A comparison of the actual and expected pain response following insertion of an intrauterine contraceptive device

Abstract

The expected, immediate, and three-minute pain response following IUCD insertion was evaluated in 84 nulliparous women undergoing a first IUCD insertion. Expected pain was significantly higher than immediate pain and both were significantly higher than three-minute pain. Immediate pain following IUCD insertion was positively related to expected pain but the relationship was not strong enough to be of clinical value. The pain was significantly related to the degree of cervical resistance and this relationship was made much more obvious by the use of the expected pain parameter which is a valuable additional clinical measurement in pain research. IUCD insertion pain consists of a short cervical (less than 3 minutes) and longer fundal component. Avoiding excessive uterine manipulation during device insertion results in lower immediate and later pain response scores for a given device when comparisons are made with other studies, where standard techniques were used.

PIP: This study was aimed at evaluating actual versus expected pain levels associated with an IUD insertion technique developed by the authors. This technique eliminates prior uterine sounding and use of local anesthesia or oral analgesia. It was tested in 84 nulliparous women ages 18-40 years who were undergoing their 1st IUD insertion. Expected pain before IUD insertion, immediate pain, and 3-minute pain following insertion were evaluated on a visual analog scale recorder. Expected pain was significantly higher than immediate pain, and both were significantly higher than 3-minute pain. Immediate postinsertion pain was independent of age, gravidity, or day of cycle but dependent on expected pain and cervical resistance; however, the relationship was not strong enough to be of clinical value. The relationship between cervical resistance and the difference in expected and immediate pain scores was highly significant (p0.001). The 3-minute pain score was significantly different from the immediate pain score but was not related to the expected pain score. Follow-up ratings were obtained from 44 study participants; the relationship between 3-minute pain score and follow-up symptoms was significant. These results confirm the clinical observation that IUD insertion without prior uterine sounding results in immediate and 3-minute pain levels that are lower than those expected by patients. IUD insertion pain appears to consist of a short cervical component and a longer (more than 3 minutes) fundal component. The cervical pain response can be abolished through use of local anesthesia whereas fundal pain should be treated with antiprostaglandin analgesics.