Abstract
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 = 49 implant; response
rate = 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.
Key Words
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of Pediatric and Adolescent GynecologyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Understanding the decline in adolescent fertility in the United States, 2007-2012.J Adolesc Health. 2016; 59: 577
- Births: final data for 2016.Natl Vital Stat Rep. 2018; 67: 1
- Adolescent pregnancy, birth, and abortion rates across countries: levels and recent trends.J Adolesc Health. 2015; 56: 223
- Committee on Adolescent Health Care Long-Acting Reversible Contraception Working Group, The American College of Obstetricians and Gynecologists: Committee opinion no. 539: adolescents and long-acting reversible contraception: implants and intrauterine devices.Obstet Gynecol. 2012; 120: 983
- Do adolescent women’s contraceptive preferences predict method use and satisfaction? A survey of northern California family planning clients.J Adolesc Health. 2019; 64: 640
- Use of levonorgestrel intrauterine system for medical indications in adolescents.J Adolesc Health. 2013; 52: S54
- Use of the intrauterine device among adolescent and young adult women in the United States from 2002 to 2010.J Adolesc Health. 2013; 53: 401
- Current contraceptive status among women aged 15-49: United States, 2015-2017. NCHS Data Brief, no 327.National Center for Health Statistics, Hyattsville, MD2018
- Attitudes and beliefs about the intrauterine device among teenagers and young women.Contraception. 2010; 82: 178
- Fear of intrauterine contraception among adolescents in New York City.Contraception. 2014; 89: 446
- Do knowledge and attitudes regarding intrauterine devices predict interest in their use?.Womens Health Issues. 2015; 25: 359
- “I don’t know enough to feel comfortable using them”: Women’s knowledge of and barriers to long-acting reversible contraceptives on a college campus.Contraception. 2016; 93: 556
- Evaluating different pain lowering medications during intrauterine device insertion: a systematic review and network meta-analysis.Fertil Steril. 2019; 111: 553
- Pain perception during levonorgestrel-releasing intrauterine device insertion in nulliparous women: a systematic review.J Pediatr Adolesc Gynecol. 2018; 31: 549
- Interventions for pain with intrauterine device insertion.Cochrane Database Syst Rev. 2015; 29: CD007373
- Reducing pain during intrauterine device insertion – a randomized controlled trial in adolescent and young women.Obstet Gynecol. 2017; 130: 795
- Association of anticipated insertional pain with intrauterine device initiation.J Adolesc Health. 2018; 63: 37
- Intrauterine contraception continuation in adolescents and young women: a systematic review.J Pediatr Adolesc Gynecol. 2016; 29: 659
- Participant recruitment in sensitive surveys: a comparative trial of ‘opt in’ versus ‘opt out’ approaches.BMC Med Res Methodol. 2013; 13: 3
- Systematic review of the psychometric properties, interpretability and feasibility of self-report pain intensity measures for use in clinical trials in children and adolescents.Pain. 2006; 125: 143
- Can we rely on retrospective pain assessments?.Am J Epidemiol. 2003; 157: 552
- A one-item question with a Likert or Visual Analog Scale adequately measured current anxiety.J Clin Epidemiol. 2007; 60: 356
- A randomized controlled trial of nitrous oxide for intrauterine device insertion in nulliparous women.Int J Gynecol Obstet. 2016; 135: 145
- Satisfaction with the intrauterine device insertion procedure among adolescent and young adult women.Obstet Gynecol. 2018; 131: 1130
- Clinical applications of visual analogue scales: a critical review.Psychol Med. 1988; 18: 1007
- Interpretation of visual analog scale ratings and change scores: a reanalysis of two clinical trials of postoperative pain.J Pain. 2003; 4: 407
- Adolescent experiences with IUDs: a qualitative study.J Adolesc Health. 2015; 57: 381
- Pain management for gynecologic procedures in the office.Obstet Gynecol Surv. 2016; 71: 89
- Guarding against coercion while ensuring access: a delicate balance.Guttmacher Policy Review. 2014; 17: 8
- Celebration meets caution: LARC’s boons, potential busts, and the benefits of a reproductive justice approach.Contraception. 2014; 89: 237
- Identifying counseling needs of nulliparous adolescent intrauterine contraceptive users: a qualitative approach.J Adolesc Health. 2013; 52: 293
- Barriers and facilitators to adolescents’ use of long-acting reversible contraceptives.J Pediatr Adolesc Gynecol. 2017; 30: 18
- A prospective cohort study of pain with intrauterine device insertion among women with and without vaginal deliveries.J Obstet Gynaecol. 2014; 34: 263
- Anticipated pain as a predictor of discomfort with intrauterine device placement.Am J Obstetrics Gynecol. 2018; 218: 236.e1
- Effect of an atraumatic vulsellum versus a single-tooth tenaculum on pain perception during intrauterine device insertion: a randomized controlled trial.Contraception. 2015; 92: 567
- Anxiety at outpatient hysteroscopy.Gynecol Surg. 2015; 12: 189
- Intrauterine contraception insertion pain: nursing interventions to improve patient experience.J Clin Nurs. 2018; 27: 9
- Gallup: Using text messaging to reach survey respondents.(Available:)https://news.gallup.com/opinion/methodology/221159/using-text-messaging-reach-survey-respondents.aspxDate accessed: March 8, 2019
- Intrauterine contraception in nulliparous women: a prospective survey.J Fam Plann Reprod Health Care. 2016; 42: 36
- Practical tips for intrauterine device counseling and pain relief in adolescents: an update.J Pediatr Adolesc Gynecol. 2019; https://doi.org/10.1016/j.jpag.2019.02.121
Article info
Publication history
Published online: August 08, 2019
Footnotes
The authors indicate no conflicts of interest.
Aspects of this work were presented as a poster at the Soma Weiss Student Research Day at Harvard Medical School on March 12, 2019.
Identification
Copyright
© 2019 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc.
