05/20/2025
There are multiple ways to make patients feel more comfortable during these procedures.
3 things I offer everyone:
1. Cytotec (misoprostol)- This is an oral medication you’ll take the night before and the morning of which helps to soften your cervix.
2. High dose ibuprofen 30 minutes before
3. Anti-anxiety medication like Xanax 30 minutes before
Let’s talk about the cervical block. This is injected lidocaine into four quadrants of the cervix. A cervical block can numb the cervix and the lower part of the uterus, but it does not numb the portion of the uterus where the IUD is placed. While a typical IUD procedure takes 2 minutes, this additional procedure can take another 5 minutes. It also requires a ~4 inch spinal needle —The needle alone can cause patient severe anxiety. Also, the procedure of injecting those four quadrants can be quite painful. We can do this, but you should know the facts!
IUDs can be placed under sedation or general anesthesia in the operating room after thorough counseling. We do not have anesthesiologists or sedation equipment in the office - so this is done in an OR setting.
Other things I have and will try/have tried:
- hurricane spray/spraying lidocaine on the cervix
- Inserting lidocaine into the endometrial canal
One other thing I have changed in the last few years is not using a tenaculum on the cervix. This is a sharp instrument that we used to use to grab the cervix and help maneuver the IUD into the correct position. I find that using a different type of softer clamp is much less uncomfortable for the patient and still gets the job done. It doesn’t cause any bleeding as it doesn’t poke holes in the cervix like a tenaculum does.
I have definitely changed my practice since I first started out in private practice 9 years ago. I am always trying to learn the best practices and make any procedures easier for my patients.
I truly believe the faster the procedure is, the better. You need someone quick (who does these a lot). The use of distraction is also key!
