In-office gynecologic procedures such as intrauterine device (IUD) insertion, endometrial biopsy (EMB), and manual vacuum aspiration (MVA) are essential components of reproductive healthcare but are frequently associated with significant patient discomfort, particularly among nulliparous patients and adolescents. Evidence supports several strategies to reduce procedural pain, including local anesthetic techniques such as paracervical or intracervical lidocaine blocks, intrauterine anesthetic instillation, and the use of nonsteroidal anti-inflammatory drugs. In addition, patient-centered approaches—including anticipatory counseling and trauma-informed care—can improve the overall procedural experience. Despite this growing body of evidence, pain management practices for in-office gynecologic procedures remain inconsistent across clinical settings. Quality improvement initiatives aimed at implementing evidence-based pain management strategies may help improve patient comfort and promote more consistent patient-centered care.

The objective was to determine the proportion of patients who accept pain control when it is routinely offered prior to IUD placement. Patients were offered a variety of pain management options, including non-medication methods, pre procedure pain medication, pre procedure anxiolytics, localized numbing agents, and cervical ripening agents. Their selections were recorded as part of their visit documentation. Descriptive statistics were then used to summarize patient selection of pain control options for IUD placement, reported as frequencies and percentages.

When offered pain management options, 79% of patients accepted some method of pain control for in-office gynecologist procedures. Local numbing agents were the most popular choice, with 73% of participants using some form of this method. Cervical ripening agents were the least popular, with only 4% of patients selecting this method. Just over half (58%) of participants who desired pain control when offered selected more than one method. 

This quality improvement initiative demonstrates that patients are generally receptive to pain management strategies for in-office gynecologic procedures when options are routinely offered. Patients tended to favor localized anesthetic options over systemic medications and preferred interventions that could be administered at the time of the procedure rather than requiring pre-procedure coordination. While routine offering of pain control methods improved uptake, acceptance appeared to depend in part on how options were framed and patients’ perceptions of their necessity and benefit. These findings suggest that simply presenting options may be insufficient; counseling that emphasizes the potential for procedural pain, variability in patient experience, and the benefits of local anesthetic techniques may improve acceptance. Standardizing counseling language and avoiding assumptions that patients will decline pain management may further support shared decision-making and better align pain control strategies with patient expectations and risk factors.