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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.

Financial Disclosure: Rachel B. Rapkin, MD, MPH, Sharon L. Achilles, MD, PhD, Christy Boraas, MD, MPH, and E. Bimla Schwarz, MD, MS—These authors have no conflicts of interest to disclose relative to the contents of this presentation. Miriam Cremer, MD, MPH—This author has a relevant financial relationship with the following commercial interest: Speaker: Merck. Beatrice A. Chen, MD, MPH—This author has relevant financial relationships with the following commercial interests: Site Investigator: Agile Therapeutics, Bayer Pharmaceuticals, Evofem, and Medicines360.

© 2014 by The American College of Obstetricians and Gynecologists.