Provider Perspectives on Intrauterine Device Practices in Adolescent Patients

Objectives

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 gynaecologic societies have recommended the IUD as a first-line contraceptive for adolescents, given its safety and efficacy. This study aims to understand current IUD practices and elucidate barriers to insertion.

Methods

A survey was disseminated to North American Society for Pediatric and Adolescent Gynecology members via the listserv on 2 separate occasions. Consent was obtained prior to initiation of the survey. Results from the survey were anonymous and tabulated using descriptive statistics. Ethics approval was obtained (REB22-0269).

Results

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

Conclusions

This study demonstrated that misconceptions surrounding the IUD remain. Education on contraception, specifically long-acting reversible contraceptives, is pivotal in decreasing adolescent pregnancy, reducing barriers, and improving adolescents’ attitudes toward the IUD. Pain with insertion is a limiting factor, and procedural sedation may help in managing expectations and increasing acceptance.