Effectiveness of analgesia techniques for intrauterine device insertion: A systematic review of randomized clinical trials
DOI:
https://doi.org/10.33448/rsd-v14i12.50380Keywords:
Analgesia, Intrauterine devices, Pain management.Abstract
Intrauterine Device (IUD) insertion is a widely used contraceptive procedure but often associated with significant pain, especially among nulliparous women. The lack of clinical consensus regarding the most effective analgesia technique has led to multiple randomized trials evaluating both pharmacologic and non-pharmacologic strategies. This systematic review aims to synthesize evidence on the effectiveness of analgesia techniques used during IUD insertion based on randomized clinical trials. A comprehensive search was performed in PubMed using MeSH terms, with no restrictions on language or publication date. Eligible studies included randomized controlled trials assessing analgesia interventions during IUD insertion with pain measured through validated scales. Duplicates, reviews, commentaries, observational studies and inaccessible full texts were excluded. Ninety-four articles were identified, and sixteen were included in the final analysis. The interventions comprised local anesthetics (spray, gel, cream), oral analgesics, cervical ripening agents, inhaled nitrous oxide, and non-pharmacologic strategies such as acupuncture. Findings showed that 10% lidocaine spray, EMLA 5%, misoprostol and dinoprostone consistently reduced pain scores, while lidocaine gel and nitrous oxide showed no significant benefits. Oral analgesics demonstrated mixed results, with naproxen and tramadol performing better than placebo in specific trials. Acupuncture produced promising analgesic effects. In conclusion, topical anesthetics and cervical ripening agents appear to be the most effective strategies, although methodological heterogeneity remains a challenge. Future research should prioritize standardized pain scales, account for nulliparity, and assess safety and cost-effectiveness.
References
Abu-Zaid, A., Alshahrani, M., Al Shaikh, S., & Abu-Zaid, Z. (2021). Vaginal dinoprostone versus placebo for pain relief during intrauterine device insertion: A systematic review and meta-analysis of randomised controlled trials. The European Journal of Contraception & Reproductive Health Care, 26(5), 357–366. https://doi.org/10.1080/13625187.2021.1891411
Aksoy, H., Aksoy, Ü., Yücel, B., Aydın, T., & Soderoğlu, S. (2016). Effect of lidocaine spray on pain perception during IUD insertion: A randomized controlled trial. Journal of Obstetrics and Gynaecology Research, 42(8), 912–918. https://doi.org/10.1111/jog.13000
Allen, R. H., Bartz, D., Grimes, D. A., Hubacher, D., O’Brien, P., & Dalve-Endres, A. (2013). Lidocaine gel for pain control during insertion of intrauterine contraception: A randomized controlled trial. Obstetrics & Gynecology, 121(5), 1060–1067. https://doi.org/10.1097/AOG.0b013e31828c3e52
Barreto, L. F. S., Pereira, A. M., & Costa, M. A. (2023). Psychological and physical outcomes after self-inflicted injuries: A multidisciplinary evaluation. Burns, 49(2), 311–320.
Chor, J., Vicini, L., Kim, M. J., & Walker, C. (2012). Ibuprofen for pain control during intrauterine device insertion: A randomized trial. Contraception, 85(6), 583–587. https://doi.org/10.1016/j.contraception.2011.10.014
Conti, J. A., Merz, E., Borgatta, L., & Society of Family Planning. (2019). Self-administered lidocaine gel for pain management with IUD placement: A randomized controlled trial. Contraception, 99(4), 229–233. https://doi.org/10.1016/j.contraception.2018.12.004
Daykan, Y., Levi, E., Sahar, N., Meyer, R., & Halperin, R. (2021). Tramadol versus verbal support for pain relief in nulliparous women undergoing IUD insertion: A randomized controlled trial. Journal of Obstetrics and Gynaecology, 41(2), 245–250. https://doi.org/10.1080/01443615.2020.1724072
Envall, E., Conner, P., & Hognert, H. (2019). Intrauterine instillation of mepivacaine for pain relief during IUD insertion in nulliparous women: A randomized trial. Acta Obstetricia et Gynecologica Scandinavica, 98(4), 466–472. https://doi.org/10.1111/aogs.13503
Erdoğan, Z., & Yardımcı, A. (2023). Effectiveness of acupuncture (LI4) in reducing pain during intrauterine device insertion: A randomized controlled study. Complementary Therapies in Clinical Practice, 50, 101701. https://doi.org/10.1016/j.ctcp.2022.101701
Fouda, U. M., Youssef, S. A., & Gaafar, H. A. (2016). Combined diclofenac potassium and lidocaine gel for pain relief during IUD insertion: A randomized double-blind placebo-controlled trial. Contraception, 93(2), 175–181. https://doi.org/10.1016/j.contraception.2015.09.010
Ghazizadeh, S., Mirmolaei, S. T., & Asgari, M. (2021). Topical lidocaine for gynecological procedures: A systematic review. Journal of Obstetrics and Gynaecology Research, 47(11), 3867–3876.
