Acceptability of intrauterine device insertion without sedation for young nulliparous people: a mixed-methods study

There is limited understanding of the pain experiences of young nulliparous people undergoing intrauterine device (IUD) insertion without sedation and how this influences the acceptability of the procedure. Although quantitative studies have measured pain intensity during insertion, little research has explored how young people perceive, experience, and contextualise this. We therefore conducted a mixed-methods study to better understand pain experiences and how this affects acceptability.

Patients aged 16-30 years getting an IUD at a family planning clinic were recruited. They completed pre- and post-insertion surveys to rate anticipated and actual pain associated with the insertion. Interviews were conducted post-insertion to discuss expectations, pain, and acceptability. We used a convergent mixed-methods design with merged integration of qualitative and quantitative data for analysis.

Altogether, 30 young people participated. Most used simple oral analgesia and local anaesthetic spray to the cervix. On average, participants rated anticipated pain as 6.63/10 and actual pain as 5.88/10. Despite describing the procedure as very painful, most felt the pain was short-lived and therefore tolerable, and that their analgesia was sufficient. Overall, participants reported the procedure as acceptable. Higher acceptability was significantly associated with feeling that their pain relief was sufficient, that the insertion went as they expected, and that they perceived the benefits of the IUD outweighed the discomfort.

Although the IUD insertion was very painful for young nulliparous patients, it was not the only determinant of insertion acceptability. Findings emphasise the importance of clinicians providing sufficient education and information about IUD insertions to support preparation and manage expectations, in addition to providing effective pain management.