Addressing Pain Management Practices and Potential Under-Medication of Women During IUD Insertion Procedures

Intrauterine devices (IUDs) are among the most effective and safe contraceptive options available to women, yet their utilization often remains limited due in part to fear of pain, lack of adequate pain management during insertion, and absence of standardized clinical guidelines. This literature review explores current pain management strategies for IUD insertion and examines the potential under-medication of women during this procedure. Ten sources were reviewed, including randomized controlled trials, a clinical trial, linear regression analyses, and meta-analyses, with inclusion criteria focusing on pain interventions for IUD insertion in women over the past decade. Findings reveal that commonly used interventions—such as NSAIDs, misoprostol, self-administered lidocaine gel, and paracervical lidocaine injections—have not consistently demonstrated statistically significant reductions in pain. However, one randomized, double-blind, placebo-controlled trial showed that 10% lidocaine spray significantly reduced pain during tenaculum placement, uterine sounding, and IUD insertion compared to placebo. Despite advancements in pain mitigation techniques, there remains a lack of consensus on a standard of care. These findings highlight the need to establish evidence-based, standardized guidelines for pain management during IUD insertion. Doing so may reduce fear-related barriers, improve patient experience, and support broader access to this highly effective form of contraception.