Evidence map›Paper›PMID 23670222›Full record

SynthesisHuman reproduction update

Management of pain associated with the insertion of intrauterine contraceptives.

K Gemzell-Danielsson, D Mansour, C Fiala, A M Kaunitz, L Bahamondes

Registry-linked trialAbstract readSystematic Review
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in Human reproduction update. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT03362905 (Lidocaine for Pain Control During Intrauterine Device Insertion), which is not on this map. Cited by 11 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
11citing papers in PubMed, 2 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT03362905 phase4unknown statusnot on this map

Lidocaine for Pain Control During Intrauterine Device Insertion: A Randomized Clinical Trial

TypeinterventionalSponsorAin Shams UniversityRan2017 to 2019Enrolled123ConditionsIUD Insertion ComplicationArmsLidocaine topical
3 · Its place in the literature

Who cites it

11 citing papers in PubMed, 2 syntheses or guidelines pooled it.

  1. Pooled it
  2. Interventions for pain with intrauterine device insertion.The Cochrane database of systematic reviews · 2015
    Pooled it
  3. Trial
  4. Pain at intrauterine device placement in a Brazilian center.International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics · 2026
    Article
  5. Article
  6. Article
  7. Article
  8. Article
  9. Review
  10. Article
  11. Practical advice for avoidance of pain associated with insertion of intrauterine contraceptives.The journal of family planning and reproductive health care · 2014
    Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

5 authors.

K Gemzell-DanielssonDepartment of Women's and Children's Health, Karolinska Institutet, Karolinska University Hospital, SE-17176 Stockholm, Sweden. kristina.gemzell@ki.se
D Mansour
C Fiala
A M Kaunitz
L Bahamondes

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundMost intrauterine contraception (IUC) placements do not require pain relief. However, small proportions of nulliparous (∼17%) and parous (∼11%) women experience substantial pain that needs to be proactively managed. This review critically evaluates the evidence for pain management strategies, formulates evidence-based recommendations and identifies data gaps and areas for further research.

methodsA PubMed literature search was undertaken. Relevant articles on management of pain associated with IUC insertion, published in English between 1980 and November 2012, were identified using the following search terms: 'intrauterine contraception', 'insertion' and 'pain'. RCTs were included; further relevant articles were also identified and included as appropriate.

resultsSeventeen studies were identified and included: 12 RCTs and one non-randomized study of pre-insertion oral analgesia, cervical priming and local anaesthesia; one systematic review and one RCT on post-insertion analgesia and two non-randomized studies on non-pharmacological interventions. There was no conclusive evidence that any prophylactic pharmacological intervention reduces pain associated with IUC insertion. However, most of the regimens studied were adopted from hysteroscopy or abortion and effectiveness in specific subsets of women has not been studied adequately. A systematic review found non-steroidal anti-inflammatory agents (NSAID) to be effective in reactively treating post-insertion pain, but no benefit was found with prophylactic use.

conclusionsNo prophylactic pharmacological intervention has been adequately evaluated to support routine use for pain reduction during or after IUC insertion. Women's anxiety about the procedure may contribute to higher levels of perceived pain, which highlights the importance of counselling, and creating a trustworthy, unhurried and professional atmosphere in which the experience of the provider also has a major role; a situation frequently referred to as 'verbal anaesthesia'.

Indexed as

Pain ManagementAbortion, InducedAnalgesicsAnesthesia, LocalAnti-Inflammatory Agents, Non-SteroidalFemaleHumansHysteroscopyIntrauterine DevicesPelvic PainAnalgesicsAnti-Inflammatory Agents, Non-Steroidalanalgesiacervical primingintrauterine contraceptionlocal anaesthesiapain

Identifiers

PMID23670222
PMCPMC3682672

What OpenQuestion holds

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Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.