Practical advice for avoidance of pain associated with insertion of intrauterine contraceptives

J Fam Plann Reprod Health Care. 2014 Jan;40(1):54-60. doi: 10.1136/jfprhc-2013-100636. Epub 2013 Sep 27.


Few studies in the scientific literature provide clear direction on the prevention or management of pain associated with intrauterine contraceptive (IUC) placement. Those that have been published have studied small numbers of women and fail to provide definitive conclusions. There are also no guidelines available detailing recognised standard approaches to this problem. The consensus recommendations in this review focus primarily on non-pharmacological and often non-evidence-based interventions. This review includes general considerations, practical recommendations for both routine and more difficult cases and guidance on the optimal choice of instruments. General considerations, including pre-insertion counselling, the setting for the procedure, the confidence and technique of the provider and the interplay between the provider and assistant, can influence women's level of anxiety and, in turn, influence their perception of pain and their overall experience. Further studies are required to refine the optimal strategy for managing pain associated with IUC insertion.

Keywords: family planning service provision; intrauterine devices.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Adult
  • Analgesics / therapeutic use
  • Anesthetics, Local / therapeutic use
  • Female
  • Humans
  • Intrauterine Devices / adverse effects*
  • Pain Management / methods*
  • Pelvic Pain / drug therapy
  • Pelvic Pain / etiology*
  • Pelvic Pain / prevention & control*
  • Practice Guidelines as Topic


  • Analgesics
  • Anesthetics, Local