<s>[INST] After an internal examination the pain in my back became unbearable.  I am a 29 year old female who has an IUD in place.  I have heavy and painful periods which also cause severe back pain. Why would having an internal examination cause such pain? [/INST] Hello. Thanks for writing to us. The internal examination is usually not so painful procedure unless there are scars and adhesions in the pelvis. Detailed investigations are needed to find the cause.I hope this information has been both informative and helpful for you. Regards, Dr. Praveen Tayal . For future query, you can directly approach me through my profile URL  drtayal72@gmail.com </s>