Perception of Pain with IUD Insertion in Nulliparous Women vs Multiparous Women: A Systematic Review

Authors

  • Emily DuBuc
  • Kimberly Magana
  • Micaela Motzko, D.O.
  • Lauren Thomas, D.O.

Abstract

Background and objective:

  • Intrauterine devices (IUD) are a popular form of long-acting reversible contraception that are highly effective. However, a common hesitation to abstain from this form of contraction is the perceived pain during the insertion procedure. Recognizing and addressing this common perception with evidence-based data will help obstetricians and gynecologists guide care for their patients. This study aims to perform a review of published literature to quantify the pain experienced during insertion for nulliparous women compared to multiparous women. 

Data Sources/Methods:

  • A search string focused on IUDs was developed by a systematic review librarian at Oklahoma State University Center for Health Sciences and applied to the following databases: Embase and Pubmed. Articles that included our search strings were sourced from January 1, 2013, to March 1, 2024. The returns were uploaded to Rayyan, a systematic review (SR) screening platform. Working in a masked, duplicate fashion, authors (E.D., K.M.) independently screened the titles and abstracts of each record to determine inclusion in this analysis. Once screening was complete, investigators were unmasked and disagreement regarding inclusion was resolved with a discussion. Data was extracted using a pilot-tested Google form. All data was extracted in a masked, duplicate fashion. Results were reported with both frequencies and percentages and bivariate analysis was performed between variables including quality rating, general characteristics, and pain, to determine the presence of any relationships. P-value less than or equal to 0.05 was considered significant. The statistical test (e.g., statistical assumptions, distributional qualities) was dependent upon the nature of the data.

Results:

  • 28 studies analyzed both parous and nulliparous patients (28/49, 57.1%), 18 analyzed nulliparous patients only (18/49, 36.7%) and 3 analyzed parous patients only (3/49, 6.1%). The most common pain measurement tool used was a Visual Analogue Scale (VAS) (41/49, 83.7%). Pain interventions were used in 36 studies (36/49, 73.5%). The most common pain intervention studied was misoprostol (10/36, 27.8%), followed by a lidocaine block (8/36, 22.2%) and lidocaine gel (8/36, 22.2%). Twenty-eight studies analyzed both parous and nulliparous women of which 14 studies directly stated that IUD insertion is more painful in nulliparous women (14/28, 50%).

Conclusion:

  • After review, we found that there is limited research measuring patient pain during IUD insertion. Based on the included studies, pain interventions should be considered for nulliparous women. There is a need for further research on this topic in an effort to update current protocols regarding pain intervention.

Author Biographies

Micaela Motzko, D.O.

Department of Obstetrics and Gynecology, Oklahoma State University Medical Center, Tulsa, Oklahoma

Lauren Thomas, D.O.

Department of Obstetrics and Gynecology, Oklahoma State University Medical Center, Tulsa, Oklahoma

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Published

2024-12-12

Issue

Vol. 8 No. 3 (2024): Article

Section

Medical

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