Abstract

BACKGROUND: Understanding predictors of pain with gynaecological procedures may facilitate individualised counselling and pain management. We aimed to study the effect of dysmenorrhoea on intrauterine device (IUD) insertion pain.METHODS: This was a planned secondary analysis of a randomised trial evaluating self-administered lidocaine gel versus placebo for IUD insertion pain. We included those participants who reported menses in the past 3months. We assessed dysmenorrhoea (in the past 3months) and procedural pain using a 100mm visual analogue scale (VAS). We categorised dysmenorrhoea as none/mild (<40mm), moderate (40-69mm) or severe (=70mm). We assessed participant pain scores at speculum insertion, tenaculum placement, IUD insertion, and overall. We compared median procedural pain scores by dysmenorrhoea group with three-way and post hoc pairwise analyses.RESULTS: We analysed 188 participants. Demographic characteristics were similar among the three dysmenorrhoea groups. Pairwise comparisons revealed higher median procedural pain scores in the severe dysmenorrhoea group compared with the none/mild dysmenorrhoea group at speculum insertion (25mm vs 8mm; p=0.007), tenaculum placement (51mm vs 31mm; p=0.04) and IUD insertion (74mm vs 61mm; p=0.04). Overall pain did not differ among the three groups (p=0.32).CONCLUSIONS: Patients with severe dysmenorrhoea experienced increased pain with all aspects of IUD insertion, including speculum and tenaculum placement, compared with those with only mild or no dysmenorrhoea. Clinicians may consider this finding when providing individualised counselling and pain management for patients undergoing IUD insertion and other gynaecological procedures. Larger studies are needed to validate the effect of dysmenorrhoea severity on pain throughout IUD insertion.

View details for DOI 10.1136/bmjsrh-2020-200918

View details for PubMedID 33789955