{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T01:37:18Z","timestamp":1787017038027,"version":"build-2736575974"},"reference-count":11,"publisher":"BMJ","issue":"2","funder":[{"name":"Duke Obstetrics and Gynecology","award":["Hammond Resident Research Fund"],"award-info":[{"award-number":["Hammond Resident Research Fund"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Sex Reprod Health"],"accepted":{"date-parts":[[2019,10,21]]},"published-print":{"date-parts":[[2020,4]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>'Slow\u2019 and \u2018cough\u2019 techniques for tenaculum placement are commonly used. This trial sought to determine if one method of placement resulted in less pain for patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This study was a randomised controlled trial of patients presenting for intrauterine device placement. Sixty-six participants were randomised to tenaculum placement via the 'slow' method (closure of tenaculum over a 5-s period) versus the 'cough' method (closure of tenaculum at the time of patient\u2019s cough). The primary outcome was pain at time of tenaculum placement measured on a 100\u2009mm visual analogue scale. The study was powered to detect a 16\u2009mm difference in pain. Secondary outcomes included pain with insertion and provider satisfaction with tenaculum grasp. Pain scores were analysed with Wilcoxon rank-sum test.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Sixty-six women were enrolled, 33 randomised to each group. Demographics were similar in each group. The primary outcome of pain with tenaculum placement showed a median pain score of 44 (IQR=21, 63) with slow placement and 32 (IQR=19, 54) with cough placement. There was no significant difference in pain scores between methods of tenaculum placement (p=0.16). There was no significant difference in overall pain scores (p=0.12). Provider satisfaction was not associated with one method of placement (p=1). Pre-procedure anxiety was significantly associated with pain at the time of tenaculum placement (p=0.01).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Neither the slow method nor cough method is superior for pain reduction or provider satisfaction. Pain with tenaculum use is significantly associated with anxiety.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Clinical trial registration<\/jats:title>\n                    <jats:p>\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"clintrialgov\" xlink:href=\"NCT02969421\">NCT02969421<\/jats:ext-link>\n                      .\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjsrh-2019-200376","type":"journal-article","created":{"date-parts":[[2019,10,30]],"date-time":"2019-10-30T17:15:56Z","timestamp":1572455756000},"page":"126-131","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":12,"title":["Pain perception with cervical tenaculum placement during intrauterine device insertion: a randomised controlled trial"],"prefix":"10.1136","volume":"46","clinical-trial-number":[{"clinical-trial-number":"nct02969421","registry":"10.18810\/clinical-trials-gov"},{"clinical-trial-number":"nct02969421","registry":"10.18810\/clinical-trials-gov"}],"author":[{"given":"Tashima","family":"Lambert","sequence":"first","affiliation":[{"name":"Obstetrics and Gynecology, Unity Health Care, Washington, District of Columbia, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tracy","family":"Truong","sequence":"additional","affiliation":[{"name":"Department of Biostatistics & Bioinformatics, Duke University, Durham, North Carolina, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2254-4127","authenticated-orcid":false,"given":"Beverly","family":"Gray","sequence":"additional","affiliation":[{"name":"Obstetrics and Gynecology, Duke University Hospital, Durham, North Carolina, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2019,10,30]]},"reference":[{"key":"2025090510584714000_46.2.126.1","doi-asserted-by":"crossref","first-page":"625","DOI":"10.1016\/j.ogc.2013.08.005","article-title":"Pain relief for obstetric and gynecologic ambulatory procedures","volume":"40","author":"Allen","year":"2013","journal-title":"Obstet Gynecol Clin North Am"},{"key":"2025090510584714000_46.2.126.2","doi-asserted-by":"crossref","first-page":"89","DOI":"10.1097\/OGX.0000000000000272","article-title":"Pain management for gynecologic procedures in the office","volume":"71","author":"Ireland","year":"2016","journal-title":"Obstet Gynecol Surv"},{"key":"2025090510584714000_46.2.126.3","doi-asserted-by":"crossref","first-page":"567","DOI":"10.1016\/j.contraception.2015.05.009","article-title":"Effect of an atraumatic vulsellum versus a single-tooth tenaculum on pain perception during intrauterine device insertion: a randomized controlled trial","volume":"92","author":"Doty","year":"2015","journal-title":"Contraception"},{"key":"2025090510584714000_46.2.126.4","doi-asserted-by":"crossref","first-page":"229","DOI":"10.1016\/j.contraception.2013.11.018","article-title":"Comparison of interventions for pain control with tenaculum placement: a randomized clinical trial","volume":"89","author":"Goldthwaite","year":"2014","journal-title":"Contraception"},{"key":"2025090510584714000_46.2.126.5","doi-asserted-by":"publisher","DOI":"10.1002\/acr.20543"},{"key":"2025090510584714000_46.2.126.6","doi-asserted-by":"publisher","DOI":"10.1016\/S0196-0644(96)70238-X"},{"key":"2025090510584714000_46.2.126.7","doi-asserted-by":"publisher","DOI":"10.1067\/mem.2001.118863"},{"key":"2025090510584714000_46.2.126.8","doi-asserted-by":"publisher","DOI":"10.1136\/jfprhc-2013-100636"},{"key":"2025090510584714000_46.2.126.9","doi-asserted-by":"publisher","DOI":"10.1136\/jfprhc-2016-101446"},{"key":"2025090510584714000_46.2.126.10","doi-asserted-by":"publisher","DOI":"10.1093\/oxfordjournals.aje.a009937"},{"key":"2025090510584714000_46.2.126.11","doi-asserted-by":"publisher","DOI":"10.1111\/j.1553-2712.2001.tb01132.x"}],"container-title":["BMJ Sexual &amp; Reproductive Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjsrh-2019-200376","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,5]],"date-time":"2025-09-05T18:23:26Z","timestamp":1757096606000},"score":1,"resource":{"primary":{"URL":"https:\/\/jfprhc.bmj.com\/lookup\/doi\/10.1136\/bmjsrh-2019-200376"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,10,30]]},"references-count":11,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2020,4,17]]},"published-print":{"date-parts":[[2020,4]]}},"alternative-id":["10.1136\/bmjsrh-2019-200376"],"URL":"https:\/\/doi.org\/10.1136\/bmjsrh-2019-200376","relation":{},"ISSN":["2515-1991","2515-2009"],"issn-type":[{"value":"2515-1991","type":"print"},{"value":"2515-2009","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,10,30]]}}}