggests several things happened at once. Pain may not have been systematically asked about or recorded. When it was reported, it might have been minimized or not taken seriously. And there's a difference between what a patient experiences and what gets written in a medical chart.
So the pain was always there, but nobody was documenting it properly?
Exactly. Or they were documenting it, but the numbers never made it into the official guidelines that shaped how other doctors were trained. Once a guideline says pain is rare, doctors expect it to be rare, and they may not listen as carefully when patients say otherwise.
What does this mean for a woman deciding whether to get an IUD?
Right now, she might be told the procedure is mildly uncomfortable. Then she experiences severe pain. She feels betrayed. She tells her friends. And suddenly the IUD seems like something to avoid, even though it's one of the most effective contraceptives available. The pain is real and deserves respect, but so does the method's effectiveness.
Can the pain actually be prevented or managed?
Yes. The study mentions analgesics, anti-inflammatories, antispasmodics. But they're not used consistently. Some clinics use them routinely. Others don't. It depends on the provider and the clinic. That inconsistency is part of the problem.
So this is fixable?
It is. But it requires acknowledging that the current system is failing women, and then actually changing how the procedure is done—how it's explained, how pain is managed, how providers are trained. That takes will and resources.