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The following is a summary of “Topical lidocaine for pessary removal and reinsertion pain reduction: a randomized clinical trial,” published in the March 2025 issue of American Journal of Obstetrics & Gynecology by Jackson et al. 

Lidocaine hydrochloride (HCl) 2% jelly may offer a more accessible alternative to lidocaine-prilocaine cream for reducing pain during pessary maintenance, but its effectiveness remains untested.  

Researchers conducted a retrospective study to compare the effect of lidocaine HCl 2% jelly vs lubricating jelly on pain during office pessary removal and reinsertion.  

They performed a randomized clinical trial in an urogynecology office at a tertiary care center. Participants were randomly allocated to receive either 5 cc of lidocaine HCl 2% jelly or water-based lubricating jelly, applied 5 minutes before pessary removal. Pain levels were estimated using the visual analog scale at baseline, pessary removal, and pessary reinsertion. The primary outcome was the visual analog scale pain score at pessary removal. A total of 66 participants (33 per group) were included to detect an absolute mean pain score difference of 2.05 cm at pessary removal.  

The results showed that between September 2022 and June 2023, 192 women were screened, and 66 were enrolled, with 33 assigned to the lubricating jelly group and 33 to the lidocaine HCl 2% jelly group. Both groups had similar baseline characteristics, with most participants being postmenopausal, using vaginal estrogen, and wearing a 70-mm ring pessary with support for pelvic organ prolapse. Other pessary types included rings without support, incontinence rings with and without support, Gellhorn, and donut, with sizes ranging from 51 mm to 96 mm. No significant differences in pessary type or size were observed between groups. Visual analog scale pain scores at pessary removal were low in both groups (3.23±3.00 cm in the lubricating jelly group vs 2.66±2.77 cm in the lidocaine jelly group). After adjusting for baseline pain, no significant difference was found between groups (mean difference=−0.56 cm, 95% CI: −1.97–0.85; P=.44). Despite this, 71.2% of participants expressed a preference for numbing jelly in future pessary examinations.  

Investigators concluded that lidocaine jelly did not provide additional pain reduction during pessary examinations compared to standard lubricating jelly, despite low reported pain levels. 

Source: ajog.org/article/S0002-9378(24)00907-4/abstract