Understanding Factors That Influence Pain During IUD Insertion

Background: The experience of pain during intrauterine device (IUD) insertion varies significantly among women, with some reporting minimal discomfort while others endure considerable pain[1]. Despite the common use of IUDs as a reliable form of contraception[2], a limited understanding exists regarding the underlying factors that contribute to this variance in pain perception. This research aims to explore not only how much pain patients experienced during the IUD insertion process, but also whether they were experiencing more pain than they had expected and their l ikelihood to have another IUD placed. Variables that may influence pain levels during the IUD insertion process were also explored. Specifically, we investigated the roles of multiparity, the utilization of pain management offered by their provider, and the type of provider that performed the procedure. We propose that multiparity, performance of the procedure by physicians, as well as utilization of pain medication offered will decrease the amount of perceived pain experienced by patients. By identifying and analyzing these factors, our study seeks to enhance our understanding of pain management during IUD insertion and ultimately improve patient experiences. Methods: 1. Survey conducted anonymously using Qualtrics. 2. The 16-question survey was distributed via a link on online platforms including Facebook, Reddit, and Instagram. 3. Participants completed an informed consent before initiating the survey. 1. 4. Inclusion criteria included individuals over the age of 18, assigned female-sex at birth, and had the IUD inserted in the USA. Exclusion criteria included incomplete surveys. 2. 5. Survey data from 317 participants who met the inclusion and exclusion criteria was collected and analyzed by a statistician. Results: The average pain score reported by participants was 6.65 out of 10. When comparing the experienced pain to the pain that was expected based on counseling, 67.3% of participants had more pain than their provider said they would, 17.7 % experienced the same level of pain as they expected, and 17.0% had less. 43.8% of participants felt that based on their experience, they would have another IUD inserted. 30.6% were unsure if they would and 25.6% of respondents would not have another IUD inserted. When considering their experience 34.1% of participants were extremely likely to return to the same provider, 20.2% were somewhat likely, 19.2% were neutral, 9.46% were somewhat unlikely, and 17.4% were extremely unlikely. There was no significant difference found between pain scores reported by individuals who had their IUD inserted by a physician and those inserted by a non-physician provider (p=0.076). A significant difference between the average pain scores reported between individuals who have labored and those who have not was found (p<0.0001). The average pain score for those who reported having been in labor was 4.56 compared to an average of 7.10 for individuals who have not (Fig 6). There was no significant of pain reported difference between patients who received pain intervention and those who did not (p=0.546). Conclusions: Current pain management strategies do not appear to be effective. Multiparity significantly decreased the amount of perceived pain reported. Utilization of offered pain management did not seem to affect perceived pain reported.No significant differenc e was found between patients who received care from physicians than from patients who received care from other providers. We recommend further study in the process of setting expectations and how that affects perceived pain.