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Satisfaction With the Intrauterine Device Insertion Procedure Among Adolescent and Young Adult Women

Akers, Aletha, Y., MD, MPH; Harding, Jennifer, MPA; Perriera, Lisa, K., MD, MPH; Schreiber, Courtney, MD, MPH; Garcia-Espana, J., Felipe, PhD; Sonalkar, Sarita, MD, MPH

doi: 10.1097/AOG.0000000000002596
Family Planning: Original Research: PDF Only

OBJECTIVE: To evaluate satisfaction with intrauterine device (IUD) insertion procedures among adolescent and young adult women.

METHODS: This secondary analysis of data from a multisite, single-blind, sham-controlled randomized trial of women having a levonorgestrel 13.5-mg IUD inserted enrolled participants from March 2015 through July 2016 at three family planning clinics in Philadelphia, Pennsylvania. Eligible participants were 14–22 years of age, nulliparous, not pregnant, and English-speaking. Randomization was computer-generated allocation in block sizes of four to a 1% lidocaine paracervical or sham block. Only patients were blinded. Satisfaction was measured with three items that assessed overall satisfaction with the procedure, whether participants would recommend the IUD to a friend, and the perception that the IUD was worth the discomfort. Predictors included demographics, sexual and reproductive history, pain after IUD insertion, and treatment group.

RESULTS: Ninety-five women enrolled; 93 (97.9%) were included in the analysis. Forty-five (47.4%) were white, 34 (36.0%) were black, 62 (66.0%) were privately insured, and 75 (79.0%) had used contraception previously. Most (n=73 [76.8%]) reported high overall satisfaction with the procedure, 64 (67.4%) would recommend an IUD to a friend, and 79 (83.2%) perceived the IUD was worth the discomfort. The odds of reporting high overall satisfaction were lower among adolescents compared with young adults (odds ratio [OR] 0.07, 95% CI 0.008–0.68); those who never had a gynecologic examination compared with those who had (OR 0.26, 95% CI 0.07–0.99); and decreased as pain score increased (OR 0.96, 95% CI 0.94–0.99). Higher pain scores were negatively correlated with the odds of recommending an IUD to a friend and perceiving the IUD was worth the discomfort.

CONCLUSION: Adolescent and young adult women report high levels of satisfaction after the IUD insertion procedure. Young age, lack of experience with gynecologic examinations, and high pain were inversely related to satisfaction.

CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov, NCT02352714.

Adolescent and young adult women aged 14–22 years report high satisfaction with the intrauterine device insertion procedure.

Department of Obstetrics and Gynecology, Craig Dalsimer Division of Adolescent Medicine, Children's Hospital of Philadelphia, Children's Hospital of Philadelphia Research Institute, PolicyLab, Roberts Center for Pediatric Research, the Department of Obstetrics and Gynecology, Thomas Jefferson University, and the Department of Obstetrics and Gynecology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.

Funded by an investigator-initiated grant from Bayer Healthcare Inc. and the Health Services Research Administration. Bayer provided the intrauterine devices. The funder had no role in the study design, data analysis, or manuscript preparation. The funder had no role in the study design, data analysis, or manuscript preparation. Also funded in part by a career development award in Women's Reproductive Health Research: K12-HD001265-18.

Corresponding author: Aletha Y. Akers, MD, MPH, Craig Dalsimer Division of Adolescent Medicine, Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, Main Building, Suite 11NW10, Philadelphia, PA 19104; email: akersa@email.chop.edu.

Financial Disclosure The authors did not report any potential conflicts of interest.

Presented at the North American Forum on Family Planning, November 5–7, 2016, Denver, Colorado; and at the North American Society for Pediatric and Adolescent Gynecology, April 20–22, 2017, Chicago, Illinois.

The authors thank Courtney Park, Kanika Ramchandani, Arden McAllister, and Chierika Ukogu for data collection and Okan U. Elci, PhD, from the Westat Company, who performed data quality checks as part of the data safety and monitoring board.

Each author has indicated that he or she has met the journal's requirements for authorship.

© 2018 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.