Sedation or no Sedation? Understanding IUD Placement Preference Among Adolescents.

OBJECTIVE: While intrauterine devices (IUDs) are highly effective for contraception and menstrual-related concerns, a significant barrier to usage in adolescents is fear of pain during placement. We sought to identify patient characteristics associated with receiving sedation for IUD placement among adolescents. STUDY DESIGN: A retrospective cohort study was performed at a single institution from January 2022 to December 2023. Patients (N=284) assigned female at birth, aged ≤18, who underwent IUD placement for any indication with or without sedation were included. Demographic and clinical characteristics were analyzed using multivariable logistic regression. RESULTS: Two hundred thirty-three patients (82.0%) underwent IUD placement in clinic without sedation and 51 (18.0%) underwent placement with sedation. There were no significant differences in age, race, ethnicity, or insurance type between cohorts. Sedation patients had a higher BMI (26.2 vs 24.3 kg/m2, P=.04), were more likely to identify as non-binary (13.7% vs 4.3%, p=.01), and were less likely to be sexually active (25.4% vs 62.7%, P<.001). In multivariable analysis, a bleeding disorder was associated with a 19.6 percentage-point higher predicted probability of undergoing sedation (95% CI 4.7-34.5 percentage points), whereas being sexually active was associated with an 11.8 percentage-point lower predicted probability (95% CI -23.3 to -0.3 percentage points). CONCLUSIONS: We identified several patient characteristics that increase the likelihood of adolescents undergoing IUD placement with sedation, including higher BMI, having a bleeding disorder, identifying as non-binary, and not being sexually active. These findings may help clinicians identify adolescents who could benefit from expanded pain management options. IMPLICATIONS: This study identifies specific adolescent patient characteristics associated with use of sedation for IUD placement, including obesity, having a bleeding disorder, identifying as non-binary, and not being sexually active. Expanding equitable pain management access may reduce deterrents to IUD use and strengthen patient-centered contraceptive care.