Original research article| Volume 95, ISSUE 3, P251-256, March 2017

Effect of cervical lidocaine–prilocaine cream on pain perception during copper T380A intrauterine device insertion among parous women: A randomized double-blind controlled trial



      The objective was to investigate the analgesic effect of cervical lidocaine–prilocaine (LP) cream in alleviating pain during copper T380A intrauterine device (IUD) insertion among parous women.

      Study design

      We conducted a randomized, double-blind, placebo-controlled trial at Assiut Women's Health Hospital, Egypt, from October 2015 to April 2016 of parous women desiring copper IUD insertion. We randomized the subjects in a 1:1 ratio to LP cream or placebo. Seven minutes prior to IUD insertion, women received 2 ml of LP cream or placebo to the anterior cervical lip, followed by 2 ml placed in the cervical canal using a Q-tip applicator. The study end point was the subjects' self-reported pain using a 10-cm visual analog scale (VAS) during cervical tenaculum placement, sound insertion, IUD insertion and 5 min postprocedure. We considered a 2-cm difference in VAS scores between study groups as clinically significant. Also, the difference in the ease of insertion score using a 10-cm VAS with 0 = very easy insertion and 10 = terribly difficult insertion was assessed.


      The study included 120 women (n=60 in each group). LP cream reduces the median VAS pain scores during tenaculum placement (2 vs. 4), sound insertion (3 vs. 6) and IUD insertion (3 vs. 6.5) with p=.0001 at all steps. A lower ease of insertion score was also determined among LP women (2.5±0.98 vs. 4.5±2.7, p=.001). Participants reported no side effects.


      Use of cervical LP cream prior to copper T380A IUD insertion may alleviate the IUD insertion pain among parous women.


      Cervical LP cream could be effective as an analgesic prior to copper T380A IUD insertion with no side effects. Further studies are needed to assess the women's satisfaction from lying with a speculum in place for 7 min while waiting for the cream to be effective.


