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Self-Administered Lidocaine Gel for Intrauterine Device Insertion in Nulliparous Women: A Randomized Controlled Trial.

Rapkin, Rachel B. MD, MPH; Achilles, Sharon L. MD, PhD; Boraas, Christy MD, MPH; Cremer, Miriam MD, MPH; Schwarz, E. Bimla MD, MS; Chen, Beatrice A. MD, MPH
Obstetrics & Gynecology: May 2014
doi: 10.1097/01.AOG.0000447053.79340.c2
Tuesday, April 29, 2014: PDF Only

INTRODUCTION: Despite their high efficacy, intrauterine device (IUD) use is limited among nulliparous women, often as a result of fear of pain. Prior studies evaluating pain management during insertion usually include multiparous women and show no benefit. This study evaluates self-administered lidocaine gel before IUD insertion in nulliparous women.

METHODS: Nulliparous women seeking IUDs were randomly assigned to self-administer 1% lidocaine or placebo gel 5 minutes before IUD insertion. Women used a visual analog scale to report pain during insertion and reported overall satisfaction with insertion and the likelihood of recommending an IUD to a friend using a Likert scale.

RESULTS: The median difference in pain between baseline and IUD insertion was 61 mm in the lidocaine group and 68 mm in the placebo (P=.133). Differences in pain score after speculum placement was 16 mm in the lidocaine group and 33 mm in the placebo group (P=.034) and scores for tenaculum placement were 32 mm in the lidocaine and 56 mm in the placebo group (P=.030). Seventy-seven percent of women were somewhat or very satisfied with their IUD placement, and 86% would probably or definitely recommend the IUD to a friend.

CONCLUSIONS: Self-administered vaginal lidocaine significantly decreased pain after speculum and tenaculum placement but did not reduce pain with IUD placement. Self-insertion of vaginal lidocaine gel may be useful before a variety of gynecologic examinations and procedures. Despite pain during IUD insertion, nulliparous women were satisfied with the insertion and most would recommend an IUD to a friend.

(C) 2014 by The American College of Obstetricians and Gynecologists.