Department of Obstetrics and Gynecology, Division of Family Planning Services and Research, Stanford University School of Medicine, Stanford, California, USA
Department of Obstetrics and Gynecology, Division of Family Planning Services and Research, Stanford University School of Medicine, Stanford, California, USA.
BMJ Sex Reprod Health. 2022 Jan;48(e1):e31-e37. doi: 10.1136/bmjsrh-2020-200918. Epub 2021 Mar 31.
Understanding predictors of pain with gynaecological procedures may facilitate individualised counselling and pain management. We aimed to study the effect of dysmenorrhoea on intrauterine device (IUD) insertion pain.
This was a planned secondary analysis of a randomised trial evaluating self-administered lidocaine gel versus placebo for IUD insertion pain. We included those participants who reported menses in the past 3 months. We assessed dysmenorrhoea (in the past 3 months) and procedural pain using a 100 mm visual analogue scale (VAS). We categorised dysmenorrhoea as none/mild (<40 mm), moderate (40-69 mm) or severe (≥70 mm). We assessed participant pain scores at speculum insertion, tenaculum placement, IUD insertion, and overall. We compared median procedural pain scores by dysmenorrhoea group with three-way and post hoc pairwise analyses.
We analysed 188 participants. Demographic characteristics were similar among the three dysmenorrhoea groups. Pairwise comparisons revealed higher median procedural pain scores in the severe dysmenorrhoea group compared with the none/mild dysmenorrhoea group at speculum insertion (25 mm vs 8 mm; p=0.007), tenaculum placement (51 mm vs 31 mm; p=0.04) and IUD insertion (74 mm vs 61 mm; p=0.04). Overall pain did not differ among the three groups (p=0.32).
Patients with severe dysmenorrhoea experienced increased pain with all aspects of IUD insertion, including speculum and tenaculum placement, compared with those with only mild or no dysmenorrhoea. Clinicians may consider this finding when providing individualised counselling and pain management for patients undergoing IUD insertion and other gynaecological procedures. Larger studies are needed to validate the effect of dysmenorrhoea severity on pain throughout IUD insertion.
了解妇科手术疼痛的预测因素可以促进个体化咨询和疼痛管理。我们旨在研究痛经对宫内节育器（IUD）放置疼痛的影响。
这是一项随机试验的计划二次分析，评估了自行给予利多卡因凝胶与安慰剂用于 IUD 放置疼痛。我们纳入了过去 3 个月内有月经的参与者。我们使用 100mm 视觉模拟量表（VAS）评估痛经（过去 3 个月）和手术疼痛。我们将痛经分为无/轻度（<40mm）、中度（40-69mm）或重度（≥70mm）。我们评估了参与者在窥器插入、钳子放置、IUD 插入和整体过程中的疼痛评分。我们通过三向和事后两两比较分析比较了不同痛经组的手术疼痛评分中位数。
我们分析了 188 名参与者。三组痛经患者的人口统计学特征相似。两两比较显示，严重痛经组在窥器插入（25mm 比 8mm；p=0.007）、钳子放置（51mm 比 31mm；p=0.04）和 IUD 插入（74mm 比 61mm；p=0.04）时的手术疼痛评分中位数更高。三组的总疼痛评分无差异（p=0.32）。
与仅有轻度或无痛经的患者相比，严重痛经患者在 IUD 放置的所有方面（包括窥器和钳子放置）都经历了更多的疼痛。临床医生在为接受 IUD 放置和其他妇科手术的患者提供个体化咨询和疼痛管理时可能会考虑到这一发现。需要更大的研究来验证痛经严重程度对 IUD 放置过程中疼痛的影响。
