Pain at intrauterine device placement in a Brazilian center

OBJECTIVE: This study explores pain at intrauterine device (IUD) placement in a large Brazilian cohort. METHODS: We undertook a cross-sectional analysis of health records from individuals aged 18 to 45 years who underwent IUD placements between 2022 and 2024 at the Department of Obstetrics and Gynecology, Universidade Estadual de Campinas Faculty of Medical Sciences, Campinas, Brazil. Insertion pain was measured immediately after the procedure using a 10-cm visual analogue scale (VAS). Scores were classified as no pain (0), mild pain (1-3), moderate pain (4-6), and severe pain (≥7). Pain relief included analgesics, antispasmodics, non-steroidal anti-inflammatory drugs (NSAIDs), and opioids. We used multivariable regression to assess the association between pre-insertion pain relief and pain during placement. RESULTS: We evaluated 6974 individuals. Of 7259 fittings analyzed, 228 (3%) occurred with no pain, 1121 (15%) with mild pain, 2003 (28%) with moderate pain, and 3907 (54%) with severe pain (median [interquartile range] pain score of 7.0 [5.0-8.0]). Clinicians provided pain relief in 429 (6%) of insertions (largely antispasmodics and NSAIDs). After adjusting for age and parity, antispasmodics were associated with moderate to severe pain (adjusted odds ratio [aOR] 1.75; 95% confidence interval: 1.15; 2.68). CONCLUSION: Our findings suggest that moderate to severe pain was experienced in 5910 (81%) of IUD insertions, in contrast with the 5% estimate in national guidelines. We also found evidence that pre-insertion antispasmodic medication was associated with higher moderate to severe pain. Our findings emphasize the need to update guidelines to recognize IUD insertion pain and provide options to manage discomfort.