Intrauterine Device Insertion Research Articles

Effect of intracervical block on self-reported intrauterine device insertion pain: a single-center prospective survey study

Objective The study aimed to determine the incidence of self-reported pain during office-based intrauterine device (IUD) placement. Methods The study included patients who had IUD placement at our clinic from April 1, 2023, to March 31, 2024 with no prior history of vaginal delivery, who were between the ages of 14 and 48 years, did not have cervicitis, and were not pregnant. Informed consent was obtained, a prequestionnaire was completed, the IUD was placed in accordance with clinician preference, and a postquestionnaire was administered. Results Thirty-seven patients answered the question about expected pain. Two (5%) reported that their pain during IUD placement was none, 22 (59%) reported that pain was better than expected, 10 (27%) reported that pain was just as bad as expected, two (5%) reported pain was worse than expected, and one (3%) indicated that their pain during IUD placement was much worse than expected. Thirty-three patients received an intracervical or paracervical block, and five patients did not receive an intracervical or paracervical block; these groups reported visual analog pain scores of 35 ± 25 mm and 58 ± 14 mm, respectively (P = 0.22). Conclusion Approximately 8% of patients in our study reported worse or much worse than expected pain with IUD placement. Patients who received an intracervical or paracervical block reported less pain, but this difference was not statistically significant. Paracervical or intracervical blocks can decrease perceived pain with IUD insertion, increasing contraceptive options for those who are concerned about painful insertions; however larger studies are needed.

A Case Report on Toxic Shock Syndrome Complicated with Symmetrical Peripheral Gangrene after Insertion of Intrauterine Contraceptive Device

A Case Report on Toxic Shock Syndrome Complicated with Symmetrical Peripheral Gangrene after Insertion of Intrauterine Contraceptive Device

Effectiveness of virtual reality in reducing Pain During Intrauterine Device Insertion: A Systematic Review and Meta-analysis

Effectiveness of virtual reality in reducing Pain During Intrauterine Device Insertion: A Systematic Review and Meta-analysis

Efficacy and Safety of EMLA Cream in Reducing Pain During Intrauterine Device Insertion: Systematic Review and Meta-Analysis of Randomized Controlled Trials

Efficacy and Safety of EMLA Cream in Reducing Pain During Intrauterine Device Insertion: Systematic Review and Meta-Analysis of Randomized Controlled Trials

Migration of intrauterine device to the bladder with associated vesicolithiasis: a case report

Migration of intrauterine device (IUD) is a frequent complication of IUD insertion. Most IUD migration is only displaced in the uterine cavity, but in rare cases IUD could migrate to other pelvic organs, such as the pelvic cavity, rectum, or the bladder. We reported a case of 80-years old female with one month history of hematuria and pain, which further examination shows vesicolithiasis and bladder mass. During lithotripsy, intrauterine device was visualized inside the stone, which the patient admitted had been inserted 40 years ago. This case is remarkable, as it is rare to have a longstanding IUD placement with intravesical migration, vesicolithiasis, and bladder malignancy.

Pain Management During Intrauterine Device Insertion in Nulliparous Women: A Scoping Review.

This study investigates the various methods of pain management during the insertion of intrauterine devices (IUDs) in nulliparous women. Currently, the only recommended method of pain management is 800 mg of ibuprofen taken one hour before insertion of the IUD. However, women continue to experience pain during the procedure. A scoping review was conducted using CINAHL, Medline, Web of Science, and Embase with inclusion criteria being English peer-reviewed articles from the last 10 years, involving nulliparous women of at least 18 years of age. The research reveals that management to minimize pain during IUD insertion can include oral analgesics, cervical blocks, and cervical softening and dilation with prostaglandins. The effect of pain management when using these techniques was further examined throughout the various steps of IUD placement, including cervical grasping, IUD insertion, and post IUD insertion. Ibuprofen is the current recommended analgesic; however, studies show that there was no significant reduction in pain found when ibuprofen is used. Alternatively, 500 mg of naproxen sodium taken prior to IUD insertion showed a significant reduction in post-IUD insertion pain (p=0.01) but did not show any significant reduction in pain during cervical grasping or during IUD insertion into the uterus. Cervical blocks using 1% lidocaine were shown to decrease pain during cervical gripping (p=0.002) and IUD insertion compared to the control group (p=0.005). The results of cervical blocks differed based on whether 1% lidocaine was injected or if a 2% lidocaine gel was used, but no significance was shown. Furthermore, cervical softening and dilation with dinoprostone 3 mg and misoprostol 3 mg demonstrated a reduction in pain during all stages of IUD insertion and after insertion (p<0.01). Pharmacological interventions with oral analgesics, lidocaine, and prostaglandins, such as dinoprostone and misoprostol, have all demonstrated some level of pain control during the IUD insertion procedure, but the use of prostaglandins and 2% lidocaine gel has been demonstrated to have the most clinically significant effect on pain control. Additionally, there has been some research examining the impact of verbal analgesics, which involves the provider using a calm, soothing voice and slow speech to put the patient at ease, and the role that anxiety about IUD insertion can influence pain, but further research is needed to determine its significance. This research provides valuable insight into enhancing the improvement of pain during and after the insertion of IUDs for nulliparous women.

