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Manual Vacuum Aspiration (MVA) for Uterine Evacuation: Pain Management

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Castleman, Laura and Carol Mann. 2009. Manual vacuum aspiration (MVA) for uterine evacuation: Pain management. Second edition. Chapel Hill, NC: Ipas.

Reducing the physical pain and anxiety experienced by women undergoing uterine evacuation is an essential component of treatment with manual vacuum aspiration (MVA). This document addresses the types and origins of discomfort that women may experience during MVA, and several techniques that may be used to decrease discomfort.

Women’s experience with pain during MVA varies widely; some women feel almost nothing at all and other women feel quite uncomfortable. Typically, the MVA procedure takes several minutes, during which most women feel a moderate amount of cramping, with the most intense cramping at the end as the procedure is completed. After the procedure has ended, cramping usually decreases rapidly. Women undergoing uterine evacuation with MVA appear to experience a level of discomfort that is similar to what women feel when undergoing an endometrial biopsy. Just as with an endometrial biopsy, approaches that enable women to remain awake and alert during the procedure will usually provide them with adequate pain relief.

MVA is a quiet technique for uterine evacuation, especially when compared to many electric vacuum aspiration (EVA) techniques. In several studies of uterine evacuations performed by MVA and EVA, women stated that they considered the absence of noise to be an advantage (Bird et al. 2001; Edelman et al. 2001). In a randomized trial of 114 women undergoing first-trimester abortion by either MVA or EVA, there was no significant difference in the numeric values women assigned to describe their pain. Yet when women were asked to qualitatively describe their discomfort, those who underwent EVA reported that the noise associated with the electric pump increased their pain (Edelman et al. 2001). Some clinicians who use MVA have commented that women ask for “the quiet procedure,” indicating their preference for this aspect of MVA (Baird et al. 2001).

There are three distinct areas of discomfort during MVA: Anxiety: Women often feel nervous about undergoing uterine evacuation, and their anxiety may aggravate their perception of pain. Conversely, women who feel less anxious are less likely to perceive pain (Wiebe et al. 1995; Stubblefield 1989).

Cervical dilatation: Cervical dilatation may be needed prior to MVA; passage of mechanical dilators through the cervix causes some discomfort.

Uterine manipulation and evacuation: Uterine instrumentation causes cramping that tends to increase when the uterus contracts at the end of the evacuation. The whole procedure is usually quite brief, and any strong cramping that occurs generally lasts only a few minutes.

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