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J Pediatr Adolesc Gynecol. 2019 Aug 8. pii: S1083-3188(19)30260-8. doi: 10.1016/j.jpag.2019.08.004. [Epub ahead of print]

Will it hurt? The intrauterine device (IUD) insertion experience and long-term IUD acceptability among adolescents and young women.

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Department of Internal Medicine, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115. Electronic address:
Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, 401 Park Drive, Suite 401E, Boston, MA 02115. Electronic address:
Department of Obstetrics and Gynecology, Cambridge Health Alliance, 1493 Cambridge Street, Cambridge, MA. Electronic address:
Division of Adolescent and Young Adult Medicine, Boston Children's Hospital, 333 Longwood Avenue, Boston, MA. Electronic address:



To examine how the intrauterine device (IUD) insertion experience affects long-term IUD acceptability among adolescents.


Text-to-web survey study.


Boston Children's Hospital and Cambridge Health Alliance in Massachusetts.


Nulliparous adolescents aged 13 to 21 years who received an IUD or etonogestrel implant between January 2012 and May 2018.


We received survey responses from 95 adolescents (n=46 IUD, n=49 implant, response rate = 9%). Mean current age (20.8 years) and time since device insertion (2.4 years) were similar between groups. Although the majority of both groups (64%) experienced moderate-to-severe pre-procedural anxiety, IUD users expected more insertional pain compared to implant users (55.6 vs 39.6, p=0.01). Compared to implant users, more IUD users experienced moderate-to-severe insertional pain (80% vs 18%, p<0.0001), recalled that the procedure hurt more than expected (52% vs 4%, p<0.0001), and endorsed lower pain management satisfaction (72.4 vs 85.6, p=0.04). Most respondents would recommend their method to a friend (75%) or consider getting the same device in the future (63%). When explicitly asked, more IUD users reported that dislike of the insertion procedure might or would probably prevent them from getting the same device in the future (41% vs 14%, p=0.005).


Compared to implant users, IUD users reported more negative insertion experiences, though pre-procedural anxiety was prevalent in both groups. Dislike of the insertion experience may negatively impact adolescents' willingness to continue using an IUD in the future. Findings should encourage multimodal interventions to holistically improve the IUD insertion experience.


Adolescent Medicine; Intrauterine Devices; Long-Acting Reversible Contraception; Pain


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