Association of Anticipated Insertional Pain With Intrauterine Device Initiation

Many providers cite pain as a barrier to intrauterine device (IUD) initiation. Our objective was to determine if young women who initiate other contraceptive methods anticipate more pain with IUD insertion than those who initiate IUDs.

In this prospective cohort study, we enrolled women ages 14-24 initiating contraception at a family planning clinic. Participants rated expected pain with IUD insertion on a 0-10 scale. IUD and implant initiators additionally rated experienced pain and whether they would recommend their method, both after procedure and at 6 months. We compared anticipated pain between IUD and other contraceptive initiators. For IUD and implant initiators, we compared pre- and postprocedure pain.

Of 172 participants, 29% initiated IUDs, 30% initiated implants, and 41% initiated other methods. The median age was 20 years (range 14-24), participants were racially diverse (39.5% white, 40.1% Hispanic, 11.0% black, 9.3% other), and 92% were nulliparous. IUD initiators were older and more likely to be white. The median pain anticipated with IUD insertion was similar among IUD (6.0, range 0-10), implant (5.0, range 0-10), and other contraceptive initiators (6.0, range 2-10) (p = .65). IUD initiators reported higher pain than expected (7.0, range 1-10) (p = .004), yet most recommended the IUD after procedure and at 6 months (78% and 74%, respectively).

Insertional pain may not be a barrier to IUD initiation. Women initiating other contraceptives anticipated similar pain with insertion than those initiating IUDs. IUD initiators experienced higher pain than expected, but most still recommended the method.