Practical Recommendations for Minimizing Pain and Anxiety with IUD Insertion

Article Figures & Data

Table 1.

Effective Pharmacologic Methods for Reducing Pain with IUD Insertion

Recommendation	Strength of Recommendation	Pros	Cons
Lidocaine-prilocaine cream and EMLA cream	A^{8,12,16–17,19}	Decreased pain with tenaculum placement, during uterine sounding, and with IUD insertion	Not commonly stocked in clinics Needs to be applied ∼5 to 15 minutes before procedure
10% lidocaine spray	A^8,12,16,18	Decreased pain with tenaculum placement, during sounding, and with IUD insertion	Not commonly stocked in clinics Needs to be applied ∼5 to 15 minutes before procedure
Lidocaine paracervical block 10-20 mL 1% lidocaine and 10 mL 2% lidocaine	A ^8,12,20–21	Decreased pain with tenaculum placement, uterine sounding, IUD insertion Decreased pain 5 minutes after placement	Pain with lidocaine injection
Tramadol 50 mg (orally)	A^12,13	Decreased pain with IUD insertion, more pain reduction than naproxen	Needs to be taken 30 – 60 minutes before procedure
Naproxen 550 mg (orally)	A^12,13	Decreased pain with IUD insertion, decreased pain 5 minutes and 15 minutes after insertion	Needs to be taken 30 – 60 minutes before procedure

Abbreviations: EMLA, Eutectic Mixture of Local Anesthetics; IUD, Intrauterine Device.

Table 2.

Nonpharmacologic Methods for Reducing Pain or Anxiety with Gynecologic Procedures

Recommendation	Strength of Recommendation	Pros	Cons
“Verbal Analgesia”/“Vocal Local”	A7,^35–37	Reduces anxiety and pain (with IUD insertion)*	Continuous communication with patient may be difficult for some clinicians
Lavender aromatherapy reduces anxiety	A^29,30	Reduces anxiety, readily available, easy to offer in a clinic setting (with IUD insertion and intrauterine insemination)	Cost, some clinic settings are fragrance-free because of patient allergies and sensitivities
Distraction: Music	A^28,31–33	Reduces anxiety and pain (with hysteroscopy and colposcopy)	May be distracting for clinicians
Pre-insertion counseling	B^7,27–28	Reduces pain (with IUD insertion)	Requires additional appointment before IUD insertion
Valsalva instead of tenaculum use	B^38,39	Reduces pain, less bleeding during procedure (with IUD insertion and endometrial biopsy, only multiparous patients included in both studies)	Evidence supports the use of tenaculum for cervix immobilization^7,41
Distraction: watching TV	B³⁴	Reduces anxiety, provides topic of conversation during procedure (with gynecologic procedures, including IUD insertion)	Cost, may be distracting for clinician
Heating pad during procedure	C⁷	May be distraction and/or source of comfort for patient (with IUD insertion procedure)	Cost