Will it Hurt? The Intrauterine Device Insertion Experience and Long-Term Acceptability Among Adolescents and Young Women

Study Objective: To examine how the intrauterine device (IUD) insertion experience affects long-term IUD acceptability among adolescents. Design: Text to Web survey study. Setting: Boston Children's Hospital and Cambridge Health Alliance in Massachusetts. Participants, Interventions, and Main Outcome Measures: Nulliparous adolescents aged 13-21 years who received an IUD or etonogestrel implant between January 2012 and May 2018. Results: We received survey responses from 95 adolescents (n = 46 IUD; n 5 49 implant; response rate 5 95/1098 (9%)). Mean current age (20.8 years) and time since device insertion (2.4 years) were similar between groups. Although a large proportion of both groups (64%) experienced moderate to severe preprocedural anxiety, IUD users expected more insertional pain compared with implant users (55.6 vs 39.6; P = .01). Compared with implant users, more IUD users experienced moderate to severe insertional pain (80% vs 18%; P < .0001), recalled that the procedure hurt more than expected (52% vs 4%; P < .0001), and endorsed lower rates of pain management satisfaction (72.4 vs 85.6; P = .04). Most respondents would recommend their method to a friend (75%) or consider getting the same device in the future (63%). When explicitly asked, more IUD users reported that dislike of the insertion procedure might or would probably prevent them from getting the same device in the future (41% vs 14%; P = .005). Conclusion: Compared with implant users, IUD users reported more negative insertion experiences, although preprocedural anxiety was prevalent in both groups. Dislike of the insertion experience might negatively affect adolescents' willingness to continue using an IUD in the future. Findings should encourage multimodal interventions to holistically improve the IUD insertion experience.