Uterine Sounding Research Articles

Levonorgestrel 52 mg intrauterine device placement without uterine sounding: A feasibility study

ObjectivesTo evaluate feasibility of levonorgestrel 52 mg intrauterine device (IUD) placement without uterine sounding. Study designWe performed a three-phase feasibility study from February 2023-May 2024. In phase one, participants had levonorgestrel 52 mg IUD placement with sounding. In the experimental phases, placement occurred without sounding and with (phase two) or without (phase three) concurrent transabdominal sonography and participants had 3-month follow-up. We defined feasibility as successful IUD placement without uterine sounding based on ultrasound confirmation. We measured total instrumentation time from the sound or inserter touching the cervix to inserter removal. Participants reported maximal pain experienced using a 100-mm Visual Analog Scale when the inserter was removed. We calculated a sample size of 30 per phase so that if there was one failed placement, the lower 95% confidence interval of the successful placement rate would be no less than 90.0%. ResultsSuccessful placement without sounding occurred in 30(100%) participants in phase two and 28(93.3%) in phase three. Median instrumentation was longest in phase one (49.5 [interquartile range (IQR) 42.3–55.0] seconds) compared to phases two (16.0 [IQR12.0–28.0] seconds, p < 0.0001) and three (25.0 [IQR 18.5–32.2] seconds, p < 0.0001). Participants’ median placement pain was 21.0 (IQR 10.3–32.8) mm in phase one with no difference in phase two (25.5 [IQR 14.3–47.0] mm, p = 0.35), but was higher in phase three (36.0 [IQR 22.8, 61.0] mm, p = 0.01). ConclusionsLevonorgestrel 52 mg IUD placement without sounding is feasible with concurrent sonography. Placement without sounding results in shorter instrumentation time but does not decrease maximum placement pain.

Comparative study between misoprostol and lidocaine before intrauterine contraceptive device insertion

Background Intrauterine contraceptive device (IUCD) is a safe, extremely effective and long-acting reversible contraceptive method. Misoprostol has definite to be a very pliable and adequate drug because its composition as a tablet that is stable and may be delivered orally, rectally or vaginally, and through the sublingual route. Lidocaine is a common local anesthetic and antiarrhythmic drug. Aims The objective of the present study was to compare between sublingual administration of misoprostol and lidocaine spray prior to IUCD insertion. Patients and methods This randomized controlled clinical trial was conducted at Department of Family Planning at Tanta University Hospital from February 2021 to March 2022. The study included 150 women into three groups each of them had 50 women. Results The pain scores during IUCD insertion and during uterine sounding were lower in group A, B. There was nonhuge distinction between both groups regarding insertion result (failed, easy or difficult insertion). There was nonhuge distinction between sublingual misoprostol and lidocaine spray regarding Visual Analogue Scale during sounding the uterus and during IUCD insertion. There was nonhuge distinction between studied groups as regard of medication related side effect except misoprostol group significant increase abdominal cramps. Conclusions The study concluded that the use of sublingual misoprostol and lidocaine before IUCD insertion reduces Visual Analogue Scale scores (pain scores) during sounding the uterus and during IUCD insertion.

Comparison Of Effectiveness Of Counselling Only, Suppository Diclofenac And Lidocaine Spray At Intrauterine Device Insertion In A Tertiary Hospital In Ghana

Objective: Perception of pain at IUD insertion is one of the main barriers of its uptake. Several pharmacological and non-pharmacological interventions have been studied but currently there is no consensus on the pain management at IUD insertion. The study aim was to compare the effectiveness of counselling only, 10% lidocaine spray of the cervix and 100mg suppository diclofenac in reducing pain at IUD insertion. Methodology: A prospective study of 99 respondents were randomized into 3 study arms; suppository diclofenac, lidocaine spray and counselling only in a ratio of 1:1:1. All participants had a baseline counselling: while those in the diclofenac arm were given 100mg diclofenac suppository 30 minutes before the procedure, those in the 10% lidocaine spray arm were given 4 pumps on the cervix before the insertion. A 10cm- Visual Analog Scale was used to assess the pain experienced during and after IUD insertion. Chi-square test, one-way ANOVA and a Post-Hoc test were used for the statistical analysis. P value of &lt; 0.05 and confidence interval of 95% were used. Results: Suppository diclofenac was superior to counselling only at speculum insertion, tenaculum application, uterine sounding, IUD placement, immediately and 5 minutes after procedure. Lidocaine spray of the cervix was also superior to counselling only throughout the procedure and up to 4 hours post procedure. Lidocaine spray of the cervix was superior to suppository diclofenac at 5 minutes and 4 hours after procedure. Conclusion: Lidocaine spray (10%) of cervix is more effective compared to 100mg Diclofenac Sodium and Counselling only in reducing pain at IUD insertion.

