Intracervical 2% Lidocaine Gel to Reduce IUCD Insertional Pain: A Randomized Controlled Trial

Abstract

ncreasing the number of women using IUCDs is an important public health goal. Fear of pain during IUCD insertion is one reason women may not want to use this highly effective birth control method. Pain at insertion of an IUCD can be distressing and may deter women from using the method. Determining an optimal method for reducing pain during IUCD insertion will benefit women and may increase the uptake of IUCDs as a contraceptive method. Prophylactic NSAIDs, as studied, do not appear to reduce pain during IUCD insertion, or four to six hours after IUCD insertion. Benefit may occur in the first couple hours after IUCD insertion in nulliparous women given naproxen, however. The use of misoprostol to prime the cervix in addition to diclofenac before IUCD insertion in nulliparous women did not appear to reduce pain and may increase side effects. No serious harms were reported in these trials, although such reporting was incomplete. The current study was conducted at Ain Shams University Maternity Hospital at family planning clinic during the period between January 2016 and January 2017. A total of 107 women sought family planning through IUCD insertion were included in the study divided into 2 groups: group A received lidocaine 2% gel topically to the cervix. group B received Q-Y gel topically to the cervix. There was no significant difference between to two groups regarding age, parity, weight, height, timing of IUCD insertion. Denoting that both groups were matched regarding factors that may influence pain sensation during the process of IUCD insertion. The two groups then were compared regarding pain felt after cervical traction, after uterine sound insertion and after IUCD insertion (3 min later) using VAS score to detect the efficacy of the tested drug on decreasing pain sensation. Regarding pain felt after cervical grasping and traction (measured by VAS), the median in group A was 2 and the interquartile range was from 0 to 3. In group B the median was 3 and the interquartile range was from 0 to 4. on comparing the 2 groups, the p value was 0.956 which is statistically insignificant. Regarding pain felt uterine sound insertion (measured by VAS), the median in group A was 3 and the interquartile range was from 1 to 5. In group B the median was 3 and the interquartile range was from 2 to 5. on comparing the 2 groups, the p value was 0.720 which was statistically insignificant. Regarding pain felt after IUCD insertion (measured by VAS), the median in grou