Abstract
Background
Many patients experience pain during intrauterine device (IUD) placement, and while quantitative studies suggest that some pain management regimens may reduce pain, no universal protocol exists. Recent guidelines recommend offering pain management for IUD placement, yet little is known about how individual patient priorities and experiences with these options vary in clinical practice.
Objective
To characterize patient experiences with clinical counseling, decision-making, and use of pain management during IUD placement, and to identify preferences for decision-support tools.
Design
A single-site qualitative analysis of pain-related experiences during IUD placement.
Methods
We recruited reproductive-aged patients who underwent outpatient IUD placement between February and July 2025. Semi-structured interviews focused on participants’ experiences with pain management during IUD placement. We coded and analyzed transcripts using thematic analysis to identify key themes related to pain management counseling, priorities for pain control, and experience with pain and anxiety medications during placement.
Results
We interviewed 20 participants who had an IUD placed within 30 days of enrollment. The mean age was 29.8 years, and 75% were nulliparous. We identified four key themes: (1) inconsistency in pain management counseling (e.g., experiences ranging from no mention of pain to comprehensive counseling about medication options); (2) multifactorial decision-making and priorities regarding pain management (e.g., participants weighed factors such as convenience, efficacy, and trust in clinician recommendations when deciding about medications); (3) varied perceived utility of pain management (e.g., some participants perceived meaningful relief from specific medications, while others doubted utility of medications); and (4) desire for standardized information (e.g., participants supported the idea of receiving structured, anticipatory guidance on pain expectations and available options).
Conclusions
Clinician counseling about pain management for IUD placement remains inconsistent, and patient experiences vary widely. Our findings highlight a need for standardized, patient-centered counseling approaches and offer patient-level insights to inform counseling and care.