Nitrous Oxide for Pain Management During In-office Transcervical Sterilization

Inclusion Criteria: * Premenopausal women desiring permanent sterilization and have chosen to proceed with a transcervical sterilization approach * Speaks English or Spanish * If relying on state or federal funding for sterilization, must have appropriate federal consents signed 30 days prior to the sterilization procedure * Agrees to either a hormonal endometrial preparation prior to the procedure or schedule the procedure during the follicular phase (days 5 through 12) of their menstrual cycle * Sexually active who agrees to contraception for 3 months post procedure, including condoms, followed by a hysterosalpingogram (HSG) for confirmation of fallopian tubal occlusion. Exclusion Criteria: * With contraindications for nitrous oxide including: respiratory infection, chronic obstructive pulmonary disease (COPD), intoxication or use of street drugs, inability to breathe through their nose. * Have taken narcotic pain medications prior to coming to their appointment * Unsure about desire to end fertility * History of pelvic inflammatory disease in the past 3 months * Pregnancy or suspicion of pregnancy * Delivery or termination of a pregnancy within the last 6 weeks * Known allergy to contrast * Uterine anomalies * Previous tubal surgery * Cervical or endometrial cancer * Allergy to Vicodin, lorazepam, or lidocaine.