It’s supposed to be "set it and forget it." That’s the whole pitch of the intrauterine device. You go into the clinic, endure a few minutes of—let's be honest—pretty intense cramping, and then you’re good for three to ten years. But then you’re in the heat of the moment, things are going well, and suddenly there’s a sharp, stabbing jab or a dull, deep ache that kills the mood instantly.
If you're dealing with pain during intercourse IUD issues, you’re definitely not alone, but you’re probably frustrated. You got the thing so you wouldn’t have to worry about pregnancy, not so you’d have to worry about whether a certain position is going to make you see stars.
The reality is that while IUDs are over 99% effective at preventing pregnancy, they aren't always a "seamless" addition to your body. Sometimes the body fights back. Or sometimes, the IUD just isn't sitting quite where it should be.
Is it the IUD or Something Else?
Sex shouldn’t hurt. Period.
But when it does, and you have a small plastic T-shape sitting in your uterus, it’s the natural first suspect. Doctors often hear patients describe two specific types of pain. There’s the "poking" sensation, which is usually related to the strings, and then there’s the deep, internal "thumping" or cramping pain. These are two very different problems with very different fixes.
Sometimes, the "pain" isn't even yours. Partners often complain about feeling a "sharp poke" or a "fishing line" sensation. Those are the monofilament strings. When an IUD is first inserted, the strings are often a bit stiff. Over time, they soften and curl around the cervix, tucked away like a well-behaved guest. But if they were cut too short, they stick straight out like tiny spears. If they’re too long, they might get in the way.
The Mystery of the Malpositioned IUD
This is where things get a bit more serious. If you are experiencing deep pain during intercourse IUD related or otherwise, it could be that the device has moved. This is called displacement or expulsion.
A study published in the journal Contraception notes that the risk of IUD expulsion is generally low—somewhere between 2% and 10%—but it’s most likely to happen in the first few months after insertion. If the IUD slides down into the cervical canal, it’s no longer just sitting in the "dead space" of the uterus. It’s now pressing against the sensitive tissue of the cervix. When your partner’s penis or a toy hits the cervix during deep penetration, it pushes against that misplaced plastic.
That hurts. A lot.
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It’s not just about the pain, though. If the IUD isn't in the fundus (the top of the uterus), it might not be working correctly. You’re essentially walking around with a piece of plastic in the wrong spot and no guarantee of birth control.
Why Your Body Might Be Rejecting the "Guest"
Your uterus is a muscle. Its entire job, historically speaking, is to push things out—whether that’s a uterine lining during a period or a baby during labor. When you put an IUD in, some bodies just don't want it there.
Chronic inflammation can occur. For some people, particularly those with a copper IUD (ParaGard), the device works by creating an inflammatory response that is toxic to sperm. For most, this stays localized. But for others, that inflammation makes the entire pelvic region feel tender. You might find that sex during certain times of your cycle—like right before your period when your uterus is already a bit lower and more sensitive—becomes unbearable.
Then there’s the issue of size.
Uteruses come in different shapes and sizes. If you have a smaller uterine cavity or a "septate" uterus (divided by a wall of tissue), a standard-sized IUD like the Mirena or ParaGard might be a tight fit. The arms of the "T" might be poking into the myometrium (the muscle wall). In these cases, switching to a smaller frame, like the Kyleena or Skyla, can sometimes resolve the discomfort because the device actually fits the "room" it’s living in.
The Role of PID and Infection
We have to talk about Pelvic Inflammatory Disease (PID). While the IUD itself doesn't cause PID, the insertion process can potentially introduce bacteria into the uterus if an underlying infection like chlamydia or gonorrhea is present.
If your pain during intercourse IUD is accompanied by:
- Unusual or foul-smelling discharge.
- Fever or chills.
- Random spotting that isn't your period.
- A heavy, "full" feeling in your pelvis even when you aren't having sex.
