Best practices for reducing pain associated with intrauterine device placement

Area of Science:

• Obstetrics and Gynecology
• Family Medicine
• Pain Management

Background:

• Intrauterine devices (IUDs) are highly effective, long-acting reversible contraceptives.
• Limited uptake persists, especially in underserved populations, adolescents, and young adults, partly due to pain during insertion.
• No standardized pain management protocol exists for IUD placement, leading to variable clinical practices.

Purpose of the Study:

• To provide practical, evidence-based, and expert-informed guidelines for managing pain during IUD placement.
• To address barriers to IUD uptake by improving the insertion experience.
• To promote patient autonomy and shared decision-making in pain relief.

Main Methods:

• A virtual expert meeting was convened with board-certified obstetrician-gynecologists, pediatricians, and a family physician.
• Consensus-based recommendations were developed covering environmental, nonpharmacological, and pharmacological pain management strategies.
• Literature review and expert opinion informed the guideline development process.

Main Results:

• Key strategies include a person-centered care model, realistic expectation setting, and comprehensive informed consent.
• Recommended nonpharmacological interventions include therapeutic language, comforting environments, and mind-body techniques.
• Pharmacological options include pre-procedural NSAIDs and anxiolytics, topical anesthesia, and paracervical/intracervical blocks.
• Procedural techniques like using appropriate instruments and gentle insertion steps enhance comfort.

Conclusions:

• Personalized, trauma-informed, and evidence-based care is crucial for a safe and acceptable IUD insertion.
• Implementing these guidelines can reduce IUD insertion pain and anxiety.
• Improved pain management is vital for increasing IUD uptake and enhancing reproductive healthcare access.