Background
Intrauterine devices (IUDs) are highly effective long-acting reversible contraceptives (LARCs) with relatively low uptake in Australia. They are typically inserted in primary care settings by trained general practitioners. Most patients report some pain during this procedure, yet health care provider (HCP) perspectives on pain management during IUD insertions is not well understood.
Methods
Individual semi-structured online interviews were conducted in 2024 with 16 HCPs who have inserted at least one IUD (outside of a training context) since 2020, in Victoria, Australia. Data were thematically analysed.
Results
Four themes were identified: managing pain requires diverse and adaptable strategies, conflicts in duty of care, awareness of and response to patient’s expected and actual pain, and systemic barriers to pain management. Participants felt that a standardised approach to pain management for IUD insertions was unsuitable, and pain management for this procedure requires patient preparation and flexible pharmaceutical and non-pharmaceutical strategies. Maintaining patient-centred care whilst inserting the IUD and managing pain was challenging, particularly as participants observed discrepancies in verbal and non-verbal cues from patients. Clinical and structural barriers impacted their ability to provide this level of care.
Conclusion
Most participants expressed satisfaction with current pain management methods, and some pain was viewed as expected for this procedure, revealing a possible disconnect between provider and patient expectations. Findings indicate that updated clinical guidelines, funding that reflects the time and skill required to complete this procedure and improved access to IUD insertions under anaesthetic would better support HCPs in mitigating their patient’s pain.
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