Studies suggest the majority of individuals report that pain during coil fitting is mild (score 1-3) or moderate (score 4-6/10) rather than severe (7-10/10) and that’s without use of any pain medication [1]. Pain scores generally tend to be higher in those who have not have any pregnancies, have only had caesarean deliveries, and those with a history of painful periods [1]. Discomfort may be experienced at any stage during coil fitting from speculum insertion and opening, stabilising the cervix (using a tenaculum device), measuring the depth of the uterus (called ‘sounding’) and finally positioning the coil itself. Pain scores are likely to be higher with technically difficult insertions.
There have been several studies looking at the effectiveness of a number of pain management methods including oral pain medication, lidocaine spray, lidocaine gel, injections to the cervix (‘cervical block’), and application of anaesthetic cream (EMLA 5% lidocaine/prilocaine) to and inside the cervical canal.
The overall conclusion is that there is no clear “best” option. However, cervical blocks, 10% lidocaine spray applied to the surface of the cervix and external os three minutes prior to the procedure, or EMLA cream could all reduce the pain associated with insertion. Ketoprofen or Naproxen taken an hour before the procedure could be beneficial for insertion and post-insertion pain [1]. Everyone should have the choice of pain management and if it cannot be offered at a particular clinic, information about alternative providers should be offered if available.
At 2Me Clinic, we are constantly reviewing best pain management methods and currently use 10% lidocaine spray applied for 3 minutes prior to coil fitting. We also now advise being prescribed Naproxen 500mg (if there are no contraindications) taken an hour before the procedure. If this is not possible we recommend 400mg of ibuprofen taken in combination with Paracetamol 1g. From experience, we maintain that a pre-coil fitting consultation is essential to discuss the procedure, and the stages during the fitting where pain may potentially be experienced. We always have the option of having a chaperone to provide support during the procedure as well as creating a warm and friendly environment.
[1] FSRH Statement: Pain associated with insertion of intrauterine contraception – June 2021
