Satisfaction With IUS Insertion in Adolescents 14-22 Years Old

Intrauterine systems (IUS) are among the most effective forms of reversible contraception. Notwithstanding numerous studies demonstrating its safety and efficacy, uptake of IUS devices among U.S. young women aged 14 to 22 years has been low. Increasing the use of this effective, long acting contraception among young women is an important public health goal, as it could help to reduce the high rates of unintended pregnancies in this population. Although a number of studies have explored barriers to IUS uptake among adolescents, few have examined adolescents’ experiences with the insertion process. We examined differences in satisfaction with the IUS insertion procedure among adolescents in a randomized clinical trial (RCT) who were randomized to receive either a paracervical anesthetic nerve block or a sham block. We hypothesized that participants in the block group would be more satisfied with the IUS insertion than those in the sham group. This is a secondary data analysis using data from a RCT examining the effect on pain during IUS insertion of a paracervical nerve block compared to a sham block among women ages 14 to 22 years. Ninety-five women were randomized to receive a 10-mL 1% lidocaine paracervical anesthetic block or a sham block 3-minutes prior to insertion of a 13.5 mg levonorgestrel IUS. Subjects were recruited from 2 urban adolescent medicine clinics, 3 urban pediatric primary care clinics, 3 university student health centers, and 2 family planning clinics in Philadelphia, Pennsylvania. Satisfaction was assessed with 3 questions asked within 5 minutes after the IUS insertion. Women were asked to rate their overall satisfaction with the IUS procedure using a 5-point Likert scale that ranged from “very satisfied” to “very dissatisfied.” Women were also asked: a) if getting the IUS was worth the level of discomfort they experienced and b) if they would recommend getting an IUS to a friend. A 5-point Likert scale was used for both questions with responses ranging from “definitely yes” to “don’t know/no opinion.” Institutional Review Board approval was granted by our institution. The 95 participants were 81% age 18 or older, 44% White, 36% Black, 9% Hispanic. Two out of three participants had taken college courses and had private health insurance. Most were sexually active (92%), but never had a vaginal speculum exam (56%) or Pap smear (69%). Compared to the sham group, more participants in the block group reported being “very satisfied” with the IUS placement (83% vs 71% %, p=0.16), stated their discomfort was “definitely” or “probably” acceptable (87% vs 69%, p=0.03), and would “definitively” recommend the IUS to a friend (75% vs 60%, p=0.14). Adolescents who received a paracervical nerve block reported a significant higher acceptable discomfort as compared to those who received a sham block. No significant differences in level of satisfaction or friend recommendation were revealed. Clinicians must weigh the potential reductions in pain during IUS insertion associated with use of nerve blocks against the increased time, bleeding risks, and lack of impact on overall satisfaction with the procedure.