Related Experiment Video
Updated: Jul 16, 2026
External Cephalic Version: Is it an Effective and Safe Procedure?
Published on: June 6, 2020
Could the Valsalva manoeuvre be an alternative to the tenaculum for intrauterine device insertion?
Meral Tugba Cimsir1, Muhammet Serhat Yildiz2
1Department of Obstetrics and Gynaecology, Faculty of Medicine, Alaaddin Keykubat University, Alanya, Turkey.
Objectives:
This study investigated whether the Valsalva manoeuvre (VM) could be an alternative to use of the tenaculum for intrauterine device (IUD) insertion. The aims were to establish whether VM could provide good patient comfort and enable the insertion to be performed successfully with adequate pain control in cases where the cervix could not be passed spontaneously.
Methods:
Women who attended the outpatient clinic of Alanya Education and Research Hospital between November 2017 and December 2020 for IUD insertion were randomly assigned to the VM (n = 52) or tenaculum (n = 55) group. Insertion in the latter group was carried out by grasping the cervix with a single-toothed tenaculum. In the VM group, no tenaculum was used to grasp the cervix; instead, the woman was asked to perform VM during insertion.
Results:
IUD insertion success rates were similar between the groups. Procedural anxiety scores were slightly higher in the tenaculum group. Pain scores measured during the procedure were significantly higher in the tenaculum group compared with the VM group. Severe pain was reported by 58.2% of women in the tenaculum group, whereas 57.7% of women in the VM group reported no pain.
Conclusion:
In cases where an IUD cannot be passed through the cervical canal spontaneously, the procedure should be attempted using VM before using a tenaculum. The use of VM may lead to lower pain and anxiety levels as well as increased patient comfort.
