[Factors influencing pain during intrauterine device insertion]

Fear of pain during intrauterine device (IUD) insertion remains a barrier to its adoption. In the absence of consensus on an optimal pharmacological strategy, it is crucial to determine the factors influencing this pain to reassure and improve the patient experience.

It was a prospective study conducted in Provence-Alpes-Côte d'Azur between August 2023 and 2024, interviewing adult patients and healthcare professionals during consultations for IUD insertion. The primary outcome studied was the pain experienced during IUD insertion, measured using a numerical rating scale from 0 to 10. After an univariate analysis, a multiple linear regression was performed to identify the factors associated with this pain.

Of the 110 questionnaires analyzed, the average pain score at IUD insertion was 4.1±2.7. Factors associated with pain included European origin, no history of vaginal delivery, apprehension and use of a tenaculum. In contrast, prior IUD insertion, the presence of dysmenorrhea, menstruation at the time of insertion, or premedication had no significant effect on pain. Prior bladder emptying and the use of equimolar mixture of oxygene and nitrous oxide (EMONO) could also be considered as strategies but require further studies.

IUD insertion should be played down, given the moderate and temporary pain it causes. Physicians have a key role in identifying patients at risk of increased pain in order to provide them a personalized approach.