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GPs urged to use local anaesthesia for IUD insertion

GPs should consider using pain relief more often when fitting intrauterine devices, say researchers whose study indicates practices are less likely to use local anaesthetics.

The small survey found 41% of GPs hardly ever used, or did not use, local anaesthesia when inserting an IUD, compared with 31% of healthcare professions in integrated sexual and reproductive health services and 25% in contraception-only services.

The study of 129 healthcare professionals fitting IUDs found the most common reason for not using local anaesthesia was that IUD insertion did not require it, or that using local anaesthetic may itself cause pain and prolong the procedure.

Current guidance from the Faculty of Sexual and Reproductive Health does not recommend routine use of anaesthetic when inserting IUDs, instead advising that ‘pain relief should be discussed with women in advance.’

But the authors - whose data were published this month in the Journal of Family Planning and Reproductive Health Care - said their data indicated that pain relief should be routinely offered to more women prior to IUD insertion and that it should be included in as part of the care pathway for these patients.

Study lead Dr Hannat Akintomide, a sexual health specialist at the Margaret Pike Centre in London, said that it remained good practice to discuss, offer and use available local anaesthetic for a procedure that may cause pain.

She said: ‘All IUD inserting doctors, not only GPs, need to be confident to discuss with and offer available pain relief to their patients. 

‘As IUD insertion tends to be perceived as a painful procedure by many women, the likelihood that patients will take up an offer of use of local anaesthesia for their procedure is high. 

‘Hence, the end result may indeed be that GPs will use local anaesthesia more often than they currently do if they begin to discuss its availability and use with their patients.’

But Dr Sally Hope, a former GP and honorary research fellow in women’s health at Oxford University, felt the study was not comparing like for like.

She said: ‘As a GP who has fitted coils for almost 30 years I’ve taken the view that I fit the easy ones, and if there is a case of severe cervical stenosis or a nulliparous women I refer those to the very skilled Oxford IUCD family planning clinic.

‘This is why I think there is a difference between the fitting groups and how they practice - GPs tend not to do the difficult ones, such as those with a tight cervical canal which will be painful.’

 

 

Pulse Live

Dr Pauline Brimblecombe, a GPSI in community gynaecology, will be delivering a session on emergency contraception and the coil at Pulse Live, our new two-day annual conference for general practice. She will offer advice on offering the coil to patients at high risk of needing emergency contraception, and methods of determining a patient’s level of risk.

Pulse Live offers practical advice on key clinical and practice business topics, as well as an opportunity to debate the future of the profession, and a top range of speakers includes NICE chair designate Professor David Haslam, GPC deputy chair Dr Richard Vautrey and the Rt Hon Stephen Dorrell MP, chair of the House of Commons health committee.

To find out more and book your place, please click here.

 

Readers' comments (2)

  • Vinci Ho

    It is still about a good discussion and communication between the individual patient and the clinician. It is a bit like gastroscopy where no sedation was advised in MOST cases but at least the choice is there for your patient to choose.....

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  • My practice coleague and I use Instillagel for all our fittings and it works really well. We do not routinely refer Nulliparous women to other services and have encountered barely any failed insertions in this group, who are increasingly asking for and IUD/IUS. Good procedure counselling and preparation is essential to success and some appropriate analgesia beforehand is also useful.

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