Be aware of possible need for pain control during IUD placement

The Society of Obstetricians and Gynaecologists of Canada (SOGC) has issued a statement on the importance of patient counselling and pain management during the placement of intrauterine devices (IUDs). The SOGC notes that IUDs are the recommended first-line contraceptive method; IUDs are highly effective, but underutilized. Insertion of an IUD can be painful for some patients. Healthcare providers should counsel patients on what to expect during the IUD placement process and discuss pain control options. Certain patients may experience more pain or discomfort during IUD insertion. These would include patients with a history of trauma, chronic pelvic pain, sexual pain or painful periods, as well as those who are postpartum, have difficulty with or have never had speculum exams, and those who are anxious about the procedure. However, despite being at a higher risk of pain, these patients still might be good candidates for an IUD. Anxiety about the insertion procedure, as well as anticipated and actual pain related to the procedure, are key barriers to IUD use. Healthcare providers can help patients by ensuring a supportive reassuring environment where each patient understands that they can request that the procedure be paused or halted at any time. Healthcare providers and patients should also work together to choose an appropriate pain management plan, if needed. Oral analgesics are usually sufficient for pain management during IUD insertion, including the following options: Ketoprofen 150 mg, one hour prior to the procedure Ketorolac 20 mg, 40–60 minutes prior to the procedure Naproxen sodium 550 mg, one hour prior to the procedure Tramadol 50 mg, one hour prior to the procedure. Local anesthetic options are also summarized in the SOGC statement. These can be applied within minutes prior to the procedure. For example, 4 g of lidocaine/prilocaine cream can be applied to the anterior cervical lip and cervical canal about seven minutes prior to the procedure. The SOGC emphasizes that pain and/or discomfort associated with IUD insertion is usually manageable and should not be a barrier to using an IUD. Insertion of an IUD is a common outpatient procedure that typically takes five to 15 minutes, with possible additional time if pain management is required. Complications during IUD insertion are rare. Reference 1. Society of Obstetricians and Gynaecologists of Canada. Statement on intrauterine devices, counselling and pain management. December 15, 2022. https://sogc.org/common/Uploaded%20files/Latest%20News/Statement_on_Intrauterine_Devices-E.pdf (accessed January 12, 2023).

Be aware of possible need for pain control during IUD placement

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