(8) “Just a pinch”? A national survey of provider attitudes regarding IUD procedure analgesia management and options

Background: The intrauterine devices (IUD) is a popular and effective contraception option, however, pain associated with insertion remains a chief concern for recipients as well as a barrier for obtaining an IUD. Pain localized to the gynecologic community has an extensive history of being ignored and mimized– pain associated with IUD procedures is no exception. The purpose of this study is to better understand differences in professional training and opinions regarding analgesia for IUD procedures.

Methods: After receiving IRB approval, we conducted a national Web-based Qualtrics survey of IUD providers (n=657). The 63-question survey asked about providers’ professional demographics, likelihood of providing various forms of analgesia to nulliparous and multiparous patients, cervical preparation, and procedural instrumentation. We predicted statistically significant differences in likelihood of prescribing NSAIDS, anxiolytics, and nitric oxide for nulliparous vs multiparous patients. We predicted no statistical differences of likelihood of prescribing medications in regards to provider ethnicity, race, and location of practice.

Results: Linear-regression models and one-way ANOVA tests were used to determine significant differences in the frequency of analgesia recommendation by provider demographics. Prescribing practices were found to vary by professional credentials (CNM vs. MD/DO), location (urban, rural, suburban), region, and race. Notably, cisgender male providers and providers in practice more than five years were significantly less likely to prescribe multiple analgesic methods to both nulliparous and multiparous patients.

Conclusions: The variability in prescribing practices observed in this study is curious and concerning. The differences in analgesia prescription likelihood suggests that some patients undergoing IUD procedures are not offered all analgesic methods that may be available. This research highlights the need to continue conversations regarding provision of analgesia for IUD procedures and adopt a more patient-centered approach to minimize pain and suffering for this contraception utilization.