Though IUDs are among the most effective forms of contraception, some patients and providers are often deterred from this option due to fear of painful insertion. Lidocaine spray, gel, and 1% lidocaine paracervical block have been utilized as methods of pain reduction with IUD insertion; research shows that some methods may be more effective than others.
Research best supports the 1% lidocaine paracervical block for pain reduction. In the randomized, single-blind, placebo-controlled trial by Mody, et al. (2018), the authors find that a 20-mL buffered 1% lidocaine paracervical block decreases pain with IUD placement (primary outcome), uterine sounding (secondary outcome), and 5 minutes after placement (secondary outcome). There was no perceived pain difference for speculum insertion or tenaculum placement. Although administration of the paracervical block may cause pain, nulliparous patients who receive the paracervical block rate overall pain with IUD insertion as lower.
There is less evidence to recommend lidocaine spray or gel for pain reduction with IUD insertion. Conti, et al. (2019) conclude from their randomized controlled trial that self-administered lidocaine gel prior to IUD insertion does not reduce pain when compared to placebo. NIH is currently recruiting for a clinical trial to study pain perception with IUD insertion using 10% lidocaine spray compared with placebo.
Thus, the 20-mL buffered 1% lidocaine paracervical block is an effective method for pain reduction with IUD insertion and should be offered to all patients. Further research is needed regarding use of lidocaine sprays and gels for pain reduction.
Conti JA, Lerma K, Schneyer RJ, Hastings CV, Blumenthal PD, & Shaw KA. Self-administered vaginal lidocaine gel for pain management with intrauterine device insertion: a blinded, randomized controlled trial. American Journal of Obstetrics & Gynecology. 2019;220:177. e1-7.
Mody SK, Farala JP, Jimenez B, Nishikawa M, & Ngo LL. Paracervical block for intrauterine device placement among nulliparous women: a randomized controlled trial. Obstetrics & Gynecology. 2018;132(3):575-582. doi: 10.1097/AOG.0000000000002790.
The Reproductive Health Access Project does not accept funding from pharmaceutical companies. We do not promote specific brands of medication or contraception. The information in the Contraceptive Pearls is unbiased, based on science alone.