Is an IUI supposed to cause a sharp, constant pain during the procedure? My doctor had to use a tenaculum to open my cervix more, and the entire time he was using it I felt pain -- not cramping like with an HSG, but pain. I told him so, and he said it was okay. Is it really okay?

-- Michelle

Intrauterine insemination (IUI) is rarely painful if performed by a skilled physician. During the procedure, a soft catheter is placed through the cervix into the uterus. If the cervix is scarred, or if the canal is twisted, placing the catheter may be uncomfortable. Rarely, an instrument called a tenaculum is necessary to straighten the cervical canal and allow placement of the catheter. The placement of the tenaculum is quite painful unless an injection of local block is used. I would recommend you ask for this next time before the tenaculum is placed.

Another possible cause of pain is a "rough" approach in placing the catheter. Once the catheter is placed through the inner cervical opening, it does not need to be advanced further. However, an unskilled doctor may push the catheter firmly past the cervix and force it into the top wall of the uterus, causing pain. Occasionally a bit of spotting or red discharge and even some fluid drainage can follow the IUI. Do not be alarmed; this is quite frequent, it and does not mean the IUI will fail. But I believe that IUI should not be painful. If you experienced pain, ask your doctor why it occurred and what will be done to minimize the pain if you need the procedure again.