Multiple uterine perforations during manual vacuum aspiration: the need to increase the clinical awareness of attending healthcare professionals.

The risk of uterine perforation during manual vacuum aspiration (MVA) is reduced by using Karman cannula (which has a rounded tip) during the procedure. A 35-year-old multigravida at 13 gestational weeks presented with vaginal bleeding of a day duration and ultrasound evidence of retained products of conception suggestive of incomplete miscarriage. The patient was rhesus D positive and stable. She had MVA which was performed using Karman cannula, and developed severe vaginal bleeding. The differential diagnoses were incomplete uterine evacuation and uterine perforation. During a laparotomy in Lloyd-Davies position, haemoperitoneum and six uterine perforations on the anterior and fundal parts, each approximately 5 mm in length (Figure 1), were found. The perforations were repaired and a check uterine curettage under oxytocic cover showed an empty uterus. The abdominal cavity was washed and closed. She was transfused three units of red blood cell concentrate and had a normal six weeks follow-up. When an instrument inserted into the uterus is pushed beyond the estimated depth of the uterus, a perforation must be suspected and the condition may be managed conservatively. A surgical procedure complicated by surgeon's loss of perception (in this case tactile) of tissues' anatomy is hazardous.

Ex-vivo forces associated with intrauterine device placement and perforation: a biomechanical evaluation of hysterectomy specimens

BackgroundThis biomechanical analysis of hysterectomy specimens assesses the forces associated with intrauterine device placement. These include compressive forces required to cause uterine perforation with two commonly available commercial intrauterine device placement instruments and a metal uterine sound.MethodsWe obtained hysterectomy specimens at a single academic center. All specimens resulted from excision for benign conditions in premenopausal women by any operative method. Within one hour of excision, we stabilized uterine specimens in an apparatus specifically designed for this analysis. A single, experienced clinician performed all experimental maneuvers and measured forces with a Wagner FDIX-25 force gauge. The investigator applied traction on a tenaculum to approximate force used during an intrauterine device placement. The maximum compressive force to the uterine fundus was determined by using manufacturers’ placement instruments for two commercially available products and a metal sound.ResultsSixteen individuals provided hysterectomy specimens. No complete perforations occurred while using loaded intrauterine devices; in a single observation the LNG IUS entered the myometrium. The plastic intrauterine device placement rod bowed in all attempts and did not perforate the uterine serosa at the fundus. A metal uterine sound created a complete perforation in all specimens (p < .001). The lowest mean maximum force generated occurred with the levonorgestrel intrauterine system placement instrument 12.3 N (SD ± 3.8 N), followed by the copper T380A intrauterine device placement instrument 14.1 N (SD ± 4.0 N), and highest for the metal sound 17.9 N (SD ± 7.6 N) (p < 0.01).ConclusionsIn this ex-vivo model, metal uterine sounds caused complete perforation and intrauterine device placement instruments did not.This study received Institutional Review Board (IRB0059096) approval.

Comparison of Intrauterine Device Insertion-Related Pain and Ease of Procedure at Different Times During Menstruation.

