Skip to main content
PMC home page
NIHPA Author Manuscripts logoLink to NIHPA Author Manuscripts
. Author manuscript; available in PMC: 2020 Jan 1.
Published in final edited form as: Obstet Gynecol. 2019 Jan;133(1):189–190. doi: 10.1097/AOG.0000000000003044

Paracervical Block for Intrauterine Device Placement Among Nulliparous Women: A Randomized Controlled Trial

Sheila K Mody 1, Lynn L Ngo 2
PMCID: PMC6414079  NIHMSID: NIHMS1510870  PMID: 30575661

In Reply:

We thank Dr. Levine and Dr. Fernandez for their interest in our article.1 We agree that pain with intrauterine device (IUD) placement is multifactorial. Regarding the specific points in their Letter, please see our response below.

  1. A standard, single-tooth tenaculum was used in this study. All participants received 2 cc of 1% lidocaine at the tenaculum site. The control and intervention group had the similar pain scores with the tenaculum placement.

  2. A review by Whiteman et al in 2013 did not find timing of IUD placement with menses to be associated with less insertion pain.2 Even if there were some benefit to IUD placement with menses, since this was a randomized controlled trial, those who had the IUD placed during menses should be evenly distributed between our study groups and should not be a confounding factor in our data analysis.

  3. We acknowledge that our study looked at pain control for the standard size IUDs. Our study found a benefit to using 20 cc of buffered 1% lidocaine with standard size IUDs. The Akers et al. study showed a benefit to using a lidocaine paracervical block for the smaller frame IUDs among nulliparous women.3 We do not counsel nulliparous women that they should not use the standard size IUDs. The standard 52-mg LNG IUD has a favorable side effect profile and duration of use.

Footnotes

Financial Disclosure

The authors did not report any potential conflicts of interest.

Contributor Information

Sheila K. Mody, Division of Family Planning, Fellowship in Family Planning, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Diego.

Lynn L. Ngo, Department of Obstetrics and Gynecology, Southern California Permanente Medical Group, San Diego, California.

REFERENCES:

  • 1.Mody SK, Farala JP, Jimenez B, Nishikawa M, Ngo LL.Paracervical Block for Intrauterine Device Placement Among Nulliparous Women: A Randomized Controlled Trial. Obstet Gynecol 2018;132:575–582. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 2.Whiteman MK, Tyler CP, Folger SG, Gaffield ME, Curtis KM. When can a woman have an intrauterine device inserted? A systematic review. Contraception 2013;87(5):666–673. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 3.Akers AY, Steinway C, Sonalkar S, Perriera LK, Schreiber C, Harding J, Garcia-Espana JF. Reducing Pain During Intrauterine Device Insertion: A Randomized Controlled Trial in Adolescents and Young Women. Obstet Gynecol 2017. October;130(4):795–802. [DOI] [PubMed] [Google Scholar]

RESOURCES