A Comparative Study Evaluating Pain Experienced During Intrauterine Device Insertion in Women

A Regional, Multicenter Comparative Study Evaluating Pain Experienced During Intrauterine Device Insertion in Women According to Their Parity

The intrauterine device (IUD) is a reversible contraceptive method with good efficacy and long-lasting action.

One of the obstacles to IUD insertion, both for healthcare professionals and patients, is the fear of painful insertion.

There is little data in the literature on the pain experienced by patients, and even less in relation to their parity.

Several studies have been conducted and show that nulliparous women seemed to experience more intense pain compared to multiparous women (2.7 vs 1.9 p<0.05)

The hypotheses of this study are:

• Pain is more intense in nulliparous women than in multiparous women.
• Nulliparous women are more anxious before IUD insertion than multiparous women.
• Satisfaction rates at 6 and 12 months do not differ according to parity.

Pain will be assessed at each stage of IUD insertion using a numerical pain scale from 0 to 10 for speculum insertion, Pozzi forceps insertion, and IUD insertion, by the patient herself. Pain will be reassessed 5 minutes after insertion, also by the patient.

Patients' anxiety levels will be assessed before insertion using the Spielberger State Anxiety Scale. This is a self-administered questionnaire comprising 20 items. This is a 4-point Likert scale assessing the intensity of the subject's feelings ("no," "somewhat no," "somewhat yes," "yes").

The satisfaction rate will be assessed by telephone questionnaire at 6 and 12 months, allowing us to evaluate the continuation rate as well as potential side effects of this method of contraception, such as amenorrhea, spotting, headaches, or mastalgia.

Based on the results, the aim of this study is to propose appropriate pain management and information to reduce any anxiety and reassure patients about their satisfaction with this method of contraception.

Inclusion Criteria:

• Patients aged 18 or older
• Patients desiring intrauterine device (IUD) contraception.
• Patients without contraindications to the desired IUD contraception (uterine malformation, pregnancy, undiagnosed vaginal bleeding, current STI, Wilson's disease, uterine cancer, uterine fibroids, current phlebitis, breast cancer, hormone-sensitive condition, etc.).
• Patients agreeing to participate in the study.
• Patients agreeing to be contacted at 6 months and 1 year.

Exclusion Criteria:

• Patients under 18 years of age.
• Patients 25 years of age or younger who have not been screened for Chlamydia and Gonorrhea prior to IUD insertion.
• Patients with a contraindication to IUD insertion.
• Patients with risk factors for sexually transmitted infections.
• Patients with comprehension difficulties and/or a language barrier.
• Patients who object to participating in the study.
• Intrauterine device insertion by a practitioner in training (first insertion).