ObjectiveFear of pain during the copper intrauterine device (Cu-IUD) insertion may lead patients to reject this highly effective birth control method. The aim of this study was to investigate the pain scores associated with IUD insertion and the ease of procedure at different times during menstruation.MethodIn this prospective cohort trial, eligible women received IUD at three-time segments of menstruation: Group I, at 0.5 to 0.69-time segment (n=53); Group II, at 0.7 to 0.89-time segment (n=67); and Group III, at 0.9 to 1-time segment (n=72). The time segments during menstruation were calculated for each participant by dividing the menstrual cycle day of IUD insertion to total number of menses days. The score of pain experienced at different steps of IUD insertion during and five min. after the procedure measured by Wong-Baker FACES Pain Rating Scale (WBS) and the ease of insertion were compared among groups.ResultsThere were significant differences in age (p=0.011) and time since the last delivery (p=0.017). After adjusting for potential confounding factors, the mean WBS score and the ease of insertion were not statistically significant among groups, respectively (p=0.664 and p=0.149). The most painful step was observed as uterine sounding (median, 4 [interquartile range {IQR}, 2]). No significant correlation was observed between WBS scores, the ease of insertion, and main characteristics of the participants.ConclusionThe most painful step of IUD insertion was observed as uterine sounding. IUD insertion-related pain and the ease of procedure do not appear to be different at any time in the second half of menstruation.

Effect of self-administered vaginal dinoprostone on pain perception during copper intrauterine device insertion in parous women: a randomized controlled trial

To assess efficacy and safety of self-administered 3 mg dinoprostone vaginally in reducing pain during copper intrauterine device (IUD) insertion in parous women. Randomized, double-blinded, placebo-controlled trial. Family planning clinic in a tertiary referral hospital. Multiparous women who were attending a family planning clinic and requesting copper IUD insertion. We randomly assigned 160 participants into two groups: The dinoprostone group (n = 80) received 3 mg dinoprostone vaginally, and the placebo group (n = 80) received placebo vaginally. Our primary outcome was mean pain scores during IUD insertion. Our secondary outcomes were mean pain scores during tenaculum application, during uterine sounding, and 15 minutes after insertion, ease of insertion, satisfaction score, need for additional analgesics, and side-effects. Both groups showed no significant difference in anticipated pain score (P=.41), pain during tenaculum placement (P=.22), and pain during sound insertion (P=.07). The dinoprostone group had significantly lower pain scores during IUD insertion (34.8 ± 10.1 vs. 57.8 ± 11.8) and 15 minutes after insertion (20.6 ± 6.4 vs. 29.6 ± 6.2), easier IUD insertion (43.6 ± 21.9 vs. 64.7 ± 18.1), and higher satisfaction (83.9 ± 11.6 vs. 63.0 ± 9.1) compared with the placebo group. Fewer patients required additional analgesics in the dinoprostone group compared with the placebo group (P=.01). Side-effects were similar between the groups. Self-administered 3 mg dinoprostone vaginally before copper IUD insertion in parous women reduces pain scores during IUD insertion, making insertion easier and increasing women's satisfaction, with tolerable side-effects. NCT04046302.

10% lidocaine spray for pain control during intrauterine device insertion: a randomised, double-blind, placebo-controlled trial

BackgroundVarious medications have been investigated for their efficacy in pain reduction during intrauterine device (IUD) insertion, but there is currently no standard recommendation. This study aimed to investigate the efficacy...

Benefits of Self-administered Vaginal Dinoprostone 12 Hours before Levonorgestrel-releasing Intrauterine Device Insertion in Nulliparous Adolescents and Young Women: A Randomized Controlled Trial.

To assess safety and efficacy of self-administered vaginal dinoprostone 12hours before a 52-mg levonorgestrel intrauterine device (LNG-IUD) insertion in adolescents and young nulliparous women. Randomized controlled trial. Tertiary referral hospital. Nulliparous adolescents and young women aged 18-22years. Participants were randomly assigned into 2 groups; the dinoprostone group (n=65) received dinoprostone 3mg vaginally, and the placebo group (n=65) received placebo tablets vaginally. Primary outcome was pain scores during LNG-IUD insertion measured using a visual analogue scale. Secondary outcomes were pain scores during speculum insertion, tenaculum placement, uterine sounding, and 20minutes postprocedure, ease of insertion, Women's satisfaction score, need for additional analgesics, and side effects. The dinoprostone group had significantly lower pain scores during LNG-IUD insertion (2.83±1.08 vs 3.95±1.63), tenaculum placement (2.97±1.41 vs 4.55±1.53) and sounding of uterus (3.55±1.71 vs 5.12±1.37) compared with the placebo group (P<.001). No significant differences were found between both groups regarding anticipated pain scores (P=.85), pain during speculum insertion and 20minutes postinsertion and insertion duration (P=.53). Women's satisfaction, provider reported ease of insertion, and need for additional analgesia were significantly better among dinoprostone users (P<.001, < .001, and .02, respectively). Side effects and procedure complications were similar for the 2 groups. Self-administered dinoprostone 3mg vaginally 12hours before a 52-mg LNG-IUD insertion in nulliparous adolescent and young women effectively reduced pain during insertion and increased women's satisfaction and ease of insertion reported by clinicians.

