<s>[INST] I have the paragard iud Ive had for almost three years. Off and on Ive had problems with severe pains that seem to be from gas but I can feel it in my cervix. This month during my period I had severe pains and cramping just like when they put it in. When I checked it I could feel a bump but my strings were still in place. Went to my local clinic that I had it inserted at and they looked for about thirty seconds said, oh your strings are there so youre fine, and dismissed me. I need to know if I should be worried about these pains? They were so intense my husband couldnt even bump against me without causing me pain. I dont have insurance so a second opinion isnt an option. Im really afraid the pain means its perforating something... [/INST] Hello, You are right to become concerned about the position of the intrauterine device. In the current scenario, the accurate position of the device can be known through a trans-vaginal sonogram and/or an MRI of the pelvis. If the device has been confirmed to be in-situ, then the cause of the pain should be identified and the possibilities are some pelvic infection and endometriosis. Though you may get relief through use of antispasmodics, since you say the pain is sever, you should get investigated further. Hope this helps. </s>