Ovsepyan Viktoriya, Kelsey Petra, Evensen Ann E
From the University of Wisconsin School of Medicine and Public Health - Department of Family Medicine and Community Health Madison, Wisconsin (VO, AEE); One Medical Austin, Texas (PK).
J Am Board Fam Med. 2024 Nov-Dec;37(6):1150-1155. doi: 10.3122/jabfm.2024.240079R1.
Intrauterine devices (IUDs) are one of the most effective, long-lasting, and convenient contraceptive methods available in the United States. Unfortunately, the anticipated pain and anxiety associated with an IUD insertion procedure deter many people from using this contraceptive method.
A literature review was conducted on PubMed by searching the terms "IUD insertion", "pain management", "anxiety", "gynecologic procedures". The Cochrane database was also searched for reviews about pain management methods during IUD insertions. Findings were summarized using the American Academy of Family Physicians' Strength of Recommendation Taxonomy (SORT) scale.
Pharmacologic methods that can be used to reduce pain with IUD insertion include naproxen, tramadol, lidocaine paracervical blocks, 10% lidocaine spray, lidocaine-prilocaine cream, and EMLA cream. Non-pharmacologic methods for reducing pain or anxiety during gynecologic procedures include pre-insertion counseling, "verbal analgesia", lavender aromatherapy, distraction with music or television, using Valsalva maneuver instead of tenaculum during IUD insertion, and use of heating pad during procedure.
Moderately effective pharmacologic and non-pharmacologic methods exist for reducing pain and anxiety with IUD insertion. These treatment methods should be offered to create a more comfortable experience for patients. Additional research is needed to determine the comparative efficacy of these methods.
宫内节育器（IUD）是美国可用的最有效、持久且方便的避孕方法之一。不幸的是，与宫内节育器插入手术相关的预期疼痛和焦虑使许多人不愿使用这种避孕方法。
通过在PubMed上搜索“宫内节育器插入”“疼痛管理”“焦虑”“妇科手术”等术语进行文献综述。还在Cochrane数据库中搜索了关于宫内节育器插入期间疼痛管理方法的综述。使用美国家庭医生学会的推荐强度分类法（SORT）量表对研究结果进行了总结。
可用于减轻宫内节育器插入疼痛的药物方法包括萘普生、曲马多、宫颈旁利多卡因阻滞、10%利多卡因喷雾、利多卡因-丙胺卡因乳膏和EMLA乳膏。在妇科手术期间减轻疼痛或焦虑的非药物方法包括插入前咨询、“言语镇痛”、薰衣草芳香疗法、用音乐或电视分散注意力、在宫内节育器插入期间使用瓦尔萨尔瓦动作而非子宫钳，以及在手术过程中使用加热垫。
存在适度有效的药物和非药物方法来减轻宫内节育器插入时的疼痛和焦虑。应提供这些治疗方法，为患者创造更舒适的体验。需要进一步研究来确定这些方法的比较疗效。
