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Letters to the editor
Further comment on the avoidance of pain associated with intrauterine contraceptive insertion
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  1. John Guillebaud, FRCSEd, FRCOG
  1. Emeritus Professor of Family Planning and Reproductive Health, University College, London, UK, j.guillebaud@lineone.net

https://doi.org/10.1136/jfprhc-2014-101071

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    Having read Bahamondes et al.'s letter1 in the July 2014 Journal, I remain unconvinced that we can do so little beyond good ‘verbal anaesthesia’ and insertion expertise (crucial though these are) to help those few individuals who, unmistakably, suffer significant pain at intrauterine contraceptive (IUC) insertion. I agree with Dr Pillai's remark in her letter2 in the April 2014 Journal that women's concerns around the fitting are the main barrier to improving the woefully low uptake of IUCs in the UK, which in a recent survey for women aged 18–49 years was 10%, in contrast to 19% in Sweden.3 Such a major discrepancy is not caused by any known difference between the UK uterus and the Swedish uterus!

    Does premedication with an anti-prostaglandin drug such as mefenamic acid fail to reduce the uterine cramping pain component of IUC insertion? I remain unconvinced because:

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