Intrauterine contraception (IUC) is a form of long-acting reversible contraception, which is widely accepted as reliable and safe. However, many patients are deterred from ICUs by the fear of pain upon the insertion and the anxiety of the procedure (P). Here, nursing intervention in the form of reassurance and distraction during IUC insertion (I) is compared to oral and local analgesics (C) as a method for relieving pain (O) before, during, and after the procedure (T).
Typically, the pain during and after IUC insertion is addressed by local or oral analgesia. Cervical anesthesia has been proven efficient but requires a painful injection (Mody et al., 2018). However, so-called “verbal analgesia” is as effective as certain oral analgesics (Daykan et al., 2021). Furthermore, the pain during IUC insertion is often determined by the patient’s anxiety (McCarhthy, 2018). An effective way of reducing pain and anxiety is a distraction, which can be provided in the form of media (e.g., music or television) or conversation (McCarhthy, 2018).
Before IUD insertion, the nursing intervention includes psychological preparation interviews, providing information, particularly about expected pain level, and comforting the patient. It is vital to make sure that the patient has been tested negative for sexually transmitted diseases. During IUD insertion, the nurse provides distraction and comfort to the patient. After the IUD insertion, the nurse observes the physical and mental state of the patient and educates the patient on the self-care and pain management methods they can use. The following points are crucial in the patient’s education: when experiencing continuous pain within 20 days after the procedure, the patient must seek immediate medical attention; the patient should check for threads after each period; tampons are safe to use for patients with IUDs.
Patient care before, during, and after the procedure is required to ensure a positive and safe patient experience and can be a determinant factor in promoting safe and effective contraception methods, such as IUDs. Before the procedure, the patient should be informed about possible pain and measures taken to alleviate it. It is important to note that the exact level of pain is subjective and varies highly between patients. In some cases, the expectation of pain can be a pain trigger in itself, so the nurse should exercise caution and maintain a balance between honesty and reassurance (McCarhthy, 2018).
This balance can be achieved by explaining to the patient that the level of pain is variable and describing the measures taken to minimize pain and discomfort. During the procedure, it is essential to monitor the patient’s physical and mental state and react accordingly to provide distraction. Educating the patient on the self-care methods is instrumental in providing pain relief and overall positive patient experience post-procedure. Ensuring privacy is paramount at all stages – before, during, and after IUD insertion.
Health Care Agency
The North American Society for Pediatric and Adolescent Gynecology (NASPAG) has developed protocols for birth control in adolescent patients, including instructions on patient care before, during, and after IUD insertion (Geyer et al., 2020). Most health care agencies regulating birth control methods, while recommending proper education of the patients, do not acknowledge the benefits of verbal analgesia, albeit note limited medication effectiveness. According to CDC, the use of medications to ease the IUD insertion is considered either ineffective (nonsteroidal anti-inflammatory drugs and nitric oxide donors) or somewhat effective with moderate to low-quality evidence (lidocaine) (CDC, 2021).
The ability to alleviate pain through distraction and verbal reassurance is a powerful tool for nurses. This method can ease the pain and discomfort, provide a better patient experience, and help establish trust between the patient and healthcare workers when used effectively. Furthermore, since pain and anxiety are significant detractors of receiving IUDs, nursing interventions counteracting those detracts can be extremely influential in encouraging more patients to use safe and reliable contraceptive devices.
CDC. (2016). US Selected Practice Recommendations for Contraceptive Use, 2016: Intrauterine Contraception. Web.
Daykan, Y., Battino, S., Arbib, N., Yaniv, R. T., Schonman, R., Klein, Z., Pomeranz J., & Pomeranz, M. (2021). Verbal analgesia is as good as oral tramadol prior to intrauterine device (IUD) insertion, among nulliparous women: A randomized controlled trial. European Journal of Obstetrics & Gynecology and Reproductive Biology, 258, 443-446.
Geyer, J., Kurkowski, J., Higgins, J., & Dietrich, J. (Eds.). (2020). NASPAG’s Protocols for Pediatric and Adolescent Gynecology: A Ready-Reference Guide for Nurses. Springer Publishing Company.
McCarthy, C. (2018). Intrauterine contraception insertion pain: nursing interventions to improve patient experience. Journal of Clinical Nursing, 27(1-2), 9-21.
Mody, S. K., Farala, J. P., Jimenez, B., Nishikawa, M., & Ngo, L. L. (2018). Paracervical block for intrauterine device placement among nulliparous women: a randomized controlled trial. Obstetrics and Gynecology, 132(3), 575.