title: Insertion characteristics of intrauterine devices in adolescents and young women: success, ancillary measures, and complications.
abstract: OBJECTIVE
  The objective of the study was to evaluate success and safety of intrauterine device (IUD) placement in a large cohort of adolescents.
  
  
  METHODS
  We examined the medical records of patients aged 13-24 years at the Children's Hospital Colorado Adolescent Family Planning Clinic with at least 1 attempt at IUD placement. We abstracted demographic, reproductive, and procedural variables. The primary outcome was successful placement at first IUD insertion visit. We compared nulliparous with parous adolescents and patients younger than 18 years with those 18 years of age and older.
  
  
  RESULTS
  Between April 2009 and December 2011, 1177 adolescent women aged 13-24 years (mean age 20.8 ± 2.5 years) had an attempted IUD placement, 1012 (86%) of which were with an advanced practice clinician. The first attempt was successful for 1132 women (96.2%). The first-attempt success rate was 95.8% for nulliparous women and 96.7% for parous women (P = .45). The first-attempt success rate was 95.5% (n = 169) for women aged 13-17 years compared with 96.3% (n = 963) for women aged 18-24 years (P = .6). Only 1.8% (n = 21) of all first-attempt successful insertions required ancillary measures. Of the 45 patients with a failed first insertion attempt, 40% (n = 18) had a second attempt with a physician, of which 78% (n = 14) were successful. Within the first 6 months of IUD placement, no perforations were identified and 24 patients (3.0%) expelled the IUD. Insertion failures and IUD expulsions were not related to IUD type, age, or parity.
  
  
  CONCLUSIONS
  Intrauterine devices can be inserted in nulliparous adolescents of any age with similar success to parous adolescents, by both physicians and advanced practice clinicians. Inability to provide ancillary measures such as paracervical block or cervical dilation should not limit access to this first-line contraceptive method.
authors.affiliation: Division of Adolescent Medicine, Department of Pediatrics, Children's Hospital Colorado, Aurora, CO; Division of Family Planning, Department of Obstetrics and Gynecology, University of Colorado, School of Medicine, Aurora, CO. Electronic address: Stephanie.Teal@ucdenver.edu.
authors.forename: Stephanie B
authors.initials: SB
authors.lastname: Teal
authors.affiliation: Division of Adolescent Medicine, Department of Pediatrics, Children's Hospital Colorado, Aurora, CO.
authors.forename: Sarah E
authors.initials: SE
authors.lastname: Romer
authors.affiliation: Division of Family Planning, Department of Obstetrics and Gynecology, University of Colorado, School of Medicine, Aurora, CO.
authors.forename: Lisa M
authors.initials: LM
authors.lastname: Goldthwaite
authors.affiliation: Division of Family Planning, Department of Obstetrics and Gynecology, University of Colorado, School of Medicine, Aurora, CO.
authors.forename: Marissa G
authors.initials: MG
authors.lastname: Peters
authors.affiliation: Division of Adolescent Medicine, Department of Pediatrics, Children's Hospital Colorado, Aurora, CO.
authors.forename: David W
authors.initials: DW
authors.lastname: Kaplan
authors.affiliation: Division of Adolescent Medicine, Department of Pediatrics, Children's Hospital Colorado, Aurora, CO; Division of Family Planning, Department of Obstetrics and Gynecology, University of Colorado, School of Medicine, Aurora, CO.
authors.forename: Jeanelle
authors.initials: J
authors.lastname: Sheeder
mesh_terms: D000293:Adolescent; D057179:Advanced Practice Nursing; D000367:Age Factors; D015331:Cohort Studies; D005260:Female; D006176:Gynecology; D006801:Humans; D007433:Intrauterine Device Expulsion; D007434:Intrauterine Devices; D007435:Intrauterine Devices, Copper; D007436:Intrauterine Devices, Medicated; D010298:Parity; D019919:Prosthesis Implantation / Q000379:methods*; D012189:Retrospective Studies; D055815:Young Adult
keywords: adolescent; advanced practice clinician; contraception; intrauterine device