A comparison of the expected and actual pain experienced by women during insertion of an intrauterine contraceptive device

Abstract

ObjectiveTo compare the expected and actual pain experienced with the insertion of intrauterine contraception in women, and to determine whether either of these are related to their personal circumstances, or affected their satisfaction with the procedure.DesignA convenience sample of 89 women aged 15–50 years attending a sexual health clinic for same day intrauterine contraception insertion were given a questionnaire that they completed following the procedure. The women were asked to rate their expectation of pain prior to insertion and to rate the actual pain they experienced immediately after insertion, on a scale of 1–10, with 10 being severe pain. Information on the women’s circumstances and their level of satisfaction with the procedure was also obtained.ResultsOverall, the median actual pain experienced by women during insertion (4) was significantly lower than the expected pain median (6) (P<0.001). For those women who had not had a previous vaginal delivery, actual pain was significantly higher compared with women who had had a previous vaginal delivery (median [interquartile range]: 6 [3.5–7.5] and 3 [1–5], P<0.001, respectively), but there was no significant difference between expected and actual pain experiences. In women who had a previous vaginal delivery, actual pain was much lower than expected (P<0.001). Neither actual nor expected pain experiences were linked to any other sociodemographic reproductive health or service use factors.ConclusionAll women had a high expectation of pain prior to IUD insertion, but for those who had had a previous vaginal delivery, this was significantly greater than that actually experienced. Satisfaction levels overall were high. Counseling of women should take into account their expected pain prior to IUD insertion and consideration should be given to alternative and additional methods of pain relief in women who have not had a previous vaginal delivery.

Intrauterine contraception insertion pain: nursing interventions to improve patient experience

“…() and Brima et al . () cite an earlier study (Newton & Reading ) when advocating psychological preparation interviews to reduce anxiety and pain expectation. Providing information and clarifying uncertainties resulted in higher tolerance of discomfort.…”

“…Brima et al . () compare the expectation of pain with actual pain levels during IUC insertion and discuss a possible link between anxiety and pain anticipation. All of the participants in this convenience sample study anticipated a high level of IUC insertion pain when completing a numerical pain rating scale prior to the procedure.…”

“…In their UK study, Brima et al (2015) conclude that sociodemographic factors such as age and race have little bearing on actual pain experienced and also determine the most common predictor of greater pain was never having a vaginal delivery. Participants with prior experience of a vaginal delivery reported scores of expected pain as much as 50% higher than actual insertion pain, whereas there was much less discrepancy between the pre-and postinsertion pain scores of women without a vaginal delivery.…”

“…It may be useful to explain to the patient that the level of pain experienced during IUC insertion is highly variable and therefore difficult to predict, whilst also reassuring her of the measures that will be taken to minimise any discomfort (Bahamondes et al 2014). Brima et al (2015) compare the expectation of pain with actual pain levels during IUC insertion and discuss a possible link between anxiety and pain anticipation. All of the participants in this convenience sample study anticipated a high level of IUC insertion pain when completing a numerical pain rating scale prior to the procedure.…”

Intrauterine mepivacaine instillation for pain relief during intrauterine device insertion in nulliparous women: a double-blind, randomized, controlled trial

“…The fear of pain during insertion is most often built on stories about other people's experiences (84). The internet has come to be the most important source for collecting information about contraception among adolescents in Sweden (85).…”