I assumed getting an intrauterine device inserted for the first time would be uncomfortable. But I wasn’t prepared for it to be the worst physical pain of my life.

I consider myself to have a somewhat high pain tolerance: I’ve gotten several tattoos, I’ve had a double mastectomy, and, as a child, I underwent a spinal tap when I had spinal meningitis. I hate Pap smears and wince during them; I had a cervical biopsy once and winced through the cramping. But it was all tolerable. At least, tolerable enough not to make me scream like a child, even when I was still a child.

I thought the pain of IUD placement would be comparable to the cervical biopsy I had: a pinch and uncomfortable cramping. After all, that’s how IUD insertion is often characterized: as discomfort and three notable cramps.

As the doctor began placing my copper Paragard IUD, I waited for those cramping feelings. Instead, it felt like I was being stabbed. I suddenly morphed into a child, or perhaps even an animal. I felt myself hyperventilating, my legs shaking, my back and neck immediately sweating profusely, and—worst of all—uncontrollable sobbing while screaming out, “I’m sorry for being such a baby.”

The doctor said my reaction was normal, but I felt humiliated and embarrassed for having what I thought was such an out-of-character experience. I feared the doctor thought I was being dramatic. As I walked out of the medical center, I nearly threw up and my legs shook for a couple of hours. The actual cramps—not the sharp pains I was feeling—came later and they continued for weeks.

What was this barbaric procedure I underwent? If painkillers and numbing cream exist, surely this would be the time to administer them, right? Was I being too dramatic?

I started asking around and sharing my experience. After talking to others who’ve also gotten an IUD, I learned that my experience was not uncommon.

Lauren Krouse, who’s 28 and lives in Washington, D.C., said getting a Paragard inserted was “the single most painful experience” of her life. She saw stars and nearly blacked out, then she writhed in pain for hours after driving herself home. It’s a decision she now considers unsafe due to the physical agony.

She said she didn’t feel she “was adequately prepared for the astounding pain.”

Bianca Silva, like me, screamed out and cried when she got a Paragard put in. She had anticipated it being unpleasant but wasn’t too worried.

“I knew it was supposed to feel a little more intense than a Pap smear but not that bad,” she said, adding that she was surprised by her reaction. “It was the opposite of what I expected. I felt like something was trying to rip my body.”

Silva, who’s 29 and lives in New York City, was so disturbed that she got the IUD removed the same day. If she knew it was going to be that painful, she said, she would have asked for anesthesia.

Yet anesthesia, or any prescribed pain management for IUD placement, is extremely rare. In fact, it’s nearly nonexistent.

Dr. Jennifer Chin, a gynecologist completing a fellowship in complex family planning, told Rewire News Group that in five years of placing IUDs in patients, she’s given pain medication to only two.

Because “for most people [IUD insertion] does not cause significant pain,” Chin said, she doesn’t usually offer pain management.

“In general, we do not give pain management with the exception of recommending taking ibuprofen about 30 minutes beforehand,” she said. “That has been shown to help out with the cramping after the placement.”

But in a randomized controlled trial of 202 women, published in the journal Contraception in 2015, ibuprofen did not actually help with IUD insertion pain.

Chin said lidocaine gel or a paracervical block (an injection of the lidocaine into the tissue around the cervix) is sometimes used, but only when a doctor predicts the patient’s pain level will be high.

Some providers may suggest patients use misoprostol, a medication used to soften and dilate the cervix, according to Dr. Meera Shah, chief medical officer at Planned Parenthood Hudson Peconic. However, she noted that research shows it’s not helpful in most cases.

Chin said her primary way to alleviate pain is talking her patients through the “discomfort.” She informs them that there will be three “significant cramps”—once due to a clamp that holds the cervix open, the second from the uterine sound, and, finally, from the insertion of the IUD itself.

“I find that if my patients know to know that this progression is happening and that we are moving towards being done with the procedures, that helps out a lot,” Chin said.

Shah similarly suggested that lower pain levels can coincide with having a provider who explains the process.

“Anxiety, fear, or stress may make the experience less comfortable for some patients, which is why it’s so important to find a provider you trust who is willing to explain the process with you and discuss any potential side effects beforehand,” she said.

My extreme IUD pain was attributed to anxiety as well. But I was anxious about the cramping I had anticipated, not the searing pain I ended up experiencing. A 2013 study suggests that health providers could be underestimating the pain many people feel during an IUD insertion, with patients measuring their pain twice as high as their providers did.

“I think there is a historical tendency to minimize women’s reports of pain, both in the reproductive arena and in health more broadly, and [to] attribute them to psychological factors, such as anxiety,” Rene Almeling, an associate professor of sociology at Yale University who specializes in gender and medicine, told Rewire News Group.

Another 2013 study shows that, yes, for the majority of patients, IUD placements do not require pain relief. But it also says that for about 17 percent of women who haven’t given birth and for about 11 percent of women who have, the pain is “substantial” and “needs to be proactively managed.”

That’s approximately 1 in 10 women who have given birth and nearly 2 in 10 women who haven’t. While certainly a minority, it’s also not a number to scoff at.

In 2018, Casey Johnston wrote for the Outline “that if men had to have IUDs inserted like women do, it would be a hell of a lot more like getting one’s wisdom teeth out: substantial efforts to mitigate the pain during and after, where the option of going under general anesthesia is not unusual.”

“It seems like medical researchers are at least actively looking into women’s reports of pain, and I hope those efforts continue as long as women [do] continue to experience unnecessary pain with IUD insertion,” Almeling said. “It’s very important to believe women’s accounts of pain and to take them seriously and to try to do everything possible [to keep them] from experiencing unnecessary pain.”

Now that it’s been a few months, my IUD has settled and the pain has subsided. While I’m glad I got it and am happy this kind of birth control is accessible, I still wish I had taken either a pain killer or anti-anxiety medication during the painful insertion. If I ever have to go through the process again, that’s what I’ll be doing, whether prescribed or not.