Is this going to hurt? An investigation into managing pain for the insertion of intrauterine contraceptives for women in the UK.

Abstract

The insertion of intrauterine contraceptives (IUCs) can be an invasive and painful procedure for women, and current guidelines by the Faculty of Sexual and Reproductive Health (FSRH), and National Institute of Clinical Excellence (NICE) do not provide recommendations for analgesia as standard. This survey and review demonstrate evidence for the pain experienced by women during insertion of IUCs and summarises literature on pain modulation methods. IUCs are devices which alter the environment of the uterus and cervical mucus to be inhospitable to a fertilised egg, thus avoiding unwanted pregnancy. Some are also licensed for use in treating dysmenorrhea, or painful periods. Primary data was sourced through an online survey on SurveyMonkey.com and shared via social media to 75 anonymous women who had had an IUC inserted. The survey results show the most common pain score on a scale of 0-10 was 8, and 46% participants felt the pain experienced was higher than anticipated. Women who had not had children prior to the procedure (nulliparous) had higher mean pain scores than women with children (multiparous). These findings confirmprevious research proving nulliparous women find the procedure more painful than multiparous women. Current literature demonstrates evidence of the efficacy of paracervical lidocaine blocks as pain relief for IUC insertion (IUC-I). The findings from this study provide evidence for a more comprehensive review of protocols for IUC-I in the UK, as currently no analgesia is licensed or recommended, and it can be an unnecessarily painful experience for women.