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Date of Award

Spring 2024

Degree Name

Master of Medical Science (Physician Assistant)

Department

Physician Assistant; College of Health Sciences

First Advisor

Jacinta Hollinger

Abstract

Intrauterine Devices (IUDs) are a form of long- acting contraceptive that are used worldwide in preventing unwanted pregnancy. Despite their high success rate, there is a lot of hesitancy in women to choose this as their form of preferred birth control. Some of this comes from lack of patient education and other social factors, but another portion is the fear of pain during insertion. Unfortunately, there is no standard of care to mitigate pain with IUD insertion, and use of different modalities continue to be a heavily debated topic. It is believed the cause of pain with IUD insertion is multifactorial which makes finding an appropriate treatment difficult. Taking oral analgesics a few hours prior to insertion is frequently recommended, however, this has not been found to have significant success. There are other, more potent analgesic options including ketorolac or tramadol that have provided some improvement mostly with post-procedure pain. Topical anesthetics and paracervical blocks have also had some success with pain during insertion but there are some disadvantages to each. Cervical primers such as misoprostol and dinoprostone have started to fall out of favor but can be still considered especially in those who have more difficult insertion. Non-pharmacologic modalities that improve patient anxiety have also provided some improvement with pain during and after IUD insertion and should always be considered an option for the provider to utilize. Ultimately, the decision of what to use should be discussed and shared between patient and provider.

Additional Files

Poster Presentation PDF.pdf (13639 kB)
FINAL Capstone PDF!.pdf (704 kB)

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Pain Prophylaxis with IUD Insertion

Intrauterine Devices (IUDs) are a form of long- acting contraceptive that are used worldwide in preventing unwanted pregnancy. Despite their high success rate, there is a lot of hesitancy in women to choose this as their form of preferred birth control. Some of this comes from lack of patient education and other social factors, but another portion is the fear of pain during insertion. Unfortunately, there is no standard of care to mitigate pain with IUD insertion, and use of different modalities continue to be a heavily debated topic. It is believed the cause of pain with IUD insertion is multifactorial which makes finding an appropriate treatment difficult. Taking oral analgesics a few hours prior to insertion is frequently recommended, however, this has not been found to have significant success. There are other, more potent analgesic options including ketorolac or tramadol that have provided some improvement mostly with post-procedure pain. Topical anesthetics and paracervical blocks have also had some success with pain during insertion but there are some disadvantages to each. Cervical primers such as misoprostol and dinoprostone have started to fall out of favor but can be still considered especially in those who have more difficult insertion. Non-pharmacologic modalities that improve patient anxiety have also provided some improvement with pain during and after IUD insertion and should always be considered an option for the provider to utilize. Ultimately, the decision of what to use should be discussed and shared between patient and provider.