Uterine rupture in pregnancy after an intervention complicated by uterine perforation: Case report and systematic review of literature

ObjectivesThe present study is a descriptive study of characteristics of women who had a uterine rupture during pregnancy with a history of uterine perforation and no previous caesarean section. Study designWe present a case report of a woman with a uterine rupture in pregnancy subsequent to a perforation made by uterine sounding and we performed a systematic review including all case-reports of uterine ruptures after perforation during dilatation and curettage or due to uterine sounding. Results14 case-reports were included in this review. 12 out of 14 women presented with abdominal pain prior to the uterine rupture. In eight out of 14 cases an abdominal ultrasound was performed and in five ultrasounds a uterine wall defect was detected, in two other cases free fluid was visible and in one case fetal bradycardia was seen. Neonatal outcome was uneventful in six cases, there where two immature fetuses born and in two cases there was fetal demise. ConclusionUterine rupture in a (supposed) unscarred uterus is a relatively unknown complication. We recommend clinicians to be aware of uterine rupture in pregnant women with abdominal pain and a history of uterine manipulation. When a uterine rupture is suspected and mother and fetus are in suspected good condition, an ultrasound examination could be an easy and fast next step.

Paracervical Block for Intrauterine Device Placement Among Nulliparous Women: A Randomized Controlled Trial.

To investigate whether a 20-mL buffered 1% lidocaine paracervical block decreases pain during intrauterine device (IUD) placement. In a randomized, single-blind, placebo-controlled trial, women were assigned to receive either a 20-mL buffered 1% lidocaine paracervical block or no block before IUD placement. The primary outcome was pain with IUD placement measured on a 100-mm visual analog scale. Our sample size had 80% power (α=0.05) to detect a 20-mm difference in visual analog scale scores with a SD of 28 mm. Secondary outcomes included pain with speculum placement, paracervical block administration, tenaculum placement, 5 minutes postprocedure, and overall pain perception. From October 7, 2014, through October 26, 2017, 64 women were enrolled and analyzed (33 in the paracervical block arm, 31 in the no-block arm). There were no differences in baseline demographics between the groups. Women who received the paracervical block reported less pain with IUD placement compared with women who received no block (median visual analog scale score of 33 mm vs 54 mm, P=.002). Pain was significantly less in the intervention group for uterine sounding (30 mm vs 47 mm, P=.005), 5 minutes after placement (12 mm vs 27 mm, P=.005), and overall pain perception (30 mm vs 51 mm, P=.015). Participants who received the paracervical block experienced more pain with block administration compared with placebo (30 mm vs 8 mm, P=.003). There was no perceived pain difference for speculum insertion (10 mm vs 6 mm, P=.447) or tenaculum placement (15 mm vs 10 mm, P=.268). A 20-mL buffered 1% lidocaine paracervical block decreases pain with IUD placement (primary outcome), uterine sounding (secondary outcome), and 5 minutes after placement (secondary outcome). Although paracervical block administration can be painful, perception of pain for overall IUD placement procedure is lower compared with no block. ClinicalTrials.gov, NCT02219308.

Uterine Sounding: Is There a Difference between Blind and Hysteroscopically Directed Measurements?

Study ObjectiveTo evaluate the accuracy of traditional blind uterine sounding in measuring uterine cavity length (UCL), compared with measurement by hysteroscopic guidance. DesignA cross-sectional descriptive study (Canadian Task Force classification III). SettingAcademic multispecialty medical center. PatientsFifty-eight women undergoing elective hysteroscopic procedures. InterventionUCL measurement. MeasurementsUCL measurements were obtained by the traditional blind sounding technique and by hysteroscopically directed measurement. Hysteroscopic measurements were assumed to represent true uterine cavity length. Differences between the 2 measurements were calculated to analyze error and bias. ResultsMean UCL for blind sounding and hysteroscopically directed measurements were 80.81 mm and 86.55 mm, respectively. The magnitude of error between measurements was >10 mm in 36.2% of cases, with underestimation of true UCL in 55.17% of cases. ConclusionTrue UCL is underestimated by blind sounding, and the frequency, magnitude, and direction of error may be greater than are clinically acceptable.

