What to Know About Having Sex When You Have an IUD

Having an IUD shouldn't cause significant changes to your sex life, but painful sex could indicate that your IUD has moved.

doctor holding iud birth control
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An intrauterine device (IUD) is a small T-shaped plastic device inserted into the uterus to help prevent pregnancy. Since this contraception type stays in the uterus, you may wonder if having sex with an IUD feels different. Or, you may have concerns that your bedroom activities may make your IUD fall out or move.

Both hormonal and copper IUDs are extremely effective forms of birth control and are more than 99% effective at preventing pregnancy (Lanzola, 2022). When inserted correctly, an IUD can prevent pregnancy for 3 to 10 years (Lanzola, 2022). And while it's rare for an IUD to fall out or move, having sex is not a risk factor for IUD complications.

Here's what to expect when you have sex and have an IUD, plus signs you need to see your doctor.

How Does Sex Work With an IUD Inserted?

Getting an IUD shouldn't drastically change your sex life; its purpose, after all, is to help prevent pregnancy from having sex. But, depending on the type of IUD and the timing of your menstrual cycle, some IUDs do not immediately protect you against pregnancy.

Hormonal IUDs slowly release the hormone levonorgestrel to prevent pregnancy. This is usually achieved by preventing ovulation, thinning the uterus lining to prevent an egg from implanting, or thickening the cervical mucus to prevent sperm from reaching the uterus (Lanzola, 2022). But suppose you have a hormonal IUD inserted more than seven days since your last period started. In that case, you'll need to avoid sex or use backup contraception for seven days (CDC, 2022).

Copper IUDs, on the other hand, can act as emergency contraception when inserted within 5 days of unprotected sex (CDC, 2022). Copper IUDs use copper wire to create a reaction that kills sperm and drastically decreases its ability to move (Lanzola, 2022). If you have a copper IUD you won't need to use another form of contraception and can have sex immediately after it's inserted.

However, just because you can have sex after IUD insertion doesn't mean you'll want to. The actual IUD insertion process can be uncomfortable or painful for some folks, and you may experience cramping afterward (Lanzola, 2022). So take all the time you need before jumping back in.

Can My Partner Feel My IUD During Sex?

During sex, your partner should not be able to feel your IUD. This is because it is inserted into your uterus (Lanzola, 2022). During penetrative sex, the penis may hit the cervix (the area that connects the uterus to the vagina). But the penis cannot enter the cervix and reach your IUD.

However, it is possible for your partner to feel your IUD strings during penetrative sex (ACOG, 2021). These two strings are designed to extend past your cervix, which makes it easy for your ob-gyn to remove your IUD in the future. But bumping into these strings should not be intense or painful.

"Sometimes if the string is super short, it could poke the penis," says Christine Greves, MD, an ob-gyn at the center for obstetrics and gynecology at Orlando Health in Florida. "If the string is longer, it can curve underneath the cervix and has less of a likelihood of being noticed."

If you're concerned about your partner feeling your IUD strings, you can talk to your ob-gyn about trimming or curling your strings (ACOG, 2021). But, your partner should barely notice anything poking them during sex.

Does Sex Hurt With an IUD?

Sex isn't supposed to hurt with or without an IUD. But, in the rare instance that your partner feels the actual IUD and not the strings, sex would also be painful for you. This is because pain during sex can indicate your IUD has moved to your cervix or the lower part of your uterus. Other signs your IUD may have moved include the inability to feel the IUD strings with your fingers, abdominal pain, and abnormal bleeding (ACOG, 2021).

While it is rare for your IUD to shift, it is possible, especially after insertion. However, research shows many IUDs that move after insertion move back into the correct position within 3 months (de Kroon, 2003).

Speak to your healthcare provider if you think your IUD may have migrated. If your IUD is no longer in your uterus or not correctly placed, it may not work effectively, increasing the odds of an unintended pregnancy.

Can Rough Sex Dislodge an IUD?

"It's highly unlikely that sex could dislodge an IUD," says Dr. Greves. Because of the location of your IUD, even the most enthusiastic sex positions and experiences shouldn't displace your IUD or cause it to fall out.

Greves notes that because the IUD sits in the uterus rather than the vagina or cervix, it's unlikely to move from any form of penetration. Again, that's because a penis or a sex toy doesn't enter the uterus during penetrative sex.

In general, it's very unlikely that your IUD will move, fall out (what's known as expulsion), or poke through your uterine wall (perforation). Having sex with an IUD is not a risk factor for these complications either.

Research indicates that 2-10% IUDs fall out within the first year (Madden, 2014). You may be more at risk of expulsion if you get your IUD inserted immediately after giving birth (Armstrong, 2022).

Uterine perforation is also very rare, with research estimating that 1 in 1,000 IUD insertions result in perforation (Rowlands, 2016). However, improper IUD insertion, being postpartum, breastfeeding, and having a small or tilted uterus may increase your risk of uterine perforation (Heinemann, 2015).

Is It Normal to Bleed After Sex With an IUD Inserted?

It's not uncommon to experience bleeding or cramping the first few months after IUD insertion (Diedrich, 2014). Folks typically report that these symptoms go away or are significantly less intense than what they experienced before IUD insertion (Diedrich, 2014).

If spotting does not go away a few months after getting your IUD, this could indicate your IUD has moved. Check to see if you can feel the IUD strings with clean fingers; if they've disappeared, call your healthcare provider to get checked out.

When to See Your Doctor

Having an IUD should not make sex painful or uncomfortable for you or your partner. But if you're experiencing pain or having painful sex with an IUD, see your healthcare provider to check your IUD hasn't moved. IUDs also don't protect you from sexually transmitted infections (STIs), so pain or abnormal symptoms could also be a sign of an STI.

Other signs you need to see a healthcare provider about your IUD include:

  • Severe cramping or abdominal pain
  • Heavy bleeding (similar to a period) during or after sex
  • Fever or chills with no clear explanation
  • Unusual discharge or vaginal odor

If your healthcare provider determines your IUD has moved, they will remove and reinsert your IUD. Uterine perforation can be more serious and may require surgery to remove the embedded IUD (Silva, 2000). Depending on your risk factors, your healthcare provider may also suggest a different form of birth control.

SOURCES:

  • Lanzola EL, Ketvertis K. Intrauterine Device. In: StatPearls. Treasure Island (FL): StatPearls Publishing; July 4, 2022.
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