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Analgesia for Colposcopy: Double-Masked, Randomized Comparison of Ibuprofen and Benzocaine Gel

From the Department of Family Medicine, School of Medicine, University of Washington, Seattle, Washington.

Address reprint requests to: Lili Church, MD Department of Family Medicine UWMC Roosevelt, Box 354775 University of Washington School of Medicine 4245 Roosevelt Way NE Seattle, WA 98105 E-mail: llchurch{at}u.washington.edu

Objective: To evaluate pain relief effectiveness of oral ibuprofen and topical benzocaine gel during colposcopy.

Methods: In a double-masked, randomized controlled trial, women who attended a family medicine colposcopy clinic received one of four treatments, 800 mg of oral ibuprofen, 20% topical benzocaine, both, or placebos. Using visual analog scales, women recorded their pain after speculum placement, endocervical curettage (ECC), and cervical biopsy. Participants were 18–55 years old, spoke English, and were not taking other pain or psychotropic medications. Demographic and historical information was collected from each participant.

Results: Ninety-nine subjects participated. Twenty-five received oral ibuprofen and topical benzocaine (median pain scores on a 10-point scale for speculum placement, ECC, and biopsy were 0.75, 3.00, and 3.38, respectively), 24 received oral placebo and topical benzocaine (1.00, 3.75, and 2.63), 24 received oral ibuprofen and topical placebo (0.63, 3.75, and 2.25), and 26 received oral and topical placebos (0.75, 3.50, and 3.00). There were no statistically significant differences in patient visual analogue pain scale scores across the four groups (statistical power, ECC = 0.74, cervical biopsy = 0.62). Younger women and women who had pain with speculum placement were more likely to have increased pain during ECC. Increased pain during biopsy was associated with history of severe dysmenorrhea but no other demographic or historical factors. Women overall reported ECC and biopsy to be mildly painful, with median scores of 3.5 for ECC and 2.75 for biopsy on a 10-point scale. The range in pain scores was large, with some women reporting severe pain (for ECC minimum = 0.25, maximum = 10.0; biopsy: minimum = 0.0, maximum = 9.0).

Conclusion: Colposcopy is perceived as somewhat painful, but oral ibuprofen and topical benzocaine gel, alone or together, provided no advantage over placebo in decreasing colposcopy pain.

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