Patients' experiences and providers' observations on pain during intrauterine device insertion

Objective To determine women's (patients’) experiences of intrauterine device (IUD) insertion under our current practice and the extent to which these agreed with the observations of the health professionals (providers) who had performed the IUD insertion procedures. Method Questionnaires were used to collect information on women's experiences of the IUD insertion procedure from both patients and providers in a sexual and reproductive health service. Results Overall response rates were high (77%, 284 responses in total). Seventy-three percent of patients were nulliparous and over half nulligravid. The providers predominantly used local anaesthesia for IUD insertions (93%). Most patients reported being anxious before their procedure (86%). Patients mainly described the overall experience of their IUD insertion procedure as being associated with ‘minimal discomfort/nothing’ (42%) or ‘uncomfortable’ (41%). ‘Minimal discomfort/nothing’ (56%) and ‘uncomfortable’ (33%) were the main observations of providers. When responses of patients and their providers were compared, agreement was slight for reported pain levels (k = 0.167 CI [0.13–0.24]). Patients’ reported pain levels were significantly higher than those reported to have been observed by their providers (p < 0.001). Conclusion Patients’ and providers’ responses suggested that the IUD insertion procedure under our current practice appeared acceptable to most patients. However, providers were not usually accurate in their observations and tended to underestimate the degree of pain experienced by their patients during IUD insertion procedures

The use of local anaesthesia for intrauterine device insertion by health professionals in the UK

Background Pain associated with the insertion of an intrauterine device (IUD) is a known barrier to intrauterine contraception use in the UK. It is good practice for health professionals to discuss pain relief and use with women prior to the insertion of an IUD. Objectives This study aimed to determine the prevalence of and reasons for and against the use of local anaesthesia (LA) for IUD insertion. Methods A survey was undertaken using paper questionnaires to determine LA use for IUD insertion by UK health professionals. Results Overall, approximately one quarter (n=129) of all respondents use LA routinely, one quarter hardly ever or never use LA, while the remaining half use it sometimes. Use of LA was more prevalent among health professionals who worked in integrated sexual and reproductive health and contraception-only services, compared to general practice. UK health professionals who hardly ever or never used LA for the insertion of IUDs were more likely to be working in general practice. Conclusions The results of this survey suggest that more UK health professionals need to routinely discuss pain relief and offer this to their patients prior to IUD insertion as part of the care pathway for patients who choose to use intrauterine contraception