Practical Recommendations for Minimizing Pain and Anxiety with IUD Insertion

Author/s: 
Viktoriya Ovsepyan, Petra Kelsey, Ann E Evensen
Date Added: 
March 24, 2025
Journal/Publication: 
Journal of the American Board of Family Medicine
Publisher: 
American Board of Family Medicine
Publication Date: 
November 1, 2024
Issue: 
6
Volume: 
37
Pages: 
1150-1155
Type: 
Meta-analyses, Reviews, and Guidelines
Format: 
Article
DOI (1): 
10.3122/jabfm.2024.240079R1
PMID (1): 
40118554

RPR Commentary

An evidence-based review of methods for reducing pain during IUD insertion. Many of these would probably work as well for other painful procedures. James W. Mold, MD, MPH

Abstract

Background: Intrauterine devices (IUDs) are one of the most effective, long-lasting, and convenient contraceptive methods available in the United States. Unfortunately, the anticipated pain and anxiety associated with an IUD insertion procedure deter many people from using this contraceptive method.

Methods: A literature review was conducted on PubMed by searching the terms “IUD insertion”, “pain management”, “anxiety”, “gynecologic procedures”. The Cochrane database was also searched for reviews about pain management methods during IUD insertions. Findings were summarized using the American Academy of Family Physicians’ Strength of Recommendation Taxonomy (SORT) scale.

Results: Pharmacologic methods that can be used to reduce pain with IUD insertion include naproxen, tramadol, lidocaine paracervical blocks, 10% lidocaine spray, lidocaine-prilocaine cream, and EMLA cream. Non-pharmacologic methods for reducing pain or anxiety during gynecologic procedures include pre-insertion counseling, “verbal analgesia”, lavender aromatherapy, distraction with music or television, using Valsalva maneuver instead of tenaculum during IUD insertion, and use of heating pad during procedure.

Conclusion: Moderately effective pharmacologic and non-pharmacologic methods exist for reducing pain and anxiety with IUD insertion. These treatment methods should be offered to create a more comfortable experience for patients. Additional research is needed to determine the comparative efficacy of these methods.

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