7 responses to “Part 2: Minimizing the pain of the IUD insertion: all effort required”

  1. I find too much instrumention and procedures are unnecessary and probably even increasing anxiety in a patient who is predisposed to anxiety states.

  2. Can you share your powerpoint presentation?

    Willa Henry MD

  3. For uterine cramping consider premedicating with homeopathic magnesium phosporicum 200 C; this can then be repeated every 1-4 hours as needed. Since magnesium deficiency is so very common in Canada, especially among women, it might be helpful to encourage magnesium glycinate (dose b.i.d. to bowel tolerance, then reduce a bit) daily for a couple of weeks before and after insertion.

    Use Gelsemium 200C for anticipatory anxiety — night before and q 4 h PRN.

  4. I have been inserting IUD’s ‘old school’ for 20+ and have yet to cause anyone excruciating pain, or can only recall 1 nullip having moderate pain. So I never really feel motivated to make a change to my practice. I think the therapeutic alliance with my patients might be anxiolytic, since I don’t do them on a referral basis, or in a women’s health clinic. Usually I have had a few conversation with my patients about all forms of contraception, and what to expect, prior to the actual moment of insertion. I agree that knowing what to expect – according to what they want to know – is anxiolytic. Not all of my patients would be interested in seeing/hearing all about it. Some prefer only to know what they have to, and then want to listen to some music, and not even look at the insides of the package. I don’t think the ppt would be good for them. Last week, for the first time I gave a patient some lorazepam, because her previous MD gave it to her, and she felt she couldn’t try without it. I didn’t find it any different than any other IUD I had put in, so my n of 1 doesn’t convince me. Also, I find that putting on a tenaculum is equivalent to the pain of the injection in the cx prior to putting it on. I don’t see the benefit. I find once it is on, there is no further pain on the cervix. Maybe I have just been lucky? I go around this topic about once a year, and was very happy to see the resources and references. I am still mulling it over.

  5. Can you share your powerpoint?

  6. Thanks very much for this presentation. In the past, I also used to routinely do a cervical/paracervical block, however I’ve found that in about 80% of the patients, I can sound the uterus without a tenaculum by having them tilt their pelvis while applying downward suprapubic pressure with their hands. This serves 2 purposes – First it straightens out the anteverted uterus, and second, it gives them a sense of participating in the procedure. Years ago, working with fertility clinic patients doing intrauterine inseminations, we found that our pregnancy stats were higher when we were able to insert the IUI catheter without tenaculum, and certainly the patient experience was more positive – so I tried the same techniques here and it works well in nullips and multips. I agree wholeheartedly with your conclusion about the anxiety and anticipatory contributors to the pain experience, and really appreciate your comments about the importance of thoroughly preparing them. I find that most women aren’t interested in too much detail, but do want to have a general idea, so my pre-insertion consultation caters to as much info as they want, and I also show them how they can help with the procedure. I advise that sometimes we have to do a block and there can be some cramping, but I’ve found that each of these women leave after the insertion pleasantly surprised at having experienced little or no discomfort. I do have them take some ibuprofen pre-procedure. There are certainly some trickier ones where this minimal intervention approach doesn’t work and I need to do a block and be more aggressive, but as we hit that point, I remind her of what we discussed and talk her through it. Always glad to hear new ideas, and thanks for the resources and references. Much appreciated.

  7. I provide lorazepam to my anxious patients and give ibuprofen immediately after inserting the iucd. I’ve never done a paracervical block for inserting an iucd. I may try it but so far all my patients have been quite happy with the procedure when I do it.

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