Intrauterine Device Insertion Procedure Duration in Adolescent and Young Adult Women

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Intrauterine device (IUD) utilization in the United States is low among adolescent and young adult women. Longer procedure duration has been proposed as one potential barrier to IUD insertion in this population. We hypothesized that procedure duration would be longer in adolescents compared to young adult women. This study was a secondary analysis of a randomized clinical trial comparing the effectiveness of a lidocaine versus sham paracervical nerve block for pain control during levonorgestrel 13.5 mg IUD insertion. Adolescent and young adult women ages 14 to 22 years were recruited from three outpatient academic sites in Philadelphia, PA. Pain scores were recorded at seven steps during the procedure from speculum insertion through removal. Time stamps associated with each step were used to calculate the overall procedure duration. Cumulative IUD insertion procedure duration was estimated using the Kaplan-Meier method. Ninety-five women enrolled. Nineteen (20%) were ages 14 to 17 and 76 (80%) were ages 18 to 22 years. The median procedure duration (seconds + IQR) was longer for adolescents than young adults (555 + 428 seconds versus 383 + 196 seconds, p = 0.008). After adjusting for study site, the difference in expected median procedure duration between age groups was not significant (p=0.3832). The duration of IUD insertion procedures in adolescent and young adult women is not clinically or statistically significant. Providers should not withhold IUDs from appropriate adolescent and young adult women based on age alone.

Authors:

O'Flynn O'Brien KL, Akers AY, Perriera LK, Schreiber CA, Garcia-Espana JF, Sonalkar S