IUD Insertion Under Conscious Sedation: Patient Characteristics with Clinical Decisions

Uptake of intrauterine devices (IUDs) in the adolescent population may be limited by anxiety and pain anticipated during the insertion procedure. Our institution offers conscious sedation for IUD insertion to mitigate this concern. The objective of this study was to identify characteristics and outcomes of teens choosing between two types of conscious sedation for insertion of a levonorgestrel IUD.

This was a single-site, retrospective cohort study over a one year period, reviewing the electronic medical records of patients who had undergone an attempted IUD insertion using conscious sedation. Conscious sedation included nitrous gas (termed "light" sedation) or intravenous midazolam and fentanyl (termed "moderate" sedation). Patient demographic characteristics and medical and gynecological histories were analyzed.

There were 69 attempted IUD insertions during the study period. Most patients (75.36%) were placed under light sedation, and 92.75% were successfully inserted. The only significant factor associated with choice in the type of conscious sedation was previous sexual activity, which increased the odds by 10.0 that the patient would choose light sedation (95% CI, 1.23-81.34; P = 0.031). Differences between other factors (age, history of sexual assault, tampon use, and gender identity) were not statistically significant between successful and failed insertions.

In conclusion, history of sexual activity significantly differed between patients in our cohort who selected light sedation over moderate sedation. No other factors influenced the choice in sedative or success of IUD insertion. Knowing the characteristics of patients who choose nitrous versus intravenous sedation, and how it relates to successful insertion, may help guide pre-procedural counseling for patients regarding sedation for IUD insertion.