Getting an IUD can be very painful. There’s a solution.

When Tove Danovich recalls the first time she got an IUD, one thing stands out: the sheer pain of the procedure. After the IUD was placed, she remembers horrific, debilitating cramps.

Around a decade later, when Danovich went to a clinic for another IUD—a small, T-shaped birth control device that’s inserted past the cervix into the uterus—she asked the doctor for pain medication. The doctor gave her Ativan, an anti-anxiety drug, which Danovich found insulting. But she didn’t want to argue.

Unfortunately, Danovich’s experience is all too common; patients receiving IUDs are frequently told to take ibuprofen, grin, and bear it. But it doesn’t have to be this way.

Many clinicians point to the paracervical block—a simple, targeted injection of a local anesthetic around the cervix—as a way to greatly reduce pain during IUD insertions. Yet, in practice, paracervical blocks are rarely used for IUD procedures, a discrepancy rooted in the historical dismissal of women’s pain, limited research into IUD pain management, and patient anxiety about receiving an injection near their cervix.

One physician, however, is working to change this. Over the past two years, Roshni Kakaiya, a San Diego–based family medicine doctor, has created a training model that lets clinicians easily practice paracervical blocks—education she believes should be foundational for anyone in women’s health. The now-patented product has drawn national attention: Since last November, Kakaiya has sold 80 kits and compiled a long list of interested buyers. A kit costs $150 and comes with both a “beginner”-level silicone cervix to get the basics down, and a more realistic “advanced”-level cervix.

The hope is that these more highly trained providers will be able to offer patients a full range of pain-relief options and that paracervical blocks will become the standard of care for IUD procedures. “If we can make this experience slightly better for people, or if they feel like they have more agency, I feel like it would make a big difference,” Kakaiya said. “We can’t give patients their full range of choices if us as providers aren’t even trained.”

To insert an IUD, a clinician opens the vagina using a speculum and grips the cervix with a type of forceps, which can cause a sudden, sharp pain. A tube containing the IUD is then passed through the tiny cervical opening into the uterus, a process that is excruciating for many patients. Some experience cramping and discomfort for days after the procedure.

Research on IUD pain management is limited, and historically, there hasn’t been much data on cervical blocks. Consequently, the blocks just weren’t “valued as a procedure that was worth teaching,” said Kakaiya. “You had a whole generation of people who weren’t trained to do it, and then they can’t train others. And then that just keeps propagating.”

Today paracervical blocks during IUD insertion in the United States remain rare. One nationwide study of Veterans Affairs clinics found near-zero use. Another, based out of the University of California, San Francisco health system, found that less than half of patients receive blocks. Instead, the standard recommendation for pain relief during IUD insertion is to take 800 milligrams of ibuprofen an hour beforehand—a method that falls woefully short of addressing the intense discomfort experienced by many patients.

Yet, numerous studies over the past decade have determined that paracervical blocks are highly effective at reducing pain during the procedure. “I don’t think [clinicians] are as aware of these studies and interventions that can decrease pain during IUD placements,” said Sheila Mody, an OB-GYN and professor at the University of California, San Diego Health, whose 2018 study found that paracervical blocks significantly decrease discomfort during IUD insertion.

Although OB-GYNs like Mody are trained in paracervical blocks (they’re used in surgical abortions and miscarriages), many IUDs are placed by advanced practice clinicians—such as physician assistants and nurse practitioners—who often lack training in this technique. To address this issue, Mody trains APCs in paracervical blocks and is currently conducting three studies to further evaluate the procedure’s effectiveness.

Paracervical blocks are so effective that both the American College of Obstetricians and Gynecologists and the Centers for Disease Control and Prevention support using them during IUD insertion. “There is an urgent need for health care professionals to have a better understanding of pain-management options and to not underestimate the pain experienced by patients and for patients to have more autonomy over pain-control options,” notes a review of the literature from the American College of Obstetricians and Gynecologists, published last year.

That emphasis on patient choice is what motivated Kakaiya to develop a better way to train clinicians to perform paracervical blocks.

The training process, however, proved more complicated than Kakaiya initially expected. She quickly discovered that available pelvic models have hard plastic shells around the cervix where providers practice injecting; this prevents trainees from getting the necessary tactile feedback to learn where to inject. In response, clinicians have created their own unique prototypes to mimic the cervix, including a tomato attached to a plastic cup, a lemon attached to a PVC pipe, or, in Kakaiya’s case, a dragon fruit attached to a thick silicone tube. But these templates don’t come anywhere close to the real thing, so Kakaiya decided to make an anatomically precise, patented 3D-printed model.

The product offers clinicians an easy way to learn without having to practice on patients already undergoing nerve-racking procedures. Since last fall, when Kakaiya began selling the model, clinician interest has mushroomed. “It has been an overwhelmingly positive response,” she said. The next step is to expand the product’s reach to even more clinicians who perform IUD placements.

Mody, who recently received her own kit, believes that the device can help build confidence—especially for clinicians who are APCs or work in family medicine but haven’t received paracervical block training. “I think if you’re being trained to put IUDs in, you should be trained how to do paracervical blocks as well,” Mody said.

When Danovich decided to have her IUD removed, she was told there were a few complications and that the process would be more involved than is typical. To avoid any additional pain, she sought out a clinic that offered paracervical blocks—a process she found to be surprisingly difficult. “I remember the first things that came up were concierge clinics … but it’s cash pay, ‘we don’t take insurance,’ ” Danovich said. “It took a while to find this normal doctor’s office.”

In the end, the IUD removal was easy and relatively painless, with only brief discomfort from the injection. “I’m glad there are doctors that are really taking the fact that these procedures can be incredibly painful into consideration,” said Danovich. “That feels like the bare minimum.”