Article Text


A randomised trial comparing pain and ease of use of two different stabilising forceps for insertion of intrauterine contraception


Background Pain at intrauterine contraception (IUC) fitting may be a deterrent for women and any reduction in discomfort would be likely to be beneficial to both women and clinicians.

Aim This study investigated the associated pain and the ease of use of two different stabilising forceps at the time of IUC placement.

Design Single-blinded randomised controlled trial. One hundred parous women aged 18–50 years who had undergone at least one vaginal delivery were recruited.

Setting An integrated sexual health service in the North of England.

Methods Women were randomised to the use of either a Littlewoods forceps or a single-toothed tenaculum forceps to stabilise the cervix at the time of IUC placement. Pain levels were measured at forceps application, IUC insertion, and 5 and 10 minutes post-procedure using a visual analogue scale (VAS). A clinician graded ease of use of the forceps and any associated bleeding. Wilcoxon rank-sum tests were used to compare pain levels between the two forceps groups. Linear regression was used when adjusting for potential confounders.

Results Mean VAS scores were similar at forceps application (p=0.52), IUC fitting (p=0.10) and at 5 minutes (p=0.32). There was a statistical difference in the degree of pain experienced at 10 minutes in the tenaculum group (p=0.01). Physicians found both forceps easy to use and there was no difference in bleeding (p=0.49).

Conclusions Parous women who have had a vaginal delivery can be reassured that IUC fitting is well tolerated. Pain scores were not affected by the type of forceps used to stabilise the cervix at IUC placement. Both forceps investigated were easy to use.

  • intrauterine devices
  • intrauterine systems
  • statistics

Statistics from


  • Competing interests Diana Mansour has received honoraria and travel expenses for lecturing and taking part in conferences and advisory boards from Aspen, Astellas, Bayer Healthcare, Consilient Health, HRA Pharma, MSD and Pfizer.

  • Patient consent Obtained.

  • Ethics approval Newcastle and North Tyneside Research Ethics Committee.

  • Provenance and peer review Not commissioned; externally peer reviewed.

Request permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

Linked Articles

  • Editorial
    Rebecca H Allen
  • Highlights from this issue
    British Medical Journal Publishing Group
  • Letters to the editor
    David H Horwell