Could the Valsalva manoeuvre be an alternative to the tenaculum for intrauterine device insertion?

Abstract

Objectives

This study investigated whether the Valsalva manoeuvre (VM) could be an alternative to use of the tenaculum for intrauterine device (IUD) insertion. The aims were to establish whether VM could provide good patient comfort and enable the insertion to be performed successfully with adequate pain control in cases where the cervix could not be passed spontaneously.

Methods

Women who attended the outpatient clinic of Alanya Education and Research Hospital between November 2017 and December 2020 for IUD insertion were randomly assigned to the VM (n = 52) or tenaculum (n = 55) group. Insertion in the latter group was carried out by grasping the cervix with a single-toothed tenaculum. In the VM group, no tenaculum was used to grasp the cervix; instead, the woman was asked to perform VM during insertion.

Results

IUD insertion success rates were similar between the groups. Procedural anxiety scores were slightly higher in the tenaculum group. Pain scores measured during the procedure were significantly higher in the tenaculum group compared with the VM group. Severe pain was reported by 58.2% of women in the tenaculum group, whereas 57.7% of women in the VM group reported no pain.

Conclusion

In cases where an IUD cannot be passed through the cervical canal spontaneously, the procedure should be attempted using VM before using a tenaculum. The use of VM may lead to lower pain and anxiety levels as well as increased patient comfort.

瓦萨尔瓦捏鼻鼓气法能否代替宫内节育器放置时的钳夹 摘要

目的：此研究探讨了在宫内节育器( IUD )放置时瓦萨尔瓦捏鼻鼓气法( VM )能否代替钳夹的使用。其目的是确定VM能否提供良好的患者舒适度, 以及宫颈不能自然通过时, 在适当的疼痛控制下VM能否使IUD成功植入。

方法：将2017年11月至2020年12月在Alanya教育研究医院门诊行IUD放置的妇女随机分为VM 组( n＝ 52 )或宫颈钳组 ( n ＝ 55 )。后组采用单齿宫颈钳钳夹宫颈进行放置。VM组不使用宫颈钳钳夹宫颈；而是在放置过程中要求女性进行VM。

结果：两组IUD放置成功率相似。宫颈钳组过程焦虑评分稍高。术中测量的疼痛评分宫颈钳组明显高于VM组。宫颈钳组58.2 %的妇女出现剧烈疼痛, VM组57.7 %的妇女无疼痛。

结论：对于IUD不能自然通过宫颈管的病例, 在使用宫颈钳前应先尝试VM。进行VM或许能降低患者的疼痛和焦虑水平, 增加患者舒适度。

Keywords:

• Intrauterine device
• tenaculum
• Valsalva

Disclosure statement

No potential conflict of interest was reported by the author(s).

Author contributions

Meral Tugba Cimsir designed the study and contributed to the data collection. Muhammet Serhat Yildiz contributed to the data collection and analysis.