Classic versus uterine sound-sparing approach for insertion of copper T380A intrauterine device: A randomized clinical trial

Abstract Objective The current study compares the efficacy of the classic approach and the uterine sounding sparing approach (a new approach) for copper intrauterine device (Cu-IUD) insertion. Study design A randomized clinical trial. Setting Woman's Health Hospital, Assiut, Egypt. Materials and methods The current study was an open parallel randomized clinical study conducted in Assiut Woman’s Health Hospital, Egypt included women requesting Copper IUD insertion. Enrolled women were randomized into 2 groups; group I included women subjected to classic approach for Cu-IUD insertion and group II included women had Cu-IUD insertion using the uterine sound-sparing approach (USSA). This approach utilized transvaginal ultrasound (TV/US) for assessment of the uterine cavity length and position before IUD insertion without using uterine sounding. The primary outcome was the successful Cu-IUD insertion. Results 46 women were analyzed in group I and 46 in group II. The pain during IUD insertion and 5 min post-insertion was significantly lower in group II than group I (p Conclusions Cu-IUD can be inserted successfully without using uterine sound provided using TV/US prior to insertion. This method associated with less pain, greater women satisfaction during insertion with shorter duration.

Does sublingual misoprostol reduce pain and facilitate IUD insertion in women with no previous vaginal delivery? A randomized controlled trial

Abstract Introduction Intrauterine devices (IUDs) are good contraceptive method for women as they have a long acting contraceptive effect compared to other hormonal methods. Misoprostol or prostaglandin El (PGE1) analogue is a synthetic prostaglandin that has been used to induce cervical ripening in vaginal delivery and in medical induction of abortion. Sublingual administration of misoprostol has been shown to be more effective for cervical priming compared with oral administration and equally effective as vaginal administration. Objectives Pain assessment using both the numeric rating scale & pain visual analog scale. The secondary outcome was the successful IUD insertion without the use of adjunctive measures. Material and methods The study was a double blinded randomized controlled trial included 400 cases attended the family planning clinic in Shatby Maternity University Hospital, compared sublingual 200 μg misoprostol with placebo to facilitate IUD insertion. The following parameters have been also studied: • Misoprostol side effects within 48 h of intake: nausea, vomiting, fever, pain and bleeding. • Difficulty in IUD insertion. • Pain assessment using both the numeric rating scale & pain visual analog scale. • Failure of IUD insertion. Results Regarding the easiness of uterine sounding, there was no statistical difference between the two groups. The combined pain assessment was done using numerical rating scale recorded by the woman and VAS recorded by the health provider; the higher reading of both scales for each case was recorded and analyzed there was no statistical significant difference as regard pain reduction in using misoprostol prior to IUD insertion. As regards successful insertion of IUD, the calculated p value did not show any significant difference regarding using misoprostol for successful IUD insertion. The cumulative side effects reported in both groups showed that there is a significant statistical difference between both groups. Conclusion Although misoprostol is used in cervical ripening in labour induction and medical evacuation of missed abortion, its use to facilitate IUD insertion in women with tight cervix or in whom vaginal delivery was not experienced, has no role in pain reduction or increase the ease of IUD insertion.

