Dear Editor,
Drs Ovsepyan, Kelsey, and Evensen’s recent review and recommendations for minimizing patient discomfort with IUD insertion1 was timely in that IUD insertion pain has been a topic of concern on social media and the lay press.
It should be added that a number of studies have demonstrated the benefit of ultrasound guidance in reducing pain with IUD insertion. A recent meta-analysis2 found 7 randomized, controlled trials and showed significant reduction in pain, shorter procedure time, and increased patient satisfaction when ultrasound was used. Ultrasound guided insertion was also associated with reduced rates of complications or misplaced IUDs.
These results would suggest that direct ultrasound visualization of each patient’s unique uterine anatomy, and subsequent insertion technique that best directs the force of insertion correctly is perhaps as important as the selection of an anesthetic or distraction technique at the bedside. Successfully incorporating ultrasound guidance requires both training and some changes in office work flow, but the rewards are clear. Family physicians who strive to provide the best possible IUD insertion experience should consider incorporating an ultrasound guided technique along with the other measures suggested in Drs. Ovsepyan, Kelsey, and Evensen’s article.
