Please select the eligibility criteria that correspond to the clinical trial below.
Title: The Effect of Nitroprusside on the IUD Insertion Experience in Nulliparous Women: a Pilot Study
Brief Summary: Increasing accessibility of long-acting reversible contraceptive methods, like intrauterine devices (IUDs), is an important strategy to reduce the risk of unintended pregnancy. Unfortunately, fear of IUD insertion in women who have not had children is common among health care providers and women alike, and this limits IUD use. To increase acceptance of this highly effective contraceptive, there is need to investigate novel, low cost, easily applied and accessible techniques to improve the insertion experience. This is a pilot study to evaluate the efficacy and tolerability of nitroprusside gel applied intracervically as an intervention to improve the IUD insertion experience for both patient and provider.


Options:
A: Inclusion Criteria:

* Age \>18 OR between the ages of 12-17 with a parent/legal guardian who can consent
* English speaking
* Desires a Mirena® or ParaGard® IUD
* Nulliparous woman
* Can use laughing gas
* Has not taken narcotic pain medications prior to procedure

Exclusion Criteria:

* Currently pregnant
* If you have been pregnant before, pregnancy lasting longer than 19 weeks, 6 days
* Less than 4 weeks have elapsed from the end of a spontaneous abortion or medical abortion.
* Desires Skyla® IUD
* Pelvic Inflammatory Disease in the last 3 months
* Current mucopurulent discharge
* Uterine anomaly that distorts the uterine cavity
* Known uterine fibroid with disruption of the uterine cavity
* Copper allergy/Wilson's disease (for ParaGard®)
* Current cervical or uterine cancer
* Inability to breathe through the nose
* Significant active upper airway infection
B: Inclusion Criteria:

* age 18-45,
* Generally Healthy.
* requesting LNG-IUS for contraception as the primary indication

Exclusion Criteria:

* previous pregnancy beyond 20 weeks,
* previous IUD placement or attempted placement,
* allergy to nitroprusside,
* history of migraines,
* history of heart disease.
C: Inclusion criteria:

* Nulliparous, as defined in this study as no history of pregnancy ≥ 24 weeks gestational age
* Desires insertion of either levonorgestrel-releasing IUD (LNG-IUD) or copper T380A IUD (Cu-IUD)
* No history of pregnancy in the last 6 weeks
* Able to provide written informed consent in English and comply with all study procedures

Exclusion criteria:

* Known allergy or hypersensitivity to lidocaine or other amino amide local anesthetics
* Prior failed IUD insertion
* Prior IUD use
* Use of narcotic or benzodiazepine medication within the last 24 hours
* U.S. Centers for Disease Control Medical Eligibility Criteria (MEC) category 3 or 4 classification for use of an IUD
* Positive pregnancy test or reasonable risk of pregnancy due to unprotected heterosexual intercourse since the last menstrual period
D: Inclusion Criteria:

* Self-select either a Paragard or Mirena IUD and are appropriate for insertion as determined by their provider
* Age 18-45
* Speak English or Spanish

Exclusion Criteria:

* Lidocaine allergy
* First trimester abortion or miscarriage in the previous six weeks
* Second trimester abortion or miscarriage in the previous 12 weeks

Answer: B