Patients' experiences and providers' observations on pain during intrauterine device insertion

• Published in: The European journal of contraception & reproductive health care 2015-08, Vol.20 (4), p.319-326
• Main Authors: Akintomide, Hannat, Brima, Nataliya, Sewell, Robert D. E., Stephenson, Judith M.
• Format: Article
• Language: English
• Subjects: Adult; Anesthesia; Experience; Female; Gynecologic Surgical Procedures - adverse effects; Health Personnel - psychology; Health services; Humans; Insertion; Intrauterine device; Intrauterine devices; Intrauterine Devices - adverse effects; IUD; Medical personnel; Pain; Pain - etiology; Pain - psychology; Pain Measurement - statistics & numerical data; Pain Perception; Patient Satisfaction; Reproductive health; Surveys and Questionnaires; Young Adult
• ISSN: 1362-5187; 1473-0782
• DOI: 10.3109/13625187.2015.1031885

Abstract Objective To determine women's (patients') experiences of intrauterine device (IUD) insertion under our current practice and the extent to which these agreed with the observations of the health professionals (providers) who had performed the IUD insertion procedures. Method Questionnaires were used to collect information on women's experiences of the IUD insertion procedure from both patients and providers in a sexual and reproductive health service. Results Overall response rates were high (77%, 284 responses in total). Seventy-three percent of patients were nulliparous and over half nulligravid. The providers predominantly used local anaesthesia for IUD insertions (93%). Most patients reported being anxious before their procedure (86%). Patients mainly described the overall experience of their IUD insertion procedure as being associated with 'minimal discomfort/nothing' (42%) or 'uncomfortable' (41%). 'Minimal discomfort/nothing' (56%) and 'uncomfortable' (33%) were the main observations of providers. When responses of patients and their providers were compared, agreement was slight for reported pain levels (k = 0.167 CI [0.13-0.24]). Patients' reported pain levels were significantly higher than those reported to have been observed by their providers (p < 0.001). Conclusion Patients' and providers' responses suggested that the IUD insertion procedure under our current practice appeared acceptable to most patients. However, providers were not usually accurate in their observations and tended to underestimate the degree of pain experienced by their patients during IUD insertion procedures. Chinese Abstract 摘要： 目的 了解妇女（患者）在宫内节育器放置术中的感受与术者观察评估的一致性。 方法 在一个性健康和生殖健康服务机构，对患者和术者进行问卷调查，收集妇女在宫内节育器放置过程中的感受的信息。 结果 总共284人回答，问卷回收率较高，为77%。其中73%的妇女未生育过，超过一半未妊娠过。术者放置宫内节育器时主要采用局麻方式，占（93%）。大部分患者（86%）报告说在术前感到紧张。患者描述在宫内节育器放置过程中总的反应主要为极少的不适/没有不适（42%）或感觉不舒服（41%）。极少的不适/没有不适（56%）和感觉不舒服（33%）是术者的主要的观察意见。关于疼痛水平，患者的感受和术者的观察评估比较一致性较差( k= 0.167 CI [0.13 -0.24])。患者报告的疼痛程度明显高于她们的术者报告的观察到的疼痛程度。 结论 患者和术者的反应提示：按照我们目前的操作，宫内节育器放置过程可被大多数患者接受。然而，术者的观察评估往往不准确，并且往往会低估患者在宫内节育器放置术中感受到的疼痛的程度。