The relationship between pain at IUD insertion and negative perceptions, anxiety and previous mode of delivery

Abstract

Objective: The aim of the study was to better understand the relationship between pain during intrauterine device (IUD) insertion and anxiety, negative perceptions of IUDs and previous mode of delivery, in parous women.

Methods: We conducted a prospective cohort study between June and September 2018 in 210 women who opted for IUD placement for contraception. Sixty-six women who had previously had only vaginal delivery under epidural analgesia were allocated to the epidural delivery group; 60 women who had previously had at least one vaginal delivery without epidural analgesia were allocated to the vaginal delivery group; and 84 women who had previously had only caesarean delivery were allocated to the caesarean delivery group. Participants’ levels of anxiety before insertion were measured using the Beck Anxiety Inventory; participants’ levels of pain (anticipated pain and pain at the various stages of IUD insertion and 15 min after the procedure) were assessed using a visual analogue scale.

Results: While the experience of caesarean delivery and pre-procedure anxiety were found to be associated with higher pain scores, the presence of negative perceptions of IUDs was the most significant predictor of pain during IUD insertion (p < .001). Experience of vaginal delivery under epidural analgesia was associated with lower pain scores at IUD insertion (p < .001).

Conclusion: Fear of IUD insertion pain, pre-procedure anxiety and negative perceptions of IUDs may lead women to anticipate or feel a higher level of pain. Patient education to correct negative perceptions of IUDs and counselling to inform women of the true benefits and risks of IUDs and lower pre-procedure anxiety are a suggested strategy to manage IUD insertion pain in parous women.

摘要

目的：本研究的目的是更好的了解经产女性在宫内节育器（IUD）置入过程中的疼痛与焦虑、IUD的负面认知和先前的分娩方式之间的关系。

方法：我们对2018年6月至9月的210名选择IUD避孕的女性进行了前瞻性队列研究。将66名既往仅在硬膜外镇痛下阴道分娩的妇女分为硬膜外分娩组；将60名既往至少有一次阴道分娩而无硬膜外镇痛的妇女分为阴道分娩组；将84名既往仅行剖宫产的妇女分为剖宫产组。研究人员使用贝克焦虑量表评估了受试者置入前的焦虑程度；使用视觉模拟评分评估受试者的疼痛程度（预期的疼痛和宫内节育器置入不同阶段的疼痛以及手术后15分钟的疼痛）。

结果：剖宫产分娩手术史和术前焦虑与较高的疼痛评分相关, IUDs的负面认知是IUD置入时疼痛最有效的预测因子（p＜.001）。硬膜外镇痛下阴道分娩的经验与宫内节育器置入时较低的疼痛评分相关（p＜.001）。

结论：由于对宫内节育器置入时疼痛的恐惧、手术前的焦虑和对宫内节育器的负面认知可能会导致女性预期或感到更高程度的疼痛。通过教育患者对宫内节育器的负面认知并提供咨询, 让女性了解宫内节育器的益处和风险, 以降低手术前的焦虑, 这是管理经产女性宫内节育器置入疼痛的推荐策略。

Keywords:

• Anxiety
• insertion
• intrauterine device
• IUD
• mode of delivery
• pain
• pain with IUD insertion
• pain perception

Disclosure statement

No potential conflict of interest was reported by the authors.