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Updated: Aug 12, 2026
An Experimental Paradigm for the Prediction of Post-Operative Pain (PPOP)
Published on: January 28, 2010
Low pain scores and high feasibility: the modified Wiebe block for pain reduction during IUD insertion
Tijn M S van Winden1, Valentine C A Endtz2
1Huisartsenpraktijk Ritz en Van Winden, General Practice, Singel 261, Amsterdam, The Netherlands; Amsterdam UMC, location AMC, Department of General Practice, Amsterdam UMC, Amsterdam Public Health Research Institute, University of Amsterdam, Amsterdam, The Netherlands.
Background:
The intrauterine device (IUD) is a widely used method for reversible contraception. Research indicates that IUD insertion is frequently experienced as highly painful - an aspect often underrecognized by clinicians - particularly among younger, nulliparous women. Moreover, fear of a painful insertion is a major barrier for women considering an IUD. While pre-procedural oral analgesia is standard practice, it does not always provide sufficient pain relief, leaving many women in need of additional measures.
Methods:
We developed the Modified Wiebe as a simplified and safer version of an established intracervical block for use during IUD insertion in primary care. The technique consists of one superficial and two deep intracervical injections. We combined a literature review with a retrospective descriptive case series of consecutive IUD insertions in which this technique was applied in routine general practice.
Results:
In our case series, we applied the Modified Wiebe intracervical block in 57 IUD insertions. Most participants (93%) were nulliparous. The mean NRS pain score was 2.0 (median 2). Vasovagal symptoms were reported in 11 patients (19%), with no cases of syncope. No allergic reactions or other immediate complications were observed. All participants (100%) indicated willingness to undergo a future IUD insertion.
Conclusion:
In this pilot study, use of the Modified Wiebe was associated with remarkably low pain scores during IUD insertion. The technique is safe, quick to learn, rapidly effective, and requires only inexpensive, readily available materials. The Modified Wiebe may therefore be a promising option for wider implementation in both primary and secondary care.