Comparison between intrapartum and post puerperium insertion of copper intrauterine contraceptive device in women undergoing elective caesarean section.

Comparison between intrapartum and post puerperium insertion of copper intrauterine contraceptive device in women undergoing elective caesarean section.

Pain control during intrauterine device insertion: Transcutaneous electrical nerve stimulation.

Current practice lacks effective periprocedural pain management during common gynecological procedures such as intrauterine device insertion, increasing the possibility of significant pain and adverse reaction to such procedures. Because of this, pain can often be a barrier for a patient in choosing a form of contraception that best serves them. Transcutaneous electrical nerve stimulation offers an option for effective pain control during intrauterine device insertion. This case review characterizes five cases where patients were offered transcutaneous electrical nerve stimulation for pain control during intrauterine device insertion. The patients reported a range of no pain to moderate pain during intrauterine device insertion and rated their pain experience as better compared with prior insertions. Although limited to a case review, our findings suggest a promising clinical indication for transcutaneous electrical nerve stimulation as a pain management strategy for intrauterine device insertion.

Pain relief during intrauterine device placement in nulligravid women with both oral ketorolac and an analgesic: a double-blinded randomised trial

Objective We assessed whether the administration of oral ketorolac with an analgesic provides effective pain relief during placement of an intrauterine device (IUD) in nulligravid women. Methods We conducted a double-blinded randomised trial in the Department of Obstetrics and Gynaecology, University of Campinas Faculty of Medical Sciences, Campinas, SP, Brazil. We randomised participants who voluntarily agreed to participate to receive either one pill containing ketorolac 20 mg together with one pill containing dipyrone 300 mg, scopolamine 6.5 µg, hyoscyamine 104 µg, and homatropine 1 mg or placebo 60 min before IUD placement. The participants and providers were blinded to the randomisation group. The primary outcome was pain assessment (measured on a 0–10 visual analogue scale) during IUD placement. Results We enrolled participants and randomised them 1:1 between November 7, 2023, and January 31, 2024. We analysed 60 women in each group. There were no differences between the groups in the pain score during tenaculum placement, uterine sounding, and IUD placement, and in the overall perception of pain. However, the pain score was significantly lower 10 min after the procedure in women who received the treatment compared with women who received the placebo. Conclusion Oral ketorolac associated with an analgesic administered 60 min before IUD placement was not significantly better than placebo during tenaculum placement, uterine sounding, and IUD insertion, and did not significantly reduce the overall pain perception. However, this treatment did significantly reduce pain 10 min after the procedure. Trial registration The trial was registered at Registro Brasileiro de Ensaios Clínicos (REBEC; in English: The Brazilian Registry of Clinical Trials) under number RBR-7phn8yv on November 6, 2023. https://ensaiosclinicos.gov.br/rg/RBR-7phn8yv

Pain management in people receiving intrauterine device insertion.

Pain management in people receiving intrauterine device insertion.

General practitioners' views and experiences of postpartum contraception counselling and provision: a qualitative-descriptive study.

