title: The effect of nitroglycerin on the IUD insertion experience in nulliparous women: a pilot study.
abstract: OBJECTIVE
  Concern about pain during placement of an intrauterine device (IUD) represents a barrier to use, especially among nulliparous women. We hypothesized that nitroglycerin gel applied vaginally 30 min prior to IUD placement would reduce insertion-related pain.
  
  
  METHODS
  We designed a randomized, double-blinded, placebo-controlled pilot study to evaluate the efficacy and tolerability of 0.5-mg nitroglycerin gel (1 mL) or identical placebo gel applied vaginally in nulliparous women 30 min prior to IUD placement. The study was limited to women who opted for the levonorgestrel-releasing intrauterine system. Subjects completed a series of 100-mm visual analogue scales at several time points. The primary outcome was subject-reported pain with passage of the IUD through the cervix. Secondary outcomes included subject-reported pain at other time points, provider-reported ease of insertion, side effects, adverse events and need for additional dilation.
  
  
  RESULTS
  A total of 24 women were randomized. Baseline characteristics were similar between groups. The mean pain score with IUD deployment was 55.0 mm [standard deviation (SD) = 29.7 mm] in the placebo group and 57.4 mm (SD 22.1 mm) in the nitroglycerin group (p=.82). There was no difference in ease of insertion reported by providers. Two subjects required dilation, one in each group.
  
  
  CONCLUSIONS
  Vaginal administration of 0.5-mg nitroglycerin gel 30 min prior to IUD placement does not appear to decrease patient-reported procedural pain among nulliparous women or ease of insertion for providers.
authors.affiliation: Department of Obstetrics and Gynecology, University of Washington, Box 356460, Seattle, WA 98195-6460, USA. Electronic address: emicks@uw.edu.
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Micks
authors.affiliation: Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland, OR, USA.
authors.forename: Jeffrey T
authors.initials: JT
authors.lastname: Jensen
authors.affiliation: Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland, OR, USA.
authors.forename: Paula H
authors.initials: PH
authors.lastname: Bednarek
mesh_terms: D000282:Administration, Intravaginal; D000328:Adult; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007436:Intrauterine Devices, Medicated; D016912:Levonorgestrel / Q000008:administration & dosage; D008875:Middle Aged; D005996:Nitroglycerin / Q000008:administration & dosage*; D010146:Pain / Q000188:drug therapy*; D010147:Pain Measurement / Q000379:methods; D010865:Pilot Projects; D014665:Vasodilator Agents / Q000008:administration & dosage*; D055815:Young Adult
chemical_list: D014665:Vasodilator Agents; D016912:Levonorgestrel; D005996:Nitroglycerin
keywords: Intrauterine device; Nitric oxide donor; Pain