How do young women feel about IUD insertion?

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Intrauterine devices (IUDs) are a highly effective form of long-acting reversible contraception and recommended by the American College of Obstetricians and Gynecologists but insertion can be associated with discomfort. In a new study, researchers from Pennsylvania sought to quantify the impact of the procedure on IUD satisfaction in younger women.

Patients in the study, which was published in Obstetrics and Gynecology, were aged 14 to 22. The results reflect data from three family planning clinics in Philadelphia. 

For the multi-site, single-blind, sham-controlled randomized trial, the researchers sought women who had a levonorgestrel 13.5-mg IUD inserted between March 2015 and July 2016 at the clinics. Eligible participants were aged 14 to 22, nulliparous, not pregnant and English-speaking. Participants were randomly assigned through computer-generated allocation to block sizes of four to a 1% lidocaine paracervical or sham block. The patients were blinded about which treatment they received. To measure satisfaction, participants were asked to respond to three items: overall satisfaction with the procedure, if they would recommend the IUD to a friend, and whether the associated discomfort with the IUD was worth it. Pain at IUD insertion was recorded using a 100-mm visual analog scale.

The study enrolled 95 women and 93 (97.9%) were included in the analysis. Of the participants, 45 (47.4%) were white and 34 (36.0%) were black. Sixty-four (67.4%) were privately insured and 75 (79%) had used contraception previously. 

The majority (73 [76.8%]) reported high satisfaction with the procedure, 67 (67.4%) would recommend the device to a friend, and 79 (83.2%) perceived the IUD to be worth the discomfort. The median pain score reported immediately after insertion was 63.5 (IQR = ±53) though the lidocaine paracervical block group reported lower scores (less pain) compared to the sham block group (30.0±52 vs. 71.5±23.5, P<0.001). Higher pain scores were negatively correlated with the odds of recommending the device to a friend and perceiving the IUD as being worth the discomfort. However, there was no significant difference in likelihood of recommending IUD insertion to a friend between the lidocaine block group and the sham block group (91.5% vs 85.4%, P=0.45).

 High overall satisfaction with the device had higher odds among young adults compared to adolescents (OR = 0.07, 95% CI, 0.008-0.68); those who had a gynecologic exam compared to those who had never had one (OR = 0.26, 95% CI, 0.07-0.99). Satisfaction scores were also inversely linked to pain scores and decreased as pain scores increased (OR = 0.96, 95% CI, 0.94-0.99). There were no differences between the lidocaine block group and the sham block group in terms of satisfaction (91.5% vs 91.7%, P=0.30). 

While the study results show that most young women are satisfied with IUD insertion, the inverse relationship between that sentiment and young age, the authors said, suggests that delaying IUD insertion until patients are older may be beneficial.

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