Provider perspectives on Intrauterine device practices in adolescent patients.

Abstract

Objective: Adolescent pregnancy is a worldwide public health concern, and the intrauterine device (IUD) is known to be a safe and effective method of long-acting reversible contraception in this group. Pediatric and gynecologic societies have recommended the IUD as a first line contraceptive for adolescents given their safety and efficacy. This study aims to understand current IUD practices, elucidate barriers to insertion.

Methods: A survey was disseminated to NASPAG (North American Society for Pediatric and Adolescent Gynecologists) members via the listserv on two separate occasions. Consent was obtained prior to initiation of the survey. Results from the survey are anonymous. Results were tabulated with descriptive statistics. Ethics approval was obtained (REB22-0269).

Results: There were 55 respondents, mostly in North America (93%). As per providers, adolescents most frequently seek out the IUD for contraception (45%) and abnormal uterine bleeding (24%). Providers felt the most common barrier was misconceptions (25%), and pain with insertion (24%). Although many physicians perform office insertions, many found that a Procedural Sedation Center optimized wait times (38%) or felt that such a center would be helpful (33%).

Conclusion: This study demonstrated that misconceptions surrounding the IUD remain. Education on contraception, specifically LARCs, is pivotal in decreasing adolescent pregnancy, reducing barriers, and improving the attitude of adolescents toward the IUD. Pain with insertion is a limiting factor and procedural sedation may help in managing expectations and increasing acceptance.