14 answers to the most uncomfortable IUD questions you were too embarrassed to ask

The INSIDER Summary:

• IUDs (intrauterine devices) are more than 99% effective at preventing pregnancy.
• But the idea of a foreign device in your body can be scary.
• Lots of women have questions about the insertion process and potential complications.
• INSIDER asked a gynecologist all of the most embarrassing questions about IUDs.

Intrauterine devices (IUDs) are pretty much the gold standard when it comes to birth control. They’re more effective than the pill and easier to use — mostly because you don’t have to use them at all. You simply visit a doctor for a brief insertion procedure, and that’s it: You’ve got hassle-free contraception for the next three to 10 years, depending on which brand you choose.

But if you’re new to IUDs, you probably have lots of questions — after all, implanting a foreign object in your uterus is not something you do every day. That’s why INSIDER spoke with gynecologist Alyssa Dweck, MD, author of “The Complete A to Z for your V,” to answer all of your most embarrassing IUD questions.

Read on to find all the answers.

1. Why does the insertion hurt — and how bad is it really?

You’ve probably read online horror stories about painful insertion. Yes, there is some pain — like a really bad menstrual cramp — but it only lasts a few seconds. In order for the IUD to reach your uterus, the doctor must push it through the narrow opening in your cervix. That stretching of the cervix accounts for a lot of the discomfort, Dweck explained. And in some cases, the doctor might put a small clamp on your cervix to hold it steady, which can create a pinching sensation.

“Yes, it’s going to be a little bit of a cramp,” Dweck told INSIDER. “I typically remind people to take Advil or Motrin or some sort of an over the counter painkiller to help with pain 20 or 30 minutes before insertion. And to have someone on hand throughout the day if they need it.”

You can read five insertion stories from real women right here.

2. Why does my doctor want to insert the IUD during my period?

“It ensures that somebody’s not pregnant,” Dweck said. “The last thing we want to do is put an IUD in someone who might be pregnant and not recognize it.”

Also, doctors think that the cervix might be a bit more open during menstruation, which can make insertion a bit easier.

3. Why does my doctor want me to take a cervix-softening drug?

If you’ve never had kids or if you’ve had certain surgical procedures, you might have a narrower-than-average cervix. This can make insertion difficult.

It’s not common, Dweck said, but doctors will occasionally prescribe pre-insertion medicines that help to soften and open up the cervix. One is called Misoprostol, which can be taken orally or inserted vaginally. (FYI: possible side effects include diarrhea, headaches, stomach pain, gas, vomiting, constipation, and indigestion.) Dweck also said that estrogen tablets or creams can be used.

If your doctor thinks these interventions are necessary, he or she will let you know.

4. How much cramping and bleeding is normal after the insertion?

“You may have cramping that’s notable for about 30 minutes after [insertion]. My experience tells me that usually the cramping will be present for a day or so,” Dweck said.

Irregular bleeding can last longer. “With the hormonal IUDs it’s common to see even up to three to six months of erratic bleeding with or without your regular period,” she added.

So how do you know if your cramping and bleeding have become abnormal? Use these guidelines:

“After a day or two, requiring medication for pain is not expected,” Dweck said. If the pain is that bad, make an appointment to see your doctor.

“Foul-smelling bleeding should be checked out, because that could be a kind of infection,” she added. “Very heavy bleeding, where you’re soaking or saturating a pad or two every hour — that’s way too much and should be checked out.”

5. How long until I can have unprotected sex?

First, remember that the IUD does not protect against sexually transmitted infections, so keep using condoms to avoid those. In terms of preventing pregnancy, here’s how it breaks down:

The copper IUD (known by the brand name ParaGard) starts preventing pregnancy immediately upon insertion.

For the hormonal IUDs (Skyla, Mirena, Liletta, and Kyleena), it depends on when you had your insertion. If the IUD was put in place within 7 days of the start of your period, it’ll prevent pregnancy right away. But if you get the IUD inserted at any other time in your cycle, you’ll need to use backup birth control, like a condom, for 7 days.

