Anticipated Pain During Intrauterine Device Insertion

J Pediatr Adolesc Gynecol. 2020 Feb;33(1):27-32. doi: 10.1016/j.jpag.2019.09.007. Epub 2019 Sep 26.


Study objective: To identify predictors of anticipated pain with intrauterine device (IUD) insertion in adolescents and young women.

Design: We performed linear regression to identify demographic, sexual/gynecologic history, and mood covariates associated with anticipated pain using a visual analogue scale pain score collected as part of a single-blind randomized trial of women who received a 13.5-mg levonorgestrel IUD.

Setting: Three academic family planning clinics in Philadelphia Pennsylvania.

Participants: Ninety-three adolescents and young adult women aged 14-22 years.

Intervention: Participants received either a 1% lidocaine or sham paracervical block.

Main outcome measures: Anticipated pain measured using a visual analogue scale before and perceived pain at 6 time points during the IUD insertion procedure.

Results: Black or African American participants had a median anticipated pain score of 68 (interquartile range [IQR], 52-83), White participants had a median anticipated pain of 51 (IQR, 35-68), whereas participants of other races had a median anticipated pain score of 64 (IQR, 36-73); P = .012. In multivariate analysis, race was the only covariate that significantly predicted anticipated pain at IUD insertion. Women with anticipated pain scores above the median had significantly higher perceived pain during all timepoints of the IUD insertion procedure.

Conclusion: Increased anticipated pain is associated with increased perceived pain with IUD insertion. Black adolescent women experience greater anticipated pain with IUD insertion. This population might benefit from counseling and clinical measures to reduce this barrier to IUD use.

Keywords: Adolescent; Contraceptive devices; Intrauterine devices; Pain.

Publication types

  • Multicenter Study
  • Randomized Controlled Trial

MeSH terms

  • Adolescent
  • Adult
  • Female
  • Humans
  • Intrauterine Devices / adverse effects*
  • Levonorgestrel / administration & dosage*
  • Pain Perception*
  • Pain, Procedural / etiology
  • Pain, Procedural / psychology*
  • Single-Blind Method
  • Young Adult


  • Levonorgestrel