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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/cdn\/css\/http\/css_Xg7z6oCTVgud_Q0huYz9x9iiD5H_2YPSJ5z2ZViSWdY.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003EThis article presents results from a randomized clinical trial, demonstrating that self-administered lidocaine gel does not significantly reduce the pain associated with intrauterine device (IUD) insertion in nulliparous women, but does reduce pain during placement of the speculum and tenaculum, and therefore may be used prior to gynecological examinations and procedures [Rapkin RB et al. \u003Cem\u003EObstet Gynecol\u003C\/em\u003E 2014].\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003EContraception Clinical Trials\u003C\/li\u003E\u003C\/ul\u003E\u003Cul class=\u0022kwd-group clinical-trial\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003EContraception\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EObstetrics \u0026amp; Gynecology Clinical Trials\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EObstetrics \u0026amp; Gynecology\u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-2\u0022\u003ERachel Becker Rapkin, MD, MPH, Morsani College of Medicine, University of South Florida, and University of Pittsburgh Medical Center, Pennsylvania, USA, presented results from a randomized clinical trial, demonstrating that self-administered lidocaine gel does not significantly reduce the pain associated with intrauterine device (IUD) insertion in nulliparous women, but does reduce pain during placement of the speculum and tenaculum, and therefore may be used prior to gynecological examinations and procedures [Rapkin RB et al. \u003Cem\u003EObstet Gynecol\u003C\/em\u003E 2014].\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003EDespite their safety and efficacy in nulliparous women, IUDs remain underutilized, often because of the fear of pain associated with their insertion. To date, studies to investigate pain management have shown that the use of analgesics during IUD placement provide no clear benefit [Rapkin RB et al. \u003Cem\u003EObstet Gynecol\u003C\/em\u003E 2014]. Prof. Rapkin and colleagues conducted a randomized, double-blind, placebo-controlled trial to evaluate the efficacy of self-administered vaginal lidocaine gel before IUD insertion in nulliparous women with no history of pregnancy in the last 6 weeks. Exclusion criteria included women in whom there was prior IUD use or failed attempt at IUD insertion, use of narcotics or benzodiazepines within 24 hours, and contraindication to IUD use or amide anesthetic.\u003C\/p\u003E\u003Cp id=\u0022p-4\u0022\u003EWomen were randomized to self-administer 10 mL 2% lidocaine (n=30) or placebo gel (n=29) 5 minutes prior to IUD insertion. They used an electronic visual analog scale (VAS) to measure pain at baseline, during placement of the speculum and tenaculum, insertion of the IUD, and 5 minutes after speculum removal. Women were evaluated 1 week after IUD insertion to assess their need for pain medication after the procedure and their overall satisfaction.\u003C\/p\u003E\u003Cp id=\u0022p-5\u0022\u003EThe median pain score (\u003Ca id=\u0022xref-fig-1-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F1\u0022\u003EFigure 1\u003C\/a\u003E) was not different between baseline and IUD insertion in the lidocaine and placebo groups (61 mm vs 68 mm; p=0.13), and 5 minutes after speculum removal (29 mm vs 36 mm; p=0.52); however, differences were significant at the time of speculum placement (16 mm vs 33 mm; p=0.03) and tenaculum placement (32 min vs 56 mm; p=0.03).\u003C\/p\u003E\u003Cdiv id=\u0022F1\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/7\/16\/F1.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022Median Pain Scores During the Intrauterine Device Insertion Procedure\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-103970347\u0022 data-figure-caption=\u0022Median Pain Scores During the Intrauterine Device Insertion Procedure\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure 1.\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/7\/16\/F1.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/7\/16\/F1.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure 1.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/7\/16\/F1.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/15949\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003Cdiv class=\u0022fig-caption attrib\u0022\u003E\u003Cspan class=\u0022fig-label\u0022\u003EFigure 1.\u003C\/span\u003E \n            \u003Cp id=\u0022p-6\u0022 class=\u0022first-child\u0022\u003EMedian Pain Scores During the Intrauterine Device Insertion Procedure\u003C\/p\u003E\n         \u003Cq class=\u0022attrib\u0022 id=\u0022attrib-1\u0022\u003EReproduced with permission from RB Rapkin, MD, MPH.\u003C\/q\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cp id=\u0022p-7\u0022\u003EAt the 1-week follow-up phone call, 84% of women in the lidocaine group and 90% of women in the placebo group were somewhat or very satisfied with their IUD placement, and 83% and 93%, respectively, would probably or definitely recommend the IUD to a friend.\u003C\/p\u003E\u003Cp id=\u0022p-8\u0022\u003EProf. Rap kin concluded that although self-administered vaginal lidocaine does not reduce pain with IUD insertion in nulliparous women, it does significantly decrease pain after speculum and tenaculum placement and therefore may be used prior to gynecological procedures involving these instruments.\u003C\/p\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2014 MD Conference Express\u00ae\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/14\/7\/16.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 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