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Does Anticipated Pain in IUD Placement Deter Use?

Am J Obstet Gynecol; ePub 2017 Oct 25; Dina, et al

High levels of anticipated pain correlated with high levels of experienced pain during intrauterine device (IUD) placement, a recent study found, with nulliparity and a history of dysmenorrhea also showing an association with greater discomfort during placement. This according to a secondary analysis of the Contraceptive CHOICE Project (CHOICE) that estimated the association between anticipated pain with IUD placement and experienced pain. Patients were asked to report their anticipated pain prior to IUD placement and experienced pain during placement on a 10-point visual analog scale. Researchers found:

  • 9,256 patients from CHOICE were included between 2007 and 2011, of which 1,149 (mean age 26 years, 44% black, 53% low socioeconomic status) presented for first placement of either the original 52 mg LNG IUS or the copper IUD.
  • The median pain score was 5 for both the LNG-IUS and the copper IUD; the median experienced pain score was 5 for the LNG-IUS and 4 for the copper IUD.
  • Patients' anticipated pain was associated with increased experienced pain (adjusted relative risk for 1 unit increase in anticipated pain, 1.19).
  • Nulliparity, history of dysmenorrhea, and the hormonal IUD were also associated with increased pain with IUD placement.


Dina B, Peipert L, Zhao Q, Peipert JF. Anticipated pain as a predictor of discomfort with intrauterine device placement. [Published online ahead of print October 25, 2017]. Am J Obstet Gynecol. doi:10.1016/j.ajog.2017.10.017.