To explore Australian general practitioners' views and experiences of undertaking postpartum contraception counselling and provision during the 6-8-week postnatal check. Qualitative-descriptive study; semi-structured online interviews. General practitioners who provide postnatal care in Australian primary health care, recruited using purposive, convenience, and snowball methods, 16 June - 6 July 2023. Views and experiences of postpartum contraception counselling and provision. Twenty-three general practitioners from six states were interviewed; the mean interview time was 30 minutes (range, 21-47 minutes), twenty-two participants were women, and twenty-one worked in metropolitan areas. All participants provide postnatal checks and had the training and facilities needed for providing contraceptive implant insertions. Twelve participants had training in intrauterine device (IUD) insertion, and twenty-one worked in practices with facilities for IUD insertions. Three themes were constructed: views and preferences regarding postnatal contraception counselling; postpartum provision of long-acting reversible contraception (LARC); and opportunities for improving postpartum contraception care in general practice. While most participants recommended LARC methods at postnatal checks, only twelve were trained to insert IUDs. Time constraints, limited access to training, limited financial support, and the lack of guidelines for postnatal checks and contraception care were seen as impeding postpartum contraception counselling. Participants highlighted the importance of access to education and training, appropriate remuneration for general practitioners, multidisciplinary collaboration among health professionals, the inclusion of practice nurses, and raising awareness among mothers of the importance of postnatal checks and postpartum contraception care. General practitioners are well placed to facilitate discussions about contraception with women who have recently given birth. Postpartum contraception care in general practice could be improved by better access to contraception training, appropriate remuneration for contraception procedures, greater multidisciplinary collaboration, and national postnatal check and postpartum contraception guidelines.

The Corellation of Hypnoanasthesia with Pain Degree on Installation of Intra Uterine Device (IUD)

Aims : this study was to analyze the difference of median pain of IUD insertion in hypnoanasthesia group and IUD mounting standard group, to analyze the difference of pain reduction scores of IUD insinuation on hypnoanasthesia group and IUD mounting standard group and to analyze hypnoanasthesia relationship with degree of pain in the installation of Intrauterine Device (IUD). Research : research design used quasi experimental approach with two group post test only with control group design. Analysis of results using Mann-Whitney and Chi-Square test. Results : result of the research shows that there is difference of pain score of hypnoanasthesia group that is median value 4 and standard group of IUD insertion with median value 5 and obtained p value &lt;0.001. There was a difference of pain reduction score in the hypnoanasthesia group of 60% and in the standard group of 33.3% with p = 0.002. There is a correlation of hypnoanasthesia with degree of pain in IUD insertion with p value = 0.005. Conclusions : the hypnosis method emphasizes the emergence of positive suggestion, calm feeling, and relaxation that make it comfortable. When the condition is calm and relaxed, the brain will automatically release the hormone endorphins that reduce pain and give a sense of comfort and relaxation.

Migration of an intrauterine contraceptive device into the bladder complicated by stone formation an exceptional complication: case report and literature review

BackgroundWe report a rare and unusual case of intravesical migration of an intrauterine device with stone formation. The intrauterine device (IUD) is the most common method of reversible contraception in women. However, its insertion is not without risk, it can cause early or late complications. IUD can perforate the uterus wall and migrate into adjacent structures.Case presentationA 35 year-old female 5 gravid, 4 para has been benefited from intrauterine contraceptive device (IUCD) 5 years ago, she was presented to gynecological consultation for chronic pelvic pain with urinary symptoms. There was history of a good IUD insertion 5 years ago, considered expelled after one month of its pose. Physical examination was normal, but a pelvic ultrasound and a plain abdominal radiography allowed the detection of an IUD outside the uterine cavity, but inside bladder. A diagnostic and therapeutic cystoscopy was performed, and the IUD with calculus was successfully removed. There were no postoperative complications.ConclusionThis case is reported to highlight and to reiterate the need to think about one of the rare complication of IUD insertion, which every practitioner must know, it’s the transuterovesical migration, before concluding wrongly to its expulsion. It’s a consequence of, non-compliance with the rules for inserting an IUD and poor monitoring. The evolution towards calcification is a certain consequence; its screening involves rigorous clinical monitoring.

