<p><strong>STUDY OBJECTIVE: </strong>Intrauterine device (IUD) utilization in the United States is low among adolescent and young adult women. Longer procedure duration has been proposed as one potential barrier to IUD insertion in this population. We hypothesized that procedure duration would be longer in adolescents compared to young adult women.</p>

<p><strong>DESIGN, SETTING, AND PARTICIPANTS: </strong>This study was a secondary analysis of a randomized clinical trial comparing the effectiveness of a lidocaine versus sham paracervical nerve block for pain control during levonorgestrel 13.5 mg IUD insertion. Adolescent and young adult women ages 14 to 22 years were recruited from three outpatient academic sites in Philadelphia, PA.</p>

<p><strong>INTERVENTIONS AND MAIN OUTCOME MEASURES: </strong>Pain scores were recorded at seven steps during the procedure from speculum insertion through removal. Time stamps associated with each step were used to calculate the overall procedure duration. Cumulative IUD insertion procedure duration was estimated using the Kaplan-Meier method.</p>

<p><strong>RESULTS: </strong>Ninety-five women enrolled. Nineteen (20%) were ages 14 to 17 and 76 (80%) were ages 18 to 22 years. The median procedure duration (seconds + IQR) was longer for adolescents than young adults (555 + 428 seconds versus 383 + 196 seconds, p = 0.008). After adjusting for study site, the difference in expected median procedure duration between age groups was not significant (p=0.3832).</p>

<p><strong>CONCLUSION: </strong>The duration of IUD insertion procedures in adolescent and young adult women is not clinically or statistically significant. Providers should not withhold IUDs from appropriate adolescent and young adult women based on age alone.</p>

<p><strong>CLINICAL TRIAL REGISTRATION: </strong>Clinicaltrials.gov (NCT# NCT02352714).</p>

<p><strong>OBJECTIVE: </strong>To evaluate satisfaction with intrauterine device (IUD) insertion procedures among adolescent and young adult women.</p>

<p><strong>METHODS: </strong>This secondary analysis of data from a multisite, single-blind, sham-controlled randomized trial of women having a levonorgestrel 13.5-mg IUD inserted enrolled participants from March 2015 through July 2016 at three family planning clinics in Philadelphia, Pennsylvania. Eligible participants were 14-22 years of age, nulliparous, not pregnant, and English-speaking. Randomization was computer-generated allocation in block sizes of four to a 1% lidocaine paracervical or sham block. Only patients were blinded. Satisfaction was measured with three items that assessed overall satisfaction with the procedure, whether participants would recommend the IUD to a friend, and the perception that the IUD was worth the discomfort. Predictors included demographics, sexual and reproductive history, pain after IUD insertion, and treatment group.</p>

<p><strong>RESULTS: </strong>Ninety-five women enrolled; 93 (97.9%) were included in the analysis. Forty-five (47.4%) were white, 34 (36.0%) were black, 62 (66.0%) were privately insured, and 75 (79.0%) had used contraception previously. Most (n=73 [76.8%]) reported high overall satisfaction with the procedure, 64 (67.4%) would recommend an IUD to a friend, and 79 (83.2%) perceived the IUD was worth the discomfort. The odds of reporting high overall satisfaction were lower among adolescents compared with young adults (odds ratio [OR] 0.07, 95% CI 0.008-0.68); those who never had a gynecologic examination compared with those who had (OR 0.26, 95% CI 0.07-0.99); and decreased as pain score increased (OR 0.96, 95% CI 0.94-0.99). Higher pain scores were negatively correlated with the odds of recommending an IUD to a friend and perceiving the IUD was worth the discomfort.</p>

<p><strong>CONCLUSION: </strong>Adolescent and young adult women report high levels of satisfaction after the IUD insertion procedure. Young age, lack of experience with gynecologic examinations, and high pain were inversely related to satisfaction.</p>

<p><strong>CLINICAL TRIAL REGISTRATION: </strong>ClinicalTrials.gov, NCT02352714.</p>

<p><strong>OBJECTIVE: </strong>To estimate the effect of a 1% lidocaine paracervical nerve block on pain during intrauterine device (IUD) insertion compared with a sham block in adolescents and young women.</p>

<p><strong>METHODS: </strong>We conducted a multisite, single-blind, sham-controlled randomized trial in adolescents and young women having a 13.5-mg levonorgestrel IUD inserted. Enrollment occurred at three family planning clinics in Philadelphia, Pennsylvania. Eligible adolescents and young women were aged 14-22 years, nulliparous, not currently or recently pregnant, and English-speaking. Participants were randomized using computer-generated allocation in block sizes of four to receive a 10-mL 1% lidocaine paracervical block or a sham block (1 cm depression of the vaginal epithelium at paracervical block sites with a wooden cotton-tipped applicator). Only patients were blinded. The primary outcome was pain after IUD insertion measured with a 100-mm visual analog scale. Using a two-sided t test and assuming a 20-mm difference in visual analog scale scores, a SD of 28 mm, an α of 0.05, and 90% power, a sample of 43 participants per group was estimated.</p>

<p><strong>RESULTS: </strong>Between March 2015 and July 2016, 95 participants enrolled (47 lidocaine block group; 48 sham block group). All were included in the analysis. Forty-four percent were white, 36% black, 65% privately insured, and 79% previously used contraception. The median visual analog scale score after IUD insertion was 30.0 (95% CI 20.0-58.0) in the lidocaine block group and 71.5 (95% CI 66.0-82.0) in the sham block (P&lt;.001).</p>

<p><strong>CONCLUSION: </strong>A 10-mL 1% lidocaine paracervical nerve block reduces pain during IUD insertion in adolescents and young women compared with a sham block with pressure on the vaginal epithelium.</p>

<p><strong>CLINICAL TRIAL REGISTRATION: </strong>ClinicalTrials.gov, NCT02352714.</p>