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Pain during intrauterine device insertion
Douleur de la pose d'un dispositif intra-utérin
1. Systematic Reviews and Meta-Analysis
1.1. Generic Acupuncture
1.1.1. Sheffield 2025
Sheffield SM, Gilbert AFR, Chang KR, Dotters-Katz SK, Gleeson EI, Hagey JM, Kerner NP. Pain management for IUD insertion: a review of the clinical evidence on pharmacologic and nonpharmacologic options. Obstet Gynecol Surv. 2025 Aug;80(8):516-529. https://doi.org/10.1097/OGX.0000000000001417
| Background | Intrauterine devices (IUDs) are safe and highly effective contraceptives, yet insertion pain remains a major barrier to uptake and satisfaction. Evidence on pharmacologic and nonpharmacologic modalities for pain control is limited, and no standardized approach has been established. |
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| Objective | To summarize the available evidence on pharmacologic and nonpharmacologic strategies for managing pain during IUD insertion. |
| Methods | A literature search of PubMed and Ovid identified studies published since 1995 evaluating interventions for IUD insertion pain. Relevant articles were reviewed for inclusion. |
| Results | Strongest evidence supports cervical block, 10% lidocaine spray, and 5% lidocaine–prilocaine cream. Lower-risk interventions, such as ultrasound guidance, music, and the “cough” method, may benefit high-risk patients (nulliparous women, those with dysmenorrhea, history of violence, or high anticipated pain) despite limited evidence. Further studies are needed to clarify the efficacy of NSAIDs, dinoprostone, transcutaneous electrical nerve stimulation, and acupuncture. |
| Conclusion | Topical and injectable lidocaine preparations are more effective than pre-procedural ibuprofen for reducing IUD insertion pain. Although evidence for nonpharmacologic methods such as acupuncture remains insufficient, individualized, multimodal approaches may optimize patient comfort and satisfaction during IUD placement. |
Tufa 2025 Tufa T, Snyder E, Garbarino S, Wolderufael M, Steyn PS. Non-pharmacologic techniques for interval intrauterine device placement: a systematic review. BMJ Sex Reprod Health. 2025 Nov 3;51(Suppl 1):s38-s51. https://doi.org/10.1136/bmjsrh-2025-202840
| Background | This review assessed the effectiveness of non-pharmacologic techniques to reduce pain and improve outcomes during interval intrauterine device (IUD) placement. |
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| Methods | Databases were searched from inception to 15 December 2023 for randomized controlled trials comparing non-pharmacologic techniques with placebo or pharmacologic interventions. Outcomes included pain during IUD placement, ease of placement, need for adjunctive measures, placement success, patient satisfaction, side effects, and adverse events. Risk of bias and certainty of evidence were evaluated for all outcomes. |
| Results | Eleven RCTs (10 different techniques) were included. Ten trials had high risk of bias and one low. Among 11 RCTs assessing pain, two found reduced pain with the Valsalva breathing technique (OR 0.04; 95% CI 0.01–0.15) and acupuncture (mean difference –1.88; 95% CI –2.72 to –1.04) versus routine care. No significant differences were found for ease of placement. Most trials reported high placement success, similar need for cervical dilation and patient satisfaction, and few side effects with no adverse events. |
| Conclusion | Valsalva manoeuvre and acupuncture may lessen pain during IUD placement, though current evidence is limited and of moderate-to-low certainty. Larger, high-quality trials are warranted. |
