Whether or not to take anesthesia to remove a 20-year old IUD varies from person to person. Generally, anesthesia is not necessary, but only if the IUD is embedded or if it is sensitive to pain. 1. No need for anesthesia: before removing the 20-year-old IUD, a vaginal ultrasound is needed. If the IUD is in a normal position and is not embedded, it will be easier to remove it, and there may only be a soreness in the lower abdomen when removing it, with no obvious pain, and no need for anesthesia in this case. 2. Need anesthesia: If the IUD is embedded, it will be difficult to remove the IUD, which may be accompanied by uterine damage, or some women have poor pain tolerance, so anesthesia may be used to remove the IUD in order to avoid pain. It is recommended to go to a professional family planning clinic for the removal of the IUD, and the specialist will give you a treatment plan according to your personal situation, and you should actively cooperate with the doctor to carry out the corresponding examinations.