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Abstract The intrauterine contraceptive device (IUCD) provides long-term, reversible contraception equal in efficacy to tubal sterilization. Depending on the country, the use of IUCDs worldwide ranges from 2%to 75%. On average, 15% of reproductive-aged women in developing countries and 8% in developed countries use IUCDs. Increasing the number of women using IUCDs is an important public health goal (Grimes, 2008). One barrier to IUCD use is the fear of pain during insertion. Components of the insertion procedure that may cause pain include the application of the tenaculum to the cervix to stabilize the uterus and provide traction for straightening the cervical canal, passing the uterine sound, inserting the IUCD in the inserter tube through the cervix, and irritation of the endometrial cavity with the device (d’Arcangues, 2007). The levels of pain that women experience during IUCD insertion vary in published reports. Most women experience mild to moderate discomfort during IUCD insertion. Rarely, the pain is severe and associated with nausea and weakness. Pain may persist for a few days after insertion. Predictors of pain during IUCD insertion include nulliparity, age greater than 30 years, lengthier time since last pregnancy or last menses, and not currently breastfeeding. Psychosocial factors including expected pain also influence the pain perceived by women undergoing the procedure (Hubacher, 2007). The use of prophylactic non steroidal anti-inflammatory drugs (NSAIDs) prior to IUCD insertion has been advocated to reduce pain during insertion and has been common practice for years (Saav et al., 2007). However, in a larger randomised controlled trial (RCT) comparing prophylactic 400mg ibuprofen with placebo prior to IUCD insertion, no pain reduction was shown (Hubacher et al., 2006). Misoprostol is an inexpensive prostaglandin E1- analogue, which is associated with few side-effects (Goldberg et al., 2001; Wing andAffaney, 2006) and an effective method for treatment of missed and incomplete abortion, induction of provocative abortion as well as for labor induction and prevention and treatment of postpartum haemorrhage (Goldberg et al., 2001). |