Sedation or no Sedation? Understanding IUD Placement Preference Among Adolescents

While intrauterine devices (IUDs) are highly effective for contraception and menstrual-related concerns, a significant barrier to usage in adolescents is fear of pain during placement. We sought to identify patient characteristics associated with receiving sedation for IUD placement among adolescents.

A retrospective cohort study was performed at a single institution from January 2022 to December 2023. Patients (N=284) assigned female at birth, aged ≤18, who underwent IUD placement for any indication with or without sedation were included. Demographic and clinical characteristics were analyzed using multivariable logistic regression.

Two hundred thirty-three patients (82.0%) underwent IUD placement in clinic without sedation and 51 (18.0%) underwent placement with sedation. There were no significant differences in age, race, ethnicity, or insurance type between cohorts. Sedation patients had a higher BMI (26.2 vs 24.3 kg/m², P=.04), were more likely to identify as non-binary (13.7% vs 4.3%, p=.01), and were less likely to be sexually active (25.4% vs 62.7%, P<.001). In multivariable analysis, a bleeding disorder was associated with a 19.6 percentage-point higher predicted probability of undergoing sedation (95% CI 4.7-34.5 percentage points), whereas being sexually active was associated with an 11.8 percentage-point lower predicted probability (95% CI -23.3 to -0.3 percentage points).

We identified several patient characteristics that increase the likelihood of adolescents undergoing IUD placement with sedation, including higher BMI, having a bleeding disorder, identifying as non-binary, and not being sexually active. These findings may help clinicians identify adolescents who could benefit from expanded pain management options.

This study identifies specific adolescent patient characteristics associated with use of sedation for IUD placement, including obesity, having a bleeding disorder, identifying as non-binary, and not being sexually active. Expanding equitable pain management access may reduce deterrents to IUD use and strengthen patient-centered contraceptive care.