Practical advice for avoidance of pain associated with insertion of intrauterine contraceptives

Abstract

Few studies in the scientific literature provide clear direction on the prevention or management of pain associated with intrauterine contraceptive (IUC) placement. Those that have been published have studied small numbers of women and fail to provide definitive conclusions. There are also no guidelines available detailing recognised standard approaches to this problem. The consensus recommendations in this review focus primarily on non-pharmacological and often non-evidence-based interventions. This review includes general considerations, practical recommendations for both routine and more difficult cases and guidance on the optimal choice of instruments. General considerations, including pre-insertion counselling, the setting for the procedure, the confidence and technique of the provider and the interplay between the provider and assistant, can influence women's level of anxiety and, in turn, influence their perception of pain and their overall experience. Further studies are required to refine the optimal strategy for managing pain associated with IUC insertion.

A randomised trial comparing pain and ease of use of two different stabilising forceps for insertion of intrauterine contraception

“…Bahamondes et al 1. suggested that having a HCA present during an IUC fitting can decrease anxiety and in turn reduce a woman's experience of pain.…”

“…Anticipated pain is one of the main deterrents to women considering a copper intrauterine device (IUD) or hormonal intrauterine system (IUS) 1. Brockmeyer et al 4.…”

Pain and pain relief with intrauterine device insertion

“…Such approaches were reviewed in this journal in 2014 6. Women should be counselled on what to expect during the insertion process, and having an assistant who can sit with the patient and distract her with conversation is also helpful, the so called ‘vocal local’ or ‘verbocaine’.…”

Use of IUDs for emergency contraception: current perspectives

“…As an invasive procedure, fitting an IUD may be associated with pain at the time of the procedure, although procedural practices may minimize this. 48 If retained, menses are likely to be heavier, more prolonged, and with an increased risk of intermenstrual bleeding. Such side effects often improve over the first few months of use and of course are not relevant if the device is to be used solely for emergency contraception.…”

“…This showed disappointing results, with no improvement in discomfort. 47 A review published this year (2014) 48 provided some practical suggestions for avoiding or alleviating pain during IUD fitting. This included emphasis on the importance of good patient support (so-called "vocal local" or verbal anesthesia).…”