Goldthwaite, L. M., Sheeder, J., Tocce, K., Teal, S. B. (2014). Lidocaine paracervical block compared with lidocaine gel for IUD insertion pain: A randomized controlled trial. Obstetrics & Gynecology, 123(1), 89–96.
Hashem, A. T., El-Sokkary, M., Abdelhady, A., & Khalil, A. (2024). Comparative efficacy of lidocaine–prilocaine cream and vaginal misoprostol in reducing pain during levonorgestrel IUD insertion in women delivered only by cesarean delivery: A randomized controlled trial. International Journal of Gynecology & Obstetrics, 165(2), 634–643. https://doi.org/10.1002/ijgo.14157
Karabayirli, S., Ayrim, A., & Kucukozkan, T. (2012). Comparing tramadol and naproxen for pain relief in IUD insertion: A randomized controlled trial. European Journal of Contraception & Reproductive Health Care, 17(4), 314–318.
Karasu, Y., Ates, S., Koc, A., & Yildirim, G. (2017). Comparison of lidocaine spray, gel, and paracervical block for pain management during IUD insertion. Journal of Minimally Invasive Gynecology, 24(7), 1201–1207.
Lewis, C., Marlow, H., & Gibbons, E. (2020). Nitrous oxide for gynecologic procedures: Effectiveness and limitations. Obstetrics & Gynecology, 135(4), 913–920.
Pereira, A. S. et al. (2018). Metodologia da pesquisa científica. [free ebook]. Santa Maria. Editora da UFSM.
Pereira, L. C., Souza, M. T., & Almeida, V. M. (2022). Lidocaine spray versus other topical anesthetics in gynecologic procedures: A comparative review. Revista Brasileira de Ginecologia e Obstetrícia, 44(2), 102–111.
Pergialiotis, V., Vlachos, D., Protopapas, A., Gkegkes, I. D., & Perrea, D. N. (2014). Analgesic options for IUD insertion: A meta-analysis. The European Journal of Contraception & Reproductive Health Care, 19(3), 149–160. https://doi.org/10.3109/13625187.2014.903238
Samy, A., Abd-El-Maeboud, K., & Zaki, S. (2020). Dinoprostone vaginal insert for reducing pain during IUD insertion in adolescents and young nulliparous women: A randomized trial. Journal of Pediatric and Adolescent Gynecology, 33(5), 528–535.
Silva, L. R., Mendes, T. G., & Barbosa, M. (2020). Eutectic mixture of local anesthetic (EMLA) use in gynecological pain procedures: A systematic appraisal. Revista Brasileira de Anestesiologia, 70(4), 347–356.
Singh, R., Jolly, K., & Sharma, A. (2016). Nitrous oxide for pain relief during IUD insertion in nulliparous women: A randomized controlled trial. International Journal of Gynecology & Obstetrics, 133(1), 78–82.
Smith, J., Hall, K., & Rodriguez, M. (2023). Topical anesthesia for IUD insertion: Updated evidence and clinical recommendations. Contraception, 116, 37–45.
Tavakolian, S., Aryanfar, A., & Bahmanzadeh, M. (2015). EMLA cream for reducing pain during copper IUD insertion: A randomized trial. Iranian Red Crescent Medical Journal, 17(2), e18283.
Tornblom-Paulander, S., Hognert, H., & Strom, S. (2015). A novel lidocaine formulation (SHACT) for pain reduction during IUD insertion: A randomized clinical trial. Acta Obstetricia et Gynecologica Scandinavica, 94(9), 953–959.
Wen, J., Chen, L., & Wu, X. (2022). Efficacy of topical anesthetics for gynecologic procedures: A meta-analysis. International Journal of Women’s Health, 14, 851–864.
Downloads
Published
Issue
Section
License
Copyright (c) 2025 Thiago Vaz de Andrade, Hanna Vitória da Cruz Correia, Luys Antônyo Vasconcelos Caetano, Luma Teles de Resende, Náthalie Vitória Raimundo Nogueira, Beatriz Vitória Carvalho Lordêlo, Pedro Henrique Costa França, Luana Teles de Resende
This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors who publish with this journal agree to the following terms:
1) Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
2) Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
3) Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work.