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        • Winner B.
        • Peipert J.F.
        • Zhao Q.
        • Buckel C.
        • Madden T.
        • Allsworth J.E.
        • et al.
        Effectiveness of long-acting reversible contraception.
        N Engl J Med. 2012; 366: 1998-2007
        • Buhling K.J.
        • Zite N.B.
        • Lotke P.
        • Black K.
        INTRA Writing Group. Worldwide use of intrauterine contraception: a review.
        Contraception. 2014; 89: 162-173
        • Potter J.
        • Rubin S.E.
        • Sherman P.
        Fear of intrauterine contraception among adolescents in New York City.
        Contraception. 2014; 89: 446-450
        • Hubacher D.
        • Reyes V.
        • Lillo S.
        • Zepeda A.
        • Chen P.L.
        • Croxatto H.
        Pain from copper intrauterine device insertion: randomized trial of prophylactic ibuprofen.
        Am J Obstet Gynecol. 2006; 195: 1272-1277
        • Lopez L.M.
        • Bernholc A.
        • Zeng Y.
        • Allen R.H.
        • Bartz D.
        • O'Brien P.A.
        • et al.
        Interventions for pain with intrauterine device insertion.
        Cochrane Database Syst Rev. 2015; 29: CD007373
        • Fouda U.M.
        • Salah Eldin N.M.
        • Elsetohy K.A.
        • Tolba H.A.
        • Shaban M.M.
        • Sobh S.M.
        Diclofenac plus lidocaine gel for pain relief during intrauterine device insertion. A randomized double blinded placebo-controlled study.
        Contraception. 2016; 93: 513-518
        • Bednarek P.H.
        • Micks E.A.
        • Edelman A.B.
        • Li H.
        • Jensen J.T.
        The effect of nitroprusside on IUD insertion experience in nulliparous women: a pilot study.
        Contraception. 2013; 87: 421-425
        • Maguire K.
        • Davis A.
        • Rosario Tejeda L.
        • Westhoff C.
        Intracervical lidocaine gel for intrauterine device insertion: a randomized controlled trial.
        Contraception. 2012; 86: 214-219
        • Edelman A.
        • Schaefer E.
        • Olson A.
        • Van Houten L.
        • Bedarnek P.
        • Leclair C.
        • et al.
        Effects of prophylactic misoprostol administration prior to intrauterine device insertion in nulliparous women.
        Contraception. 2011; 84: 234-239
        • Zilbert A.
        Topical anesthesia for minor gynecological procedures: a review.
        Obstet Gynecol Surv. 2002; 57: 171-178
        • Friedman P.M.
        • Mafong E.A.
        • Friedman E.S.
        • Geronemus R.G.
        Topical anesthetics update: EMLA and beyond.
        Dermatol Surg. 2001; 27: 1019-1026
        • Zullo F.
        • Pellicano M.
        • Stigliano C.M.
        • Di Carlo C.
        • Fabrizio A.
        • Nappi C.
        Topical anesthesia for office hysteroscopy. A prospective, randomized study comparing two modalities.
        J Reprod Med. 1999; 44: 865-869
        • Liberty G.
        • Gal M.
        • Halevey-Shalem T.
        • Michaelson-Cohen R.
        • Galoyan N.
        • Hyman J.
        • et al.
        Lidocaine–prilocaine (EMLA) cream as analgesia for hysterosalpingography: a prospective, randomized, controlled, double blinded study.
        Hum Reprod. 2007; 22: 1335-1339
        • Ahmadi Doulabi M.
        • Tavakolian S.
        • Mortazavi A.
        • Akbarzade Baghban A.
        Effect of EMLA cream on pain of copper IUD insertion [article in Persian].
        Sci J Hamadan Nurs Midwifery Fac. 2013; 21: 24-30
        • Bouhassira D.
        • Attal N.
        • Alchaar H.
        • Boureau F.
        • Brochet B.
        • Bruxelle J.
        • et al.
        Comparison of pain syndromes associated with nervous or somatic lesions and development of a new neuropathic pain diagnostic questionnaire (DN4).
        Pain. 2005; 114: 29-36
        • Scavuzzi A.
        • Souza A.S.
        • Costa A.A.
        • Amorim M.M.
        Misoprostol prior to inserting an intrauterine device in nulligravidas: a randomized clinical trial.
        Hum Reprod. 2013; 28: 2118-2125
        • Apte G.
        • Nelson P.
        • Brismée J.M.
        • Dedrick G.
        • Justiz R.
        • Sizer P.S.
        Chronic female pelvic pain — part 1: clinical pathoanatomy and examination of the pelvic region.
        Pain Pract. 2012; 12: 88-110
        • McNicholas C.P.
        • Madden T.
        • Zhao Q.
        • Secura G.
        • Allsworth J.E.
        • Peipert J.F.
        Cervical lidocaine for IUD insertional pain: a randomized controlled trial.
        Am J Obstet Gynecol. 2012; 207: 384-386
        • Allen R.H.
        • Raker C.
        • Goyal V.
        Higher dose cervical 2% lidocaine gel for IUD insertion: a randomized controlled trial.
        Contraception. 2013; 88: 730-736
        • Tornblom-Paulander S.
        • Tingaker B.K.
        • Werner A.
        • Liliecreutz C.
        • Conner P.
        • Wessel H.
        • et al.
        Novel topical formulation of lidocaine provides significant pain relief for intrauterine device insertion: pharmacokinetic evaluation and randomized placebo controlled trial.
        Fertil Steril. 2015; 103: 422-427
        • Mody S.K.
        • Kiley J.
        • Rademaker A.
        • Gawron L.
        • Stika C.
        • Hammond C.
        Pain control for intrauterine device insertion: a randomized trial of 1% lidocaine paracervical block.
        Contraception. 2012; 86: 704-709
        • Rapkin R.B.
        • Achilles S.L.
        • Schwarz E.B.
        • Meyn L.
        • Cremer M.
        • Boraas C.M.
        • et al.
        Self-administered lidocaine gel for intrauterine device insertion in nulliparous women: a randomized controlled trial.
        Obstet Gynecol. 2016; 128: 621-628
        • Ljunghall K.
        • Lillieborg S.
        Local anaesthesia with lidocaine/prilocaine cream (EMLA) for cautery of condyloma acuminata on the vulval mucosa. The effect of timing of application of the cream.
        Acta Derm Venereol. 1989; 69: 362-365
        • Van der Burght M.
        • Schonemann N.K.
        • Laursen J.K.
        • Arendt-Nielsen L.
        • Bjerring P.
        Duration of analgesia following application of eutectic mixture of local anaesthetics (EMLA) on genital mucosa.
        Acta Derm Venereol. 1993; 73: 456-458
        • Tavakolian S.
        • Ghorbani M.
        • Doulabi M.A.
        • Baghban A.A.
        • Mortazavi A.
        Lidocaine–prilocaine cream as analgesia for IUD insertion: a prospective, randomized, controlled, triple blinded study.
        Glob J Health Sci. 2015; 7: 42390
        • Arnau B.
        • Jovell E.
        • Romero M.
        • Gonzalez M.
        • Esteba L.
        • Garcia A.
        Lidocaine–prilocaine cream as analgesia for hysterosalpingography: a randomized, double blinded, controlled study.
        Eur J Obstet Gynecol Reprod Biol. 2014; 182: 216-219
        • Arnau B.
        • Jovell E.
        • Redón S.
        • Canals M.
        • Mir V.
        • Jiménez E.
        Lidocaine–prilocaine (EMLA®) cream as analgesia in hysteroscopy practice: a prospective, randomized, non-blinded, controlled study.
        Acta Obstet Gynecol Scand. 2013; 92: 978-981
        • Buckley M.M.
        • Benfield P.
        Eutectic lidocaine/prilocaine cream. A review of the topical anaesthetic/analgesic efficacy of a eutectic mixture of local anaesthetics (EMLA).
        Drugs. 1993; 46: 126-151