Regional variation in health care substitution for intrauterine device insertion: a retrospective cohort study

BackgroundRising health care costs are a major concern in most Western countries. The substitution of healthcare stands as a strategic approach aimed at mitigating costs while offering medical services in proximity to patients’ residences. An illustrative instance involves the migration of outpatient hospital care to primary care settings. Notably, the insertion of intrauterine devices (IUDs) can be safely executed within primary care contexts. In order to establish a pragmatic objective for the rate of IUD substitution, we conducted an evaluation of regional disparities in healthcare substitution pertaining to the insertion of intrauterine devices. Furthermore, we investigated disparities in the follow-up ultrasound and reinsertion of IUDs between primary and secondary healthcare environments.MethodsAll women who underwent IUD insertion in Dutch primary care (by general practitioners and midwives) and secondary care (by hospital physicians) between January 1, 2016, and December 31, 2020 were included. The main outcome measures were the case-mix adjusted IUD insertion rates at the regional level by care setting and the proportions requiring follow-up ultrasound and IUD reinsertion within three months.ResultsOf the 840,766 IUD placements, 74% were inserted in primary care and 26% in secondary care. The proportion inserted in primary care increased from 70% in 2016 to 77% in 2020. The observed substitution rate ranged from 58 to 82% between regions. Compared with health care professionals in primary care, those in secondary care performed more ultrasounds to verify IUD placement (23% vs. 3%; p-value < 0.01) and more IUD reinsertions within three months (6% vs. 2%; p-value < 0.01).ConclusionsIUDs are increasingly being inserted in Dutch primary care, with peak regional IUD insertion care substitution rates at ≥ 80%. IUD insertion care substitution to primary care appears to be associated with significantly fewer women having follow-up ultrasound or IUD reinsertion within three months.

Expanding access to postpartum contraception.

Women are particularly vulnerable to unintended pregnancy in the 12 months following a birth. Improving access to postpartum contraception within maternity settings can prevent unintended and closely spaced births, improving the health of mother and child. This review will summarize the recent research in postpartum contraception (PPC), building on existing knowledge and developments in this field. Current models of postpartum contraceptive provision may not adequately meet women's needs. The COVID-19 pandemic led to changes in postpartum contraceptive provision, with an increasing emphasis placed on maternity services. Antenatal contraceptive discussion is associated with increased postpartum contraceptive planning and uptake of methods after birth. Digital health interventions may be a useful tool to support information about contraception. The most effective long-acting reversible contraceptive (LARC) methods, such as the intrauterine device (IUD) and implant, can be challenging to provide in the maternity setting because of availability of trained providers. Postpartum IUD insertion remains relatively under-utilized, despite evidence supporting its safety, efficacy and cost-effectiveness. Antenatal information needs to be partnered with access to the full range of methods immediately after birth to reduce barriers to PPC uptake. Training and education of maternity providers is central to successful implementation of PPC services.

Intrauterine device (IUD) migration to the fallopian tube: a rare location for a translocated IUD with no visceral injury

BackgroundLoss of Intra Uterine Device (IUD) following silent perforation of the uterus either during or after IUD insertion is an uncommon finding due to a lack of immediate follow-up. We report a rare case in which uterine perforation following the migration of IUD to the right fallopian tube without visceral injury. The patient presented with lower abdominal pain and pain during sex for one year since IUD insertion. On examination, we noted tenderness on the right suprapubic region and on speculum examination, no IUD thread was seen. A radiological pelvic examination showed an empty uterus without an IUD. Laparotomy and retrieval of migrated IUD was done followed by repair of perforated uterus.ConclusionMigrated IUD with silent uterine perforation without visceral injury is a distressing clinical condition both to the patient and the clinician. This case is reported to increase awareness in doing immediate vaginal examination and pelvic ultrasound post-IUD insertion.

