More than a pinch: a review of pain management during intrauterine device placement.

PURPOSE OF REVIEW: Pain during intrauterine device (IUD) insertion is currently a major focus of contraceptive care, driven by patient advocacy, social media discourse, and growing recognition that procedural pain may deter patients from seeking an IUD. Concurrently, professional organizations have released updated guidance on pain management during IUD placement. This review summarizes contemporary evidence regarding patient risk factors, procedural techniques, and pharmacologic and non-pharmacologic interventions for IUD insertion pain. RECENT FINDINGS: Recent literature demonstrates that pain during IUD placement is multifactorial and influenced by patient characteristics, including nulliparity, dysmenorrhea, anxiety, and anticipated pain. Among available interventions, the strongest evidence supports local anesthetic approaches. Ultrasound-guided placement may reduce pain and procedural difficulty. In contrast, routine use of misoprostol is not supported by current evidence. Data regarding non-pharmacologic environmental interventions, oral anxiolytics/opiates, nitrous oxide, intravenous sedation, and operating room-based anesthesia care remain limited or conflicting. SUMMARY: Effective pain management for IUD placement likely requires a multimodal, patient-centered approach that addresses both physiologic and psychological contributors to pain. Future research should prioritize standardized outcome measures, comparative effectiveness studies, and implementation and cost-effectiveness analyses to inform equitable integration of evidence-based pain management strategies for IUD insertions.