Will It Hurt? the Intrauterine Device (IUD) Insertion Experience and Long-Term IUD Acceptability Among Adolescents and Young Women.

Abstract

Purpose: To examine how the intrauterine device (IUD) insertion experience affects long-term IUD acceptability among adolescents. Methods: This text-to-web survey study was conducted at Boston Children’s Hospital, Boston, Massachusetts, and Cambridge Health Alliance, Cambridge, Massachusetts. English-speaking adolescents who received an IUD or etonogestrel implant between January 2012 and May 2018 and who were between the ages of 13 and 21 years and nulliparous at the time of the procedure were eligible. Main outcome measures were willingness to recommend the device and willingness to get the same device in the future. Results: We received survey responses from 45 adolescents (n=21 IUD users, n=24 implant users, response rate = 4.10%). Mean current age (21 years) and time since insertion (2.4 years) were similar between the IUD and implant groups. Both groups anticipated moderate insertional pain, and 70% of respondents experienced moderate-to-severe pre-procedural anxiety. Compared to the implant group, significantly more IUD users reported moderate-to-severe insertional pain (85% vs 29%, p=0.001), recalled that the procedure hurt more than expected (57% vs 4%, p=0.0001), and endorsed lower pain management satisfaction (67.8 vs 90.0, p=0.03). Most would recommend their chosen method to a friend (86% IUD, 79% implant) or consider getting the same device in the future (67% IUD, 71% implant). However, when explicitly asked if dislike of the insertion procedure would prevent them from getting the same device in the future, significantly more IUD users reported that dislike of the insertion procedure might or would probably prevent them from getting the same device in the future (43% vs 8%, p=0.01). Conclusions: Nulliparous adolescents receiving an IUD experience high rates of pre- procedural anxiety, anticipate painful IUD insertions, and experience more severe pain and lower procedural satisfaction compared to implant users. Dislike of the IUD insertion experience may negatively impact adolescents’ willingness to continue using an IUD in the future. Findings can inform multimodal interventions to holistically improve the IUD insertion experience.