Oral Ketorolac for Pain Relief During Intrauterine Device Insertion: A Double-Blinded Randomized Controlled Trial

ObjectiveTo evaluate if oral ketorolac provides effective pain relief during placement of an IUD for contraception. MethodsWe conducted a double-blinded randomized controlled trial in a community hospital in Columbus, Ohio. Participants that met eligibility criteria were consented and randomized to receive either oral ketorolac 20 mg or placebo 40 to 60 minutes before IUD placement. Both participants and providers were blinded to the randomization group. The primary outcome was pain reduction (measured on a 0–10 numerical rating scale) during IUD placement. Data was analyzed using a two-sided independent samples t-test. An a priori sample size was calculated to detect a clinically meaningful difference of 2 points with 80% power. The type I error probability was α = 0.05. ResultsSeventy-two participants were enrolled and randomized between May 2014 until March 2016. Thirty-five in the ketorolac group and 36 in the placebo group were analyzed. There were no differences in baseline characteristics between participants or providers, as well as pain ratings prior to the procedure, at tenaculum placement, or at uterine sounding. There was a significant decrease in the pain of the ketorolac versus the placebo group rating at IUD deployment (4.2 vs. 5.7, P = 0.031), overall pain rating (3.6 vs. 4.9, P = 0.047), and pain 10 minutes after the procedure (1.1 vs, 2.5, P = 0.007). ConclusionOral ketorolac given 40 to 60 minutes prior to IUD insertion is effective in reducing pain during IUD deployment, overall pain, and pain 10 minutes after IUD placement.

Naproxen Sodium for Pain Control With Intrauterine Device Insertion: A Randomized Controlled Trial.

To evaluate whether 550 mg oral naproxen sodium given 1 hour before intrauterine device (IUD) insertion is effective for pain relief as compared with placebo. This was a randomized, double-blind, placebo-controlled trial. The primary outcome was pain with IUD insertion measured on a 100-mm visual analog scale (VAS). Our sample size was calculated to detect a 15-mm difference in VAS scores with 80% power (α=0.05). Secondary outcomes included pain with tenaculum placement, uterine sounding, and 5 and 15 minutes postinsertion. A total of 118 women were enrolled and analyzed (58 in the naproxen sodium arm, 60 in the placebo arm, 97% nulliparous) between May 11, 2015, and March 25, 2016. There were no differences in baseline demographics or reproductive characteristics between arms. There were no differences in median VAS pain scores for the primary outcome of pain with IUD insertion between the naproxen sodium arm compared with the placebo arm (69 compared with 66 mm, P=.89). There were no differences in the secondary outcomes of median VAS pain scores with tenaculum placement (37 compared with 32 mm, P=.97) or uterine sounding (60 compared with 58 mm, P=.66). However, median pain scores postprocedure were lower in the naproxen arm as compared with the placebo arm: 17 compared with 26 mm (P=.01) at 5 minutes and 13 compared with 24 mm (P=.01) at 15 minutes postinsertion. Oral naproxen sodium does not reduce pain with IUD insertion but does reduce pain after insertion and should be considered as a premedication. ClinicalTrials.gov, http://clinicaltrials.gov, NCT02388191.

EXPERIENCE OF EMPATHY TO DEATH

As part of the autoethnography approach the biographical reflection on death is presented. Various life situations of respondents allow to reconstruct the complexity and ambiguity of «on the verge of death» state of cancer patients and their relatives. The first participant had survived the growth of the tumor, the diagnosis and surgery. The diagnosis turned out to be negative, but it has not prevented a strong fear of death at the beginning, solitude and escape from people finding new place in the world that suddenly changed, return to life, and constant reflection. The second is operated patient with diagnosed throat cancer. From time to time he writes down his thoughts, answers, comments, participating in the conversation only gestures and faintly uterine sounds, which sometimes add up to a word. His wife is the third one and the main in interview. She talks about what happened, shares the fears, talks about the proximity of death, complaining about her lack of restraint and, at the same time, encourages the husband. The fourth is the one who is trying to link the text into a single narrative, who stumbled, seeing his friend’s emaciated, smiling, with a scar, did not believe at first the story right about the tumor, surgery, a whole year spent with the disease.

