While catching up with a friend, Mallory Tatman discovered they were both getting intrauterine device (IUD) insertions in the coming weeks.
Neither of them were worried about the procedure, as young women are increasingly turning to IUDs as a form of contraception. Even after her friend called from the doctor's office to express how painful it was, Tatman thought she was exaggerating. The Houston native always felt she had a high pain tolerance, and decided to record herself receiving the IUD as proof.
But, the experience that followed was jarring.
“I figured it would feel like a Pap smear, like a typical experience," she says. "Well, (the doctor) went to insert the IUD, and it was the worst pain ever. It just felt like someone stabbed inside of me.”
Tatman later posted the video to TikTok to spread awareness of how painful these procedures can be.
She's not alone. Nicole Marpaung, 23, also went viral for sharing a recording of her IUD procedure on TikTok, accumulating 6.5 million views. In her comment section, other people commiserated over how their IUD insertions had brought the worst pain of their lives. "They don't tell you how bad it is when you go to do it," one user wrote.
In August, the CDC released updated recommendations that encourage doctors to offer patients lidocaine and pain management tools during IUD insertions. But, Tatman believes there is still a long way to go to ensure no one has an experience like hers. These videos, she says, are a good way to start the discussion.
What is an IUD and why can getting one be painful?
An intrauterine device, or IUD, is a tiny device that is inserted into your uterus to prevent pregnancy. IUDs are divided into two types: hormonal IUDs and copper IUDs.
IUDs are long-acting reversible contraceptives and are one of the most effective, mistake-proof methods of birth control. They are also more than 99% effective as emergency contraception when inserted within five days after unprotected sex.
To insert an IUD, a doctor will put a speculum into the vagina, and then use a special inserter (a small tube) to pass the IUD through the cervical opening and into the uterus.
Some people won't feel any pain with the procedure and others will, according to Dr. Franziska Haydanek, an OBGYN and online health educator.
Everyone's experience is different, and women who have had vaginal births, particularly in the past two years, are less likely to experience pain during IUD placement. If someone's cervix is tightly closed, having the IUD inserter go through will be more painful. And, when the IUD is deployed (opened into the uterus), it can touch the top of the uterus and cause uterine cramping for some patients.
Why people are posting their IUD experiences online
Marpaung had originally recorded the video for herself but later wanted to bring attention to these painful procedures by sharing her experience online. Tatman was left confused after her procedure and wanted to know if other people had experienced the same thing.
"I couldn't believe I went through that amount of pain," Tatman says. "But most of my comments were just about how painful it is. It's an old video, but I still get comments asking questions, like, 'I'm about to get mine. How bad does it hurt?'"
Before the release of August's updated CDC practice recommendations, the most up-to-date information was from the CDC's 2016 report. Previously, doctors were not encouraged to offer pain medication to patients receiving IUDs, leaving people in the dark about how to manage their care and reduce discomfort going into the procedure.
Marpaung says she asked about the pain beforehand, and her doctor said it would just be uncomfortable, not painful.
"I didn't realize what the procedure was like," she says. "They brought out this clamp to dilate my cervix. And then they have this scissor thing that clamps right at my uterus, but it literally looks like a medieval torture device."
That device is the tenaculum, a tool with two hooked ends that holds the cervix in place as the uterus is measured and the IUD is placed.
Marpaung began cramping "immediately," but the doctor was "downplaying" her pain while trying to keep her calm. "After the procedure, I didn't even have five minutes after they put it in me (to recover)," she says. "They were like, 'Alright. You're all set, bye.'"
She had to take the rest of the day off work and felt too ill to drive home after the procedure.
Videos like Tatman and Marpaung's can serve as a "warning" ahead of the procedure, and provide a space for people to ask each other questions and offer support — both posts have tens of thousands of comments.
But these first-hand accounts can also lead to anxiety for viewers before their own procedures. Haydanek says that while raising awareness through social media is a positive thing, information received online should be discussed with your doctor.
"Otherwise, you're taking lay people's words and experiences as facts, and it may not be what is medically true, or what is true to you as the patient in the situation," she says.
Will updated CDC recommendations be enough to provide relief?
According to Haydanek, providers can be informed of updated CDC recommendations for any topic through continuing medical education each year, conferences and medical journals. However, offering pain control is not required.
Haydanek says that pain control should be discussed with patients ahead of time so that they're given all of their options. However, Tatman and Marpaung want lidocaine to be required, not suggested, for every IUD procedure.
"Do it for everyone so no one will have to experience that," Marpaung says. "It's an unnecessary pain."
In the reality show "The Secret Lives of Mormon Wives," several of the cast members received laughing gas (nitrous oxide) before getting Botox. At a dentist's office near Tatman, the same drugs are offered for routine visits: "I'm like, 'OK you're getting laughing gas for getting your teeth cleaned' ... It's very backwards. I don't understand it."
"In women's health, trying to get anything that's not traditionally offered is the hardest thing," Tatman says. "There should be a pre-care, during-care and after-care, like a whole policy that should be followed when getting an IUD, just like any other procedure."