Étude RIESC : risques d’infections uro-génitales et d’expulsion dans l’association stérilet et coupe menstruelle

ObjectivesThe increase in intrauterine devices (IUDs) contraception, and the growing use of reusables menstrual hygiene products such as the menstrual cup, necessitates an assessment of the implications of their co-use. The objectives are to assess whether women with IUDs who use menstrual cups have an increased risk of IUD expulsion and/or a change in the risk of upper and lower urogenital tract infections compared to women who use other menstrual hygiene products. MethodAn observational, prospective, multicenter study was conducted in France between 2020 and 2023. Participants were recruited by health professionals and data were collected by telephone questionnaire at the time of IUD insertion and at one year. The primary endpoints were the occurrence of IUD expulsion and the occurrence of urogenital tract infections in menstrual cup users compared to non-users. ResultsOne hundred and three women out of 119 included were analyzed, 25 of them were regular menstrual cup users and five experienced IUD expulsion. Among regular users, 12% experienced IUD expulsion compared to 2.6% among non-users, with no statistically significant difference (Chi2=3.65; P=0.056). Regarding urogenital tract infections, nine women (36%) of the regular menstrual cup users had urogenital infections, compared with 27 (34.6%) of the non-users or not regular users, with no statistically significant difference. ConclusionThe tendency of menstrual cup users to expel their IUDs is a reason for caution, although it is not sufficient to contraindicate co-use. Physicians should therefore systematically screen such co-use and inform patients of the risks and monitoring instructions.

Trends in Continuation of Long-Acting Reversible Contraception Among Adolescents Receiving Medicaid

PurposeDespite increasing use of long-acting reversible contraception (LARC) among U.S. adolescents, there is limited literature on factors affecting intrauterine device (IUD) or subdermal implant use. This study aimed to describe statewide rates, and associated patient and provider factors of adolescent IUD or implant initiation and continuation. MethodsThis retrospective cohort study used N.C. Medicaid claims data. 10,408 adolescents were eligible (i.e., 13–19 years, female sex, continuous Medicaid enrollment, had an IUD or implant insertion or removal code from January 1, 2013, to October 1, 2015). Bivariate analyses assessed differences in adolescents using IUD versus implant. Kaplan-Meier curves were created to assess IUD or implant discontinuation through December 31, 2018. ResultsAdolescents initiated 8,592 implants and 3,369 IUDs (N = 11,961). There were significant differences in nearly all provider and patient factors for those who initiated implants versus IUDs. 16% of implants and 53% of IUDs were removed in the first year. Younger (i.e., age <18 years old), Hispanic, and Black adolescents had higher adjusted continuation of implants compared with older and White adolescents, respectively (both p < .001). Those whose IUD was inserted by an obstetrician/gynecologist provider had lower continuation of IUDs compared with non-obstetrician/gynecologist providers (p < .001). DiscussionWe found that age-related, racial, and ethnic disparities exist in both implant and IUD continuation. Practice changes to support positive adolescent experiences with implant and IUD insertion and removals are needed, including patient-centered health care provider training in contraception counseling, LARC initiation and removal training for adolescent-facing providers, and broader clinic capacity for LARC services.

Effectiveness of an educational intervention on knowledge and practice of young midwifery college students about IUD and Pap smear, Babol, Iran.

The high status of midwifery within the Millennium Development Goals (MDGs) is closely tied to enhancing clinical education. The purpose of this study was to review the effect of education on the knowledge and practice of midwifery students about Intrauterine Device (IUD) and Pap smears. This quasi-experimental study was conducted over the course of four semesters, involving 128 bachelor of midwifery students. The sampling method was non-random, utilizing convenience sampling. Four consecutive 45 min weekly sessions were held, which included three theory sessions and one practical training session. Education was conducted in face-to-face training sessions using different methods such as lectures, question and answer, slide shows, educational films and brochures, and training participants with moulage. The data were gathered using a questionnaire covering demographic characteristics, various aspects of IUD and Pap smear knowledge, along with checklists for IUD insertion and Pap smear. Paired-samples T-test and multiple regression test were used to analyze the data. A significance level of p<0.05 was set for the analysis. The results of this study showed that there was a significant difference in the average knowledge across various aspects of IUD and Pap smear before and after the intervention (p<0.001). On multiple regression analysis, residence and income significantly influenced knowledge (β=0.313, p=0.001 and β=-0.384, p=0.001, respectively). Also, multiple regression analysis indicated that the use of IUD among family or friends and age significantly impacted practice (β=-0.450, p=0.005 andβ=-0.206, p=0.030, respectively). The educational intervention yielded a noticeable enhancement in the knowledge and practical skills of midwifery students. These students tend to achieve higher levels of success and deliver superior services to both patients and clients.

Intrauterine Device Insertion during Cesarean Section

Intrauterine Device Insertion during Cesarean Section