As social media messaging increasingly discusses how Intrauterine Device (IUD) placements can be very painful, more and more patients are seeking pain control options. For clinicians, it is important that we are proactive about addressing these concerns and explain how we can help manage pain associated with the IUD placement.
Changing the narrative around pain management options for IUD placements
Pain control for IUD placements has evolved significantly over the last decade. Many patients pursuing IUDs today have not delivered a baby. Because the cervix has not been dilated by a delivery, these patients may have more pain with IUD placements, especially compared to earlier eras when most IUD placements were for multiparous patients.
As clinicians, we need to reconcile the reality that IUD placements can be painful with the ever-growing body of evidence from randomized controlled trials showing that we have effective interventions to reduce pain control. Randomized controlled studies on local injections of lidocaine have shown that while the injection may cause some discomfort, it is less painful than the IUD placement pain among people who have not had delivered a baby.
In my own clinical experience, where I routinely offer paracervical blocks to people who have not vaginally delivered, both clinic staff and trainees have witnessed the substantial improvement in pain control for IUD placement. Patients are often grateful for a less painful experience, which in turn contributes to clinician and staff job satisfaction.
Counseling about cervical blocks for IUD placements
I often counsel patients that there is something we can give them to decrease pain with IUD placement. I describe lidocaine as a medication given by injection, noting there may be mild discomfort with the injection, which on average is about a 3 on a scale of 1 to 10. I then explain that the lidocaine decreases the pain of the IUD placement itself and afterwards. When presented this way, most patients chose to receive lidocaine and report a better experience with IUD placement or IUD removal and replacement.
After the procedure, it is important to have patients remain lying down for about 10 minutes to recover. Patients often appreciate not being rushed out of the clinic and being allowed to recover. In addition, I will sometimes play relaxation spa music or dim the lights with the patient’s permission.
Making cervical blocks part of your clinical practice
I often hear clinicians say that they are hesitant to incorporate lidocaine into their practices due to concerns about time constraints and clinic flow. My response is simple: just try it. In my experience, offering pain control can actually improve clinic flow, as patients recover more quickly and leave feeling better after less painful procedures. It doesn’t take much longer to prepare the lidocaine, and it is very much appreciated by patients that we are able to offer something to help them have a less painful procedure.
Almost all my patients tell me that their IUD placement with lidocaine was “so much better than expected,” whether compared with a prior IUD placement or their expectations for a first IUD placement. I have promised them that I will continue to advocate for more clinicians to offer evidence-based interventions to decrease pain for IUD placements.