A hormonal coil fitting should be made as painless as possible for all patients. This applies particularly in women who have not yet given birth vaginally. There are generally three very effective strategies for achieving this:
- Cervical priming: pharmacological preparation of the cervix is very effective (see chapter Cervical Priming).
- Using conical dilators rather than hegar’s dilators. The conical shape allows significantly better regulation of dilation compared to non-conical dilators, such as Hegar’s dilator. That means that less pain is caused. Another advantage is the reduced risk of infection, as it is only necessary to enter the cervix once, instead of repeated stretching with Hegar’s dilators of different sizes. That also makes the procedure quicker, which is easier on the patient. Suitable dilators include the Denniston_Dilators or the Hamann Zervikometer, www.zervikometer.de. which was developed especially for IUD/IUS fittings.
- Intracervical local anaesthetic: in the event of any pain around the cervical canal during fitting of an IUD/IUS, a local anaesthetic is a very effective option for pain relief. For this, a few small deposits (2-3 ml in total) of a local anaesthetic around the inner and outer cervix will usually suffice.
In special circumstances the IUS may also be fitted under a short general anaesthetic. The anaesthesia need only be short and superficial as there will only be a little pain during induction of the very brief dilation.
Video of the Mirena® being fitted