Pain Management During Intrauterine Device Insertion in Nulliparous Women: A Scoping Review

This study investigates the various methods of pain management during the insertion of intrauterine devices (IUDs) in nulliparous women. Currently, the only recommended method of pain management is 800 mg of ibuprofen taken one hour before insertion of the IUD. However, women continue to experience pain during the procedure. A scoping review was conducted using CINAHL, Medline, Web of Science, and Embase with inclusion criteria being English peer-reviewed articles from the last 10 years, involving nulliparous women of at least 18 years of age. The research reveals that management to minimize pain during IUD insertion can include oral analgesics, cervical blocks, and cervical softening and dilation with prostaglandins. The effect of pain management when using these techniques was further examined throughout the various steps of IUD placement, including cervical grasping, IUD insertion, and post IUD insertion. Ibuprofen is the current recommended analgesic; however, studies show that there was no significant reduction in pain found when ibuprofen is used. Alternatively, 500 mg of naproxen sodium taken prior to IUD insertion showed a significant reduction in post-IUD insertion pain (p=0.01) but did not show any significant reduction in pain during cervical grasping or during IUD insertion into the uterus. Cervical blocks using 1% lidocaine were shown to decrease pain during cervical gripping (p=0.002) and IUD insertion compared to the control group (p=0.005). The results of cervical blocks differed based on whether 1% lidocaine was injected or if a 2% lidocaine gel was used, but no significance was shown. Furthermore, cervical softening and dilation with dinoprostone 3 mg and misoprostol 3 mg demonstrated a reduction in pain during all stages of IUD insertion and after insertion (p<0.01). Pharmacological interventions with oral analgesics, lidocaine, and prostaglandins, such as dinoprostone and misoprostol, have all demonstrated some level of pain control during the IUD insertion procedure, but the use of prostaglandins and 2% lidocaine gel has been demonstrated to have the most clinically significant effect on pain control. Additionally, there has been some research examining the impact of verbal analgesics, which involves the provider using a calm, soothing voice and slow speech to put the patient at ease, and the role that anxiety about IUD insertion can influence pain, but further research is needed to determine its significance. This research provides valuable insight into enhancing the improvement of pain during and after the insertion of IUDs for nulliparous women.