BACKGROUND AND PURPOSE:  

• Conti et al. (AJOG, 2018) sought to determine the efficacy of self-administered vaginal lidocaine gel application to reduce IUD insertion pain

METHODS: 

• Randomized, blinded controlled trial (RCT) 
  • Women undergoing levonorgestrel or copper intrauterine device insertion  
• At least 15 minutes before insertion, women self-administered vaginally either 
  • 20 mL 2% lidocaine gel 
  • Placebo gel  
• Primary outcome  
  • Pain during IUD insertion: Measured on a 100-mm visual analog scale from 0 (no pain) to 100 (worst pain imaginable) 
• Secondary outcomes included  
  • Anticipated pain | Baseline pain | Pain with speculum insertion | pain with tenaculum placement 
  • Postprocedure questionnaire administered to determine acceptability and willingness to wait for pain control

RESULTS: 

• 108 in lidocaine gel group | 107 in placebo gel group 
• Median (range) time from gel administration to speculum insertion (P=0.13) 
  • Lidocaine: 21 (14–74) minutes  
  • Placebo: 20 (12–43) minutes  
• There was no difference in median pain scores during IUD insertion (P=0.09) 
  • Lidocaine: 65 (1–99) mm  
  • Placebo: 59 (5–100) mm  
• There was no difference in median pain scores related to tenaculum placement (P=0.15)  
  • Lidocaine: 30 (0-86) mm 
  • Placebo: 38 (0-84) mm 
• Median pain scores at speculum insertion were significantly lower in the treatment group (P=0.046) 
  • Lidocaine: 7 [0–81] mm  
  • Placebo: 11 [0–80] mm  
• Anticipated pain and menstrual pain were both predictors of pain with intrauterine device insertion 
• The majority of women in both groups found the amount of vaginal leakage following gel insertion to be acceptable (>80%) 
• 92% of participants stated they would be willing to wait before intrauterine device placement for lidocaine gel to take effect

CONCLUSION:  

• Self-administered lidocaine  
  • Did not decrease IUD insertion pain or tenaculum pain  
  • Did improve speculum insertion pain  
• Authors note there are other analgesics undergoing study that may be more beneficial (e.g. lidocaine-prilocaine cream)

Learn More – Primary Sources: 

Self-administered vaginal lidocaine gel for pain management with intrauterine device insertion: a blinded, randomized controlled trial

Related ObG Topics:

Can lidocaine gel replace paracervical block for gyn procedures?

Can 1% Lidocaine Reduce Pain During IUD Insertion in Nulliparous Women?

IUDs and Implants: How to Manage Potential LARC Complications