Self-administered vaginal lidocaine gel for pain control during IUD insertion in nulliparous patients: A randomized controlled trial
Awarded 2012
Complex Family Planning Fellowship Research
Rachel Rapkin, MD
University of Pittsburgh

Intrauterine devices (IUDs) are among the most effective forms of reversible contraception. Numerous studies demonstrate that IUDs are safe and effective for women who have never given birth. However, many women who have never given birth do not use IUDs because they fear that placement will be too painful. Some doctors also do not feel comfortable placing IUDs in this group of women because they fear placement will be difficult or painful. Several studies have been conducted to assess methods of decreasing pain during placement of an IUD, however, none of the methods assessed to date have effectively decreased pain.
The purpose of this study was to evaluate using lidocaine gel (a gel used to numb other areas of the body) before placement of an IUD. Women in this study used an applicator to place gel in their vaginas five minutes before having their IUD placed. Half of the women in this study received lidocaine gel, and the other half received a different gel with no numbing properties (placebo). Neither the women nor the doctors in this study knew which gel the women received. Women reported how much pain they experienced at different times during the IUD insertion procedure.
We found that women who received lidocaine gel experienced less pain during speculum placement, but had the same level of pain during the actual IUD insertion as compared to women receiving the placebo gel. Overall, women were very satisfied with their IUD placement and nearly all study participants said they would recommend getting an IUD to a friend.
This study is important for several reasons. First, it shows that even when women have pain during placement of an IUD, they still were willing to have the IUD placed. Most women stated the level of pain they experienced was acceptable. This shows that pain should not be a barrier to women receiving IUDs. Another important finding was that the lidocaine gel decreased pain when the speculum was placed, which may be useful clinically for women who avoid speculum exams due to fear of pain as speculum exams are necessary for cervical cancer screening.