Nexplanon insertion is one of the least painful minor medical procedures you can have. The area is numbed with a local anesthetic beforehand, so most people feel a brief sting from the numbing shot and then little to nothing during the actual implant placement. In a clinical study of adolescents, the average pain score during the implant insertion itself was only 6 out of 100 on a pain scale, essentially negligible for most people.
What the Insertion Actually Feels Like
The procedure has two distinct moments of sensation. The first is the numbing injection, a small shot of lidocaine into the skin of your inner upper arm. This feels like a quick bee sting or pinch and is consistently rated as the most uncomfortable part of the entire process. In a pilot study published in the Journal of Pediatric and Adolescent Gynecology, patients rated the lidocaine injection at an average of 19 out of 100 on a visual pain scale. That’s mild by any standard, roughly equivalent to a routine blood draw.
Once the numbing takes effect (usually within a minute or two), the implant is placed just under the skin using a preloaded applicator. Most people feel pressure or a pushing sensation but no sharp pain. The insertion itself scored an average of just 6 out of 100 on the same pain scale. The whole procedure takes about one to two minutes from start to finish.
Some clinics now use a numbing cream containing lidocaine and prilocaine applied to the skin before the injection, which can reduce even the sting of the needle. A randomized controlled study in Fertility and Sterility found that this topical cream significantly reduced pain during insertion compared to the standard numbing shot alone.
Soreness and Bruising Afterward
Your arm will be numb for about two to three hours after the fitting. Once the anesthetic wears off, expect tenderness and soreness at the insertion site, similar to what you’d feel after getting a flu shot but a bit more persistent. Over-the-counter pain relievers like acetaminophen can help during this period.
Bruising is extremely common. The size and color of the bruise varies from person to person, but it typically clears up within a few days if you follow aftercare instructions carefully. Removing the pressure bandage too early can make bruising worse and extend it to several weeks. The standard guidance is to keep the pressure bandage on for 24 hours and leave the smaller adhesive bandage in place for three to five days. Most people feel back to normal within a week.
How Removal Compares
Removal uses the same local anesthetic, so the numbing shot feels identical to insertion. The difference is what happens next: instead of sliding a device under the skin, your provider makes a small incision near the tip of the implant and pulls it out with forceps. If fibrous tissue has formed around the implant over the years (which is normal), your provider may need to gently separate that tissue before extracting it. This can make removal take slightly longer and cause more post-procedure soreness than insertion.
In some cases, the implant isn’t immediately visible through the incision. When that happens, the provider uses curved forceps to locate and grasp it, then carefully dissects any surrounding tissue. You shouldn’t feel pain during this process because the area is numbed, but you may feel tugging or pressure. Listed risks of removal include bleeding, bruising, and minor scarring at the incision site. Recovery follows the same general timeline as insertion, with tenderness lasting a few days to a week.
Signs Something Isn’t Right
The vast majority of insertions are straightforward, but placement problems can occasionally cause symptoms that go beyond normal soreness. If the implant is placed too deeply or in the wrong position, it can sit on or near a nerve. The most commonly affected is the ulnar nerve, which runs close to the surface near the elbow, or the medial cutaneous nerve of the forearm.
Nerve-related symptoms include persistent tingling, numbness, or shooting pain that radiates down the forearm or into the hand. These sensations are distinct from the dull ache of normal healing. In one published case, a patient experienced pain, numbness, and tingling along the inner forearm for two years before the cause was identified. These complications are rare, but if you notice tingling or numbness that doesn’t resolve within a few days of insertion, or pain that seems to be getting worse rather than better, that warrants a follow-up visit.
What You Can Do to Minimize Pain
You don’t have much control over the procedure itself, but a few things can make the experience easier. Ask your provider whether they use topical numbing cream before the lidocaine injection, since this reduces the sting of the shot. Avoid scheduling the appointment during a time when you’ll need to use that arm heavily in the hours afterward. Keep the pressure bandage on for the full 24 hours, even if it feels unnecessary, because removing it early is the most common reason bruising becomes more extensive. And don’t poke or press on the implant site out of curiosity during the first few days, tempting as it is to feel the rod under your skin.
The current recommended placement is over the triceps muscle, about 3 to 5 centimeters from the groove between the biceps and triceps. During insertion, your provider will position your arm with your hand behind your head to expose this area. This location keeps the implant away from major nerves and blood vessels, making both insertion and eventual removal safer and less painful.