6. Can I still use tampons?

Yes! “Putting a tampon in is not going to dislodge your IUD or move your strings or anything like that,” Dweck said.

7. What if I can’t feel the strings?

First, a quick explainer for the uninitiated: At the end of every IUD there are two thin strings that the doctor will eventually use to pull the device out of your body, either when it’s expired or when you decide you don’t want to use it anymore. When the IUD is in place, the strings will hang down from your cervix into the very top of your vagina. Most doctors will advise you to reach up and feel the strings once a month, at home, just to make sure that the IUD is still in place. If you’re unsure of how to reach them — or you just want to know what they feel like — ask your doctor to teach you right when you get the IUD inserted.

So what happens when you can’t find the strings during one of your self-checks?

It might not be an issue, Dweck said. Some women just have trouble feeling them, and sometimes the strings are cut so short that they’re difficult to discern. But missing strings could indicate that your IUD has moved out of place.

“If you’ve always felt the strings and all of a sudden you don’t, call your doctor and come in and get checked,” Dweck said.

8. Will my partner feel the strings during sex?

It’s possible. But the strings should get softer and less noticeable with time. If it’s really causing an issue after a few months, call your doctor — you might want to ask her to trim the strings a bit shorter.

9. How can I tell if my IUD is coming out?

Believe it or not, you’ll probably see it.

“Normally you’re going to have some pretty bad cramps, maybe some bleeding and you’re going to find your IUD either in your underwear, in your vagina, or in the toilet.”

If that happens — in case this isn’t obvious — call your doctor.

10. How can I tell if my IUD perforated my uterus?

Perforation is really rare — it happens in about 1 in 1,000 IUD insertions. Basically it means that the IUD attaches to or pushes through the wall of your uterus. If this happens, you may need surgery to get the IUD removed. If the IUD has traveled outside your uterus, you’ll probably have significant pain or discomfort. Also, do a self-check on your strings. If you can’t find them, it could indicate that your IUD has moved.

When in doubt, trust your instinct and call your doctor.

“I have to really make the plug for common sense,” Dweck said. “If something doesn’t feel right, just come in. We’d rather see.”

11. How will I know if my IUD failed and I’m pregnant?

IUDs are really effective, but no form of birth control prevents pregnancy 100% of them time. Pregnancy is highly unlikely but still possible.

First, watch for early pregnancy symptoms, like fatigue, swollen or tender breasts, and nausea.

Then you want to look out for irregular bleeding.

“What I always say is, after the first six months, when you’re used to what your IUD bleeding habits are like, start to reassess your symptoms,” Dweck said. “If you’re suddenly getting spotting when you never did, do a pregnancy test […] If you always get a monthly period with your IUD and now you don’t, do a pregnancy test. It’s [about] getting used to what usually happens and then picking up on a difference.”

12. Is it possible to pull out my IUD on accident?

It would be really tough. “I think it’s important to know that by checking your own strings, you’re not going to pull your IUD out,” Dweck said. “That would be like a physical impossibility, pretty much.”

Just don’t tug on the strings and you’ll be fine.

13. Do IUDs cause abortions?

Nope.

“I like to make it clear that the IUD does not cause an abortion. A lot of women are worried about that,” Dweck said. “[IUDs] might prevent ovulation, they definitely change the cervical mucus and the nature of the uterine lining, and they may incapacitate sperm.”

In other words, they work by preventing an egg from being fertilized in the first place. They don’t cause an “abortion” of fertilized eggs.

14. Will an IUD affect my fertility?

Nope. IUDs have long suffered from a bad reputation because of the Dalkon Shield, an IUD used back in the 1970s that increased the risk of pelvic inflammatory disease — a condition that can lead to infertility. But things have changed.

“The newer IUDs don’t seem to make people prone to the bad type of pelvic infections of the past,” Dweck said. “So that’s really important, fertility doesn’t seem to be affected.”