Paracervical block for reducing pain during intrauterine device placement: a systematic review and meta-analysis of randomized controlled trials

Abstract

Abstract Background Intrauterine devices (IUDs) are among the most effective long-acting reversible contraceptive methods. Although their placement is generally straightforward, procedure-related pain is frequently reported and may deter individuals from choosing this contraceptive method. This systematic review and meta-analysis aimed to evaluate the effectiveness of paracervical block in reducing pain during IUD placement. Methods Four electronic databases were systematically searched from inception through January 31, 2026, without language or date restrictions, to identify relevant randomized controlled trials (RCTs). A meta-analysis was performed using RevMan software, with pain during IUD placement as the primary outcome. Secondary outcomes included pain during tenaculum placement, uterine sounding, and post-IUD placement, as well as patient satisfaction. Pain scores were measured using a 100-mm Visual Analog Scale (VAS). Results Seven RCTs involving 664 participants were included. Paracervical block significantly reduced pain scores during IUD placement, tenaculum placement, uterine sounding, and post-IUD placement (p < 0.001). Furthermore, overall patient satisfaction with the procedure was notably higher in the paracervical block group (80%) compared with the control group (63%). Conclusion Paracervical block appears to be an effective and accessible strategy for reducing procedural pain during IUD placement and enhancing patient satisfaction. Incorporating this technique into routine practice could improve the patient experience and potentially increase the acceptability and uptake of IUDs as a contraceptive method. Nevertheless, findings should be interpreted with caution given the limited number of included studies and observed heterogeneity. Future large-scale standardized trials are warranted to consolidate these findings and inform evidence-based clinical guidelines.