Pain perception with cervical tenaculum placement during intrauterine device insertion: a randomised controlled trial.

Journal Article (Journal Article)

INTRODUCTION: 'Slow' and 'cough' techniques for tenaculum placement are commonly used. This trial sought to determine if one method of placement resulted in less pain for patients. METHODS: This study was a randomised controlled trial of patients presenting for intrauterine device placement. Sixty-six participants were randomised to tenaculum placement via the 'slow' method (closure of tenaculum over a 5-s period) versus the 'cough' method (closure of tenaculum at the time of patient's cough). The primary outcome was pain at time of tenaculum placement measured on a 100 mm visual analogue scale. The study was powered to detect a 16 mm difference in pain. Secondary outcomes included pain with insertion and provider satisfaction with tenaculum grasp. Pain scores were analysed with Wilcoxon rank-sum test. RESULTS: Sixty-six women were enrolled, 33 randomised to each group. Demographics were similar in each group. The primary outcome of pain with tenaculum placement showed a median pain score of 44 (IQR=21, 63) with slow placement and 32 (IQR=19, 54) with cough placement. There was no significant difference in pain scores between methods of tenaculum placement (p=0.16). There was no significant difference in overall pain scores (p=0.12). Provider satisfaction was not associated with one method of placement (p=1). Pre-procedure anxiety was significantly associated with pain at the time of tenaculum placement (p=0.01). CONCLUSIONS: Neither the slow method nor cough method is superior for pain reduction or provider satisfaction. Pain with tenaculum use is significantly associated with anxiety. CLINICAL TRIAL REGISTRATION: NCT02969421.

Full Text

Duke Authors

Cited Authors

  • Lambert, T; Truong, T; Gray, B

Published Date

  • April 2020

Published In

Volume / Issue

  • 46 / 2

Start / End Page

  • 126 - 131

PubMed ID

  • 31666302

Electronic International Standard Serial Number (EISSN)

  • 2515-2009

Digital Object Identifier (DOI)

  • 10.1136/bmjsrh-2019-200376


  • eng

Conference Location

  • England