Direct vs. standard method of insertion of an intrauterine contraceptive device: insertion pain and outcomes at 6 months

Abstract Objectives: The direct method is a procedure designed to cause less pain during insertion of an intrauterine contraceptive device (IUCD). It was first reported in 2005 and differs from the standard method of insertion recommended by IUCD manufacturers. In France, the direct method is well known and used by experienced practitioners, but it has never been evaluated against the standard method of insertion. The aim of the study was therefore to compare the direct method with the standard method in terms of pain experienced during insertion and the side effects and satisfaction rates over 6 months. Methods: A prospective observational study was conducted in France between June and December 2016 to compare the direct and standard methods of IUCD insertion. Results: The study included 535 women: 281 in the direct method group (DM group) and 254 in the standard method group (SM group). Women in the DM group reported less pain. This difference was assessed by multilevel multivariate analysis (−8.3 mm, 95% confidence interval (CI) −14.3, −2.3). There was no difference in the occurrence of infection (1.4% vs. 2.8%; p = .366) and 6-month continuation rates (89.4% vs. 89.2%; p = .936). Satisfaction rates at 6 months were higher in the DM group (93.6% vs. 87.4%; p = .019). Conclusions: The results of the study suggest that the direct method of IUCD insertion is associated with less pain and does not increase the risk of adverse effects. Widespread adoption of the direct method could improve women’s comfort and lead to a higher uptake of the IUCD as a form of contraception.