Date of Award

2024

Document Type

Dissertation

Degree Name

Doctor of Medical Science (DMSc)

Department

Department of Physician Assistant Medicine

First Advisor

Jason Brumitt

Abstract

Intrauterine devices (IUDs) are effective contraceptives, but they continue to be underutilized by adolescent and young adult females in part due to the anticipated pain of device insertion and lack of standardized analgesia during device insertion. This systematic review evaluates the use of prostaglandins (dinoprostone and misoprostol) and topical lidocaine formulations for analgesic efficacy during IUD insertion. Randomized controlled trials and systematic reviews published in the last 10 years with the primary outcome of pain reduction during IUD insertion using either prostaglandins or topical lidocaine were included given the study included nulliparous women. Electronic search via PubMed was conducted, and seven studies were deemed eligible for inclusion. In comparison to placebo, dinoprostone and lidocaine both reduce reported pain during IUD insertion, however, lidocaine (particularly in the form of lidocaine-prilocaine cream) has the most consistently documented analgesic effect during IUD insertion. Given that there is more evidence supporting the efficacy of lidocaine and the fact that lidocaine is generally more accessible than dinoprostone in outpatient settings, it is reasonable to offer as an option prior to IUD insertion, especially in young, nulliparous women.

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