You need to get to a clinic. PID can lead to scarring of the fallopian tubes and long-term pelvic pain if it isn't treated with antibiotics immediately. It’s not something to "wait and see" about.
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Practical Fixes for IUD Discomfort
Honestly, some fixes are remarkably simple.
If your partner is being poked, your doctor can usually trim the strings or, conversely, leave them long enough to tuck behind the cervix. Don’t try to "trim" them yourself—yes, people have tried—because you risk pulling the device out or creating a jagged edge that’s even worse.
If the pain is deep, try changing positions. Angles that allow for shallower penetration (like side-lying or "spooning") might bypass the direct hit to the cervix that triggers the IUD-related ache. However, if the pain persists across all positions, the "geometry" of your sex life isn't the problem; the hardware is.
When to Demand an Ultrasound
If you tell your doctor you have pain during intercourse IUD and they simply tell you to "give it time" without checking the placement, you might need a second opinion.
A simple pelvic exam can tell a provider if the strings look okay, but it can’t see inside the uterus. A "string check" only confirms the IUD hasn't fallen out completely. It doesn't confirm if one of the arms is embedded in the uterine wall or if the device has rotated. A transvaginal ultrasound is the gold standard here. It provides a clear picture of exactly where that device is sitting. If it’s even a few millimeters out of place, that could be the source of your agony.
Navigating the Copper vs. Hormonal Divide
It is worth noting that the type of IUD you have matters.
The copper IUD is notorious for causing heavier, more painful periods. This increased cramping can make the uterus more irritable in general. If you’re already prone to primary dysmenorrhea (painful periods), the copper IUD can turn a mild annoyance into a chronic pain issue that bleeds into your sex life.
Hormonal IUDs (Mirena, Liletta, Kyleena, Skyla) thin the uterine lining. For many, this reduces pain over time. But for a small subset of people, the progestin can cause side effects like vaginal dryness. If you’re dry, sex hurts. If sex hurts, you tense up. If you tense up, the penetration feels even more "impactful" against the cervix and the IUD. It’s a vicious cycle. Using a high-quality, water-based or silicone lubricant can sometimes be the missing piece of the puzzle that has nothing to do with the IUD’s physical placement.
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Actionable Next Steps
If you are hurting, don't just "tough it out." Here is the roadmap to getting back to a painless sex life.
Step 1: The Self-Check
Wash your hands and feel for your strings. They should feel like thin plastic thread, similar to fishing line, poking out of your cervix (which feels like the tip of your nose). If you feel hard plastic—the actual body of the IUD—stop having sex and call your doctor. The device is dislodging.
Step 2: Track the Pain
Does it only hurt in "doggy style"? Does it only hurt the week before your period? Is it a sharp sting (strings) or a deep throb (placement/inflammation)? Having these specific details helps your doctor move past the "it's just normal adjustment" brush-off.
Step 3: Schedule a "String Trim" or Ultrasound
Request an appointment specifically to check the IUD's position. Be firm. Use the words "dyspareunia" (the medical term for painful sex) and "impact on quality of life." If the ultrasound shows it's misplaced, it needs to be removed and potentially replaced.
Step 4: Consider a Switch
If your uterus is just "angry" at the IUD, it might not be the right method for you. Some people switch to the Nexplanon (the arm implant) or go back to the pill and find their pelvic pain vanishes within one cycle. Your birth control should work for you, not against you.
Step 5: Pelvic Floor Therapy
Sometimes, the initial pain of the IUD insertion causes the pelvic floor muscles to go into a protective spasm (guarding). Even if the IUD is perfectly placed, your muscles might still be "holding their breath." A pelvic floor physical therapist can help desensitize the area and retrain those muscles to relax during penetration.
The bottom line is that while an IUD is a great tool, it’s still a foreign object in a very sensitive part of your body. Listen to what your body is telling you. If it’s saying "ouch," it’s time to investigate.