Background: The intrauterine device (IUD) is one of the most contraceptive methods with highly effective and safe use. However, insertion through a narrow cervix may be technically difficult and painful. Objective: This study was performed to compare the effect of vaginal misoprostol and intramuscular diclofenac sodium in decreasing pain and facilitating IUCD insertion. Patients and Methods: A randomized double-blind controlled trial in Zagazig University Hospital during the period from December 2019 to November 2020. It included sixty-four women who want to insert an IUD. They were classified into four groups on a randomized basis, the first group received two tablets (400 mcg) of misoprostol in the posterior fornix of the vagina 2 hours before IUD insertion and the second group received diclofenac sodium 75 mg ampule intramuscular 2 hours before IUD insertion. The third group received two tablets (400 mcg) of misoprostol in the posterior fornix of the vagina and diclofenac sodium 75 mg ampule intramuscular 2 hours before IUD insertion while the fourth group received placebo. Pain during insertion and difficulty in IUCD insertion were evaluated.  Results: Misoprostol significantly facilitated the insertion of IUD insertion whereas diclofenac sodium lowered the average pain score for all steps of IUD insertion. Side effects were higher in the misoprostol group. Conclusion: 400 mcg of vaginal misoprostol 2 hours before IUD insertion facilitates the introduction and IM injection of 75 mg diclofenac sodium 2 hours before IUD insertion reduced the pain perception.