Use of Cervical Cap and Menstrual Disc for Application of Topical Anesthetic Prior to Intrauterine Device (IUD) Insertion
Trial Snapshot
- Phase
- Not Applicable
- Status
- Recruiting
- Enrollment
- 24
- Locations
- 1
- Primary Endpoint
- Successful Placement
Study Overview
Brief Summary
This prospective, open label, double arm, feasibility group study will recruit participants planning to undergo office intrauterine device (IUD) placement without sedation or anxiolysis at the Center for Women's Health. Participants will self-administer a topical anesthetic using a contraceptive cervical cap or menstrual disc.
Twenty-four nulliparous women will be recruited to receive one of two administration methods immediately prior to IUD placement (12 subjects in each arm): 1) menstrual disc filled with 5g eutectic mixture of local anesthetics (EMLA) cream or 2) cervical cap filled with 5g EMLA cream.
Detailed Description
Nulliparous patients undergoing IUD insertion will administer EMLA cream by menstrual disc or cervical cap prior to insertion. The medical provider will ensure proper placement of the cap or disc and perform a bi-manual exam to assess the patient's uterine position. A seven minute timer will be set, the cap/disc will be removed, and the provider will proceed with the IUD insertion according to manufacturer technique.
Visual Analog Scale (VAS) scores will be used throughout the procedure to assess participant pain throughout insertion. Participants and providers will report on pain, side effects, and procedure complications immediately after the procedure.
Study Design
- Study Type
- Interventional
- Allocation
- Randomized
- Intervention Model
- Parallel
- Primary Purpose
- Prevention
- Masking
- None
Masking Description
This is an open label study that involves no masking
Eligibility Criteria
- Ages
- 18 Years to 45 Years (Adult)
- Sex
- Female
- Accepts Healthy Volunteers
- No
Inclusion Criteria
- •Scheduled for IUD placement at the Center for Women's Health in Complex Family Planning clinic
- •Able to review and sign study consents in English
- •Generally healthy
Exclusion Criteria
- •History of any prior births, miscarriages, or abortions after 16 weeks' gestation
- •Currently pregnant, known or suspected
- •Current stringless IUD in place
- •Participants premedicated with misoprostol
- •History of chronic pelvic pain which patients take daily medication for
- •History of endometriosis, fibroids, adenomyosis, prior cervical procedures (such as Loop Electrosurgical Excision Procedure (LEEP) or cold knife cone)
- •Any contraindications to IUD placement (per current labeling including pregnancy, fibroids that distort the uterine cavity, exam consistent with pelvic inflammatory disease, allergy to any component of the levonorgestrel intrauterine system (LNG-IUS), etc.)
- •Known allergy to eutectic mixture of local anesthetics (EMLA) or lidocaine cream, silicone, menstrual disc, or cervical cap
- •Any contraindication to EMLA or lidocaine cream, menstrual disc, or cervical cap
- •Previous IUD placement or failed attempt of an IUD placement
- •Weight < 54.4kg (120 lbs)
- •Plan for use of oral anxiolysis, moderate/deep sedation, or narcotics for procedure
- •Patient requesting or patient use in the past 24 hours of oral anxiolysis, moderate/deep sedation, or narcotics
- •Any planned concomitant procedures, such as dilation and curettage (D&C), endometrial biopsy, colposcopy, hysteroscopy, etc.
- •Illicit drug use
Arms & Interventions
Menstrual disc
Participants will be provided with a menstrual disc filled with 5mg of 2.5% prilocaine-2.5% lidocaine cream and manufacturer instructions for placement. Study personnel will leave the room, and participants will undress and attempt to place the disc. The provider will return to the room, make sure the disc is correctly placed, and set a seven minute timer. After the seven minute timer, participants will self-remove the disc or the clinician will remove it and place the intrauterine device (IUD) according to manufacturer technique.
Intervention: Menstrual disc with EMLA cream (Combination Product)
Cervical cap
Participants will be provided with a cervical cap filled with 5mg of 2.5% prilocaine-2.5% lidocaine cream and manufacturer instructions for placement. Study personnel will leave the room, and participants will undress and attempt to place the cap. The provider will return to the room, make sure the cap is correctly placed, and set a seven minute timer. After the seven minute timer, participants will self-remove the cap or the clinician will remove it and place the intrauterine device (IUD) according to manufacturer technique.
Intervention: Cervical cap with EMLA cream (Combination Product)
Outcomes
Primary Outcomes
Successful Placement
Time Frame: Immediately after IUD placement procedure
The number of participants able to correctly place the cap or disc as instructed, assessed by provider
Satisfaction with pain control
Time Frame: Immediately after IUD placement procedure
Participant-reported satisfaction with pain control for IUD placement using EMLA cream measured the Patient Acceptable Symptom State (PASS) methodology.
Secondary Outcomes
- Ease of cap/disc placement(Immediately after IUD placement procedure)
- Protocol deviations(Immediately after IUD placement procedure)
- Ease of IUD placement(Immediately after IUD placement procedure)
- Procedure complications(Immediately after IUD placement procedure)
- Typical menstrual pain(On the day of IUD placement procedure prior to cap/disc placement and IUD placement)
- Pain during IUD placement procedure(Measured throughout IUD placement procedure immediately before the procedure, during placement of disc/cap, during speculum placement, during tenaculum placement, during sounding, during IUD placement, and 5 minutes after completion)
- Acceptability of pain mangement(one day post-procedure)
- Ease of cap/disc placement(Immediately after IUD placement procedure)
- Protocol deviations(Immediately after IUD placement procedure)
- Ease of IUD placement(Immediately after IUD placement procedure)
- Procedure complications(Immediately after IUD placement procedure)
- Typical menstrual pain(On the day of IUD placement procedure prior to cap/disc placement and IUD placement)
- Pain during IUD placement procedure(Measured throughout IUD placement procedure immediately before the procedure, during placement of disc/cap, during speculum placement, during tenaculum placement, during sounding, during IUD placement, and 5 minutes after completion)
- Acceptability of pain mangement(one day post-procedure)
Investigators
Julia Tasset
Principal Investigator
Oregon Health and Science University