For years, patients have said that getting an IUD can be surprisingly painful — and often felt their pain was dismissed. Now a rigorous trial backs a concrete way to help: a numbing injection called a paracervical block meaningfully reduced pain during IUD insertion.

The context

The intrauterine device (IUD) is one of the most effective forms of contraception, but placement requires passing an instrument through the cervix, which can cause sharp cramping. Historically, many clinicians offered little more than an over-the-counter painkiller, and surveys have shown a gap between the pain patients experience and what providers anticipate. The issue gained national attention as patients pushed for better pain control — making solid evidence especially welcome.

What the trial tested

The double-blind, randomized controlled trial — the gold standard — enrolled 246 patients split into three groups of 82. One group received a paracervical block with 1% lidocaine (plus epinephrine) — an injection of local anesthetic around the cervix; another received a saline injection; and a third received a capped needle (mimicking the sensation of an injection without delivering anything), controlling for the effect of the needle itself.

The results

Patients who got the real lidocaine block reported lower overall pain during placement: a median global pain score of 30 mm (on a 100 mm scale) versus 45 mm for both the saline and capped-needle groups. The benefit was particularly pronounced for nulliparous patients — those who have never given birth, who tend to experience more pain during IUD insertion — and the injection itself caused minimal discomfort. The authors concluded the evidence supports incorporating the paracervical block into routine IUD placement, especially for these higher-pain patients.

How it fits the wider evidence

The paracervical block is one of several options being studied. A large network meta-analysis of 71 trials found lidocaine 4% gel ranked as the most effective single option for insertion pain, followed by lidocaine 1% solution, while a lidocaine spray performed no better than placebo in one 2026 study. The consistent theme: lidocaine-based approaches help, and the best method may depend on the patient and setting.

Why it matters

Beyond comfort, effective pain control has real consequences: fear of pain can deter people from choosing a highly effective contraceptive, or from keeping it. Evidence that a simple, low-risk injection genuinely reduces pain gives clinicians a tool — and gives patients grounds to ask about pain-management options before the procedure. It also validates a patient concern that was long under-addressed. This summarizes research and is not medical advice; discuss options with your clinician.