Naproxen sodium for pain control with intrauterine device insertion: a randomized controlled trial

Objectives: Prior studies of naproxen sodium suggest effective pain relief with IUD insertion. It is unclear if these results apply to modern T-shaped IUDs. We hypothesized that 550 mg of oral naproxen sodium 1 h prior to IUD insertion would reduce pain compared with placebo. Methods: This was a double-blind, randomized, placebo-controlled trial. The primary outcome was pain with IUD insertion measured on a 100-mm visual analogue scale (VAS). Secondary outcomes included pain with tenaculum placement, uterine sounding and at 5- and 15-min postinsertion. A secondary analysis compared pain scores by IUD type for nulliparous subjects, independent of study drug allocation. Results: A total of 118 women were enrolled and analyzed (58 in the naproxen arm, 60 in the placebo arm, 97% nulliparous). There were no differences in baseline demographic characteristics except greater marijuana use in the past 3 months in the naproxen arm (55% vs. 30%, p=.006). There was no difference in pain at IUD insertion (median VAS 69 mm vs. 66 mm, p=.89), tenaculum placement and uterine sounding. There was significantly less pain at 5 min (16.5 mm vs. 26 mm, p=.01) and at 15 min (13 mm vs. 24 mm, p=.01) after IUD insertion. There were no significant differences in IUD insertion pain scores between IUD types, but severe subjective pain was significantly lower in the Paragard® arm (6.9% vs. 44.8% for Mirena®, p=.004, and 30.9% for Liletta®, p=.007). Conclusions: Oral naproxen sodium does not reduce pain with IUD insertion but does reduce pain following insertion.

Self-Administered Lidocaine Gel for Intrauterine Device Insertion in Nulliparous Women: A Randomized Controlled Trial.

To evaluate self-administration of vaginal lidocaine gel to decrease pain with intrauterine device (IUD) insertion in nulliparous women. In this randomized, double-blind, placebo-controlled trial, women self-administered 2% lidocaine or placebo vaginal gel 5 minutes before IUD insertion. The primary outcome was change in pain from baseline to IUD insertion on a 100-mm visual analog scale. We also assessed pain after speculum insertion, tenaculum placement, uterine sounding, and 5 minutes after IUD insertion. Secondary outcomes included patient acceptability, ease of IUD insertion, and need for pain medication for up to 7 days. From July 2012 to May 2013, 59 women were randomized; 30 received lidocaine gel and 29 placebo. Baseline demographics, including age, race, and body mass index, were similar. There was no difference in median change in pain during IUD insertion in women receiving lidocaine (61 mm [interquartile range 53-71]) compared with placebo (69 mm [interquartile range 63-80], P=.06). Women receiving lidocaine experienced less pain with tenaculum placement (32 mm [interquartile range 18-54]) compared with placebo (56 mm [interquartile range 26-75], P=.02). Most (76%) women were satisfied with their IUD insertion experience and 86% would probably or definitely recommend an IUD to a friend. Thirty-four percent of women required pain medication for at least 3 days after IUD insertion. For nulliparous women, self-administered vaginal lidocaine gel does not reduce pain with IUD insertion, but does decrease pain with tenaculum placement. ClinicalTrials.gov, http://clinicaltrials.gov, NCT01534520.

Assessment of a high-fidelity mobile simulator for intrauterine contraception training in ambulatory reproductive health centres

Objectives. Little is known about the utility of simulation-based training in office gynaecology. The objective of this cross-sectional study was to evaluate the self-reported effectiveness and acceptability of the PelvicSim™ (VirtaMed), a high-fidelity mobile simulator, to train clinicians in intrauterine device (IUD) insertion. Methods. Clinicians at ambulatory healthcare centres participated in a PelvicSim IUD training programme and completed a self-administered survey. The survey assessed prior experience with IUD insertion, pre- and post-training competency and comfort and opinions regarding the acceptability of the PelvicSim. Results. The 237 participants were primarily female (97.5%) nurse practitioners (71.3%). Most had experience inserting the levonorgestrel LNG20 IUD and the copper T380A device, but only 4.1% had ever inserted the LNG14 IUD. For all three devices, participants felt more competent following training, with the most striking change reported for insertion of the LNG14 IUD. The majority of participants reported increased comfort with uterine sounding (57.7%), IUD insertion on a live patient (69.8%), and minimizing patient pain (72.8%) following training. Of the respondents, 89.6% reported the PelvicSim IUD insertion activities as “valuable” or “very valuable.” All participants would recommend the PelvicSim for IUD training, and nearly all (97.2%) reported that the PelvicSim was a better method to teach IUD insertion than the simple plastic models supplied by IUD manufacturers. Conclusions. These findings support the use of the PelvicSim for IUD training, though whether it is superior to traditional methods and improves patient outcomes requires evaluation.