The effect of nitroglycerin on the IUD insertion experience in nulliparous women: A pilot study

Elizabeth A. Micks, Jeffrey Jensen, Paula Bednarek

Research output: Contribution to journalArticle

12 Citations (Scopus)

Abstract

Objective: Concern about pain during placement of an intrauterine device (IUD) represents a barrier to use, especially among nulliparous women. We hypothesized that nitroglycerin gel applied vaginally 30 min prior to IUD placement would reduce insertion-related pain. Study design: We designed a randomized, double-blinded, placebo-controlled pilot study to evaluate the efficacy and tolerability of 0.5-mg nitroglycerin gel (1 mL) or identical placebo gel applied vaginally in nulliparous women 30 min prior to IUD placement. The study was limited to women who opted for the levonorgestrel- releasing intrauterine system. Subjects completed a series of 100-mm visual analogue scales at several time points. The primary outcome was subject-reported pain with passage of the IUD through the cervix. Secondary outcomes included subject-reported pain at other time points, provider-reported ease of insertion, side effects, adverse events and need for additional dilation. Results: A total of 24 women were randomized. Baseline characteristics were similar between groups. The mean pain score with IUD deployment was 55.0 mm [standard deviation (SD) = 29.7 mm] in the placebo group and 57.4 mm (SD 22.1 mm) in the nitroglycerin group (p=.82). There was no difference in ease of insertion reported by providers. Two subjects required dilation, one in each group. Conclusion: Vaginal administration of 0.5-mg nitroglycerin gel 30 min prior to IUD placement does not appear to decrease patient-reported procedural pain among nulliparous women or ease of insertion for providers.

Original languageEnglish (US)
Pages (from-to)60-65
Number of pages6
JournalContraception
Volume90
Issue number1
DOIs
StatePublished - 2014

Fingerprint

Intrauterine Devices
Nitroglycerin
Pain
Gels
Placebos
Dilatation
Intravaginal Administration
Levonorgestrel
Visual Analog Scale
Cervix Uteri

Keywords

  • Intrauterine device
  • Nitric oxide donor
  • Pain

ASJC Scopus subject areas

  • Reproductive Medicine
  • Obstetrics and Gynecology
  • Medicine(all)

Cite this

The effect of nitroglycerin on the IUD insertion experience in nulliparous women : A pilot study. / Micks, Elizabeth A.; Jensen, Jeffrey; Bednarek, Paula.

In: Contraception, Vol. 90, No. 1, 2014, p. 60-65.

Research output: Contribution to journalArticle

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abstract = "Objective: Concern about pain during placement of an intrauterine device (IUD) represents a barrier to use, especially among nulliparous women. We hypothesized that nitroglycerin gel applied vaginally 30 min prior to IUD placement would reduce insertion-related pain. Study design: We designed a randomized, double-blinded, placebo-controlled pilot study to evaluate the efficacy and tolerability of 0.5-mg nitroglycerin gel (1 mL) or identical placebo gel applied vaginally in nulliparous women 30 min prior to IUD placement. The study was limited to women who opted for the levonorgestrel- releasing intrauterine system. Subjects completed a series of 100-mm visual analogue scales at several time points. The primary outcome was subject-reported pain with passage of the IUD through the cervix. Secondary outcomes included subject-reported pain at other time points, provider-reported ease of insertion, side effects, adverse events and need for additional dilation. Results: A total of 24 women were randomized. Baseline characteristics were similar between groups. The mean pain score with IUD deployment was 55.0 mm [standard deviation (SD) = 29.7 mm] in the placebo group and 57.4 mm (SD 22.1 mm) in the nitroglycerin group (p=.82). There was no difference in ease of insertion reported by providers. Two subjects required dilation, one in each group. Conclusion: Vaginal administration of 0.5-mg nitroglycerin gel 30 min prior to IUD placement does not appear to decrease patient-reported procedural pain among nulliparous women or ease of insertion for providers.",
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