If the IUD is in the muscle layer, it will be more painful to remove the IUD. It is very difficult to remove the IUD from the muscle layer, so the doctor needs to use the hook to remove the IUD slowly, which is a long process with a strong pulling force. However, this method of IUD removal may fail. If a patient’s IUD is too large to be removed by hysteroscopy or general IUD removal methods, and the patient is unable to withstand the prolonged intrauterine IUD removal, the patient may opt for surgical IUD removal, either laparoscopic or open surgery. The patient will be given anesthesia during the procedure, so the patient will not feel any pain. If the patient is able to remove the IUD by the usual methods but is very afraid of pain, the patient can use local anesthesia or insert a Stacy plug in the anus before the IUD removal for pain relief, which can effectively reduce the pain during the IUD removal process.