{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T14:57:31Z","timestamp":1790866651218,"version":"4.1.0"},"reference-count":25,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2026,4,21]],"date-time":"2026-04-21T00:00:00Z","timestamp":1776729600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,4,21]],"date-time":"2026-04-21T00:00:00Z","timestamp":1776729600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100001807","name":"Funda\u00e7\u00e3o de Amparo \u00e0 Pesquisa do Estado de S\u00e3o Paulo","doi-asserted-by":"publisher","award":["2023\/13279\u20135"],"award-info":[{"award-number":["2023\/13279\u20135"]}],"id":[{"id":"10.13039\/501100001807","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Intl J Gynecology &amp; Obste"],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>This study explores pain at intrauterine device (IUD) placement in a large Brazilian cohort.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We undertook a cross\u2010sectional analysis of health records from individuals aged 18 to 45\u2009years who underwent IUD placements between 2022 and 2024 at the Department of Obstetrics and Gynecology, Universidade Estadual de Campinas Faculty of Medical Sciences, Campinas, Brazil. Insertion pain was measured immediately after the procedure using a 10\u2010cm visual analogue scale (VAS). Scores were classified as no pain (0), mild pain (1\u20133), moderate pain (4\u20136), and severe pain (\u22657). Pain relief included analgesics, antispasmodics, non\u2010steroidal anti\u2010inflammatory drugs (NSAIDs), and opioids. We used multivariable regression to assess the association between pre\u2010insertion pain relief and pain during placement.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>We evaluated 6974 individuals. Of 7259 fittings analyzed, 228 (3%) occurred with no pain, 1121 (15%) with mild pain, 2003 (28%) with moderate pain, and 3907 (54%) with severe pain (median [interquartile range] pain score of 7.0 [5.0\u20138.0]). Clinicians provided pain relief in 429 (6%) of insertions (largely antispasmodics and NSAIDs). After adjusting for age and parity, antispasmodics were associated with moderate to severe pain (adjusted odds ratio [aOR] 1.75; 95% confidence interval: 1.15; 2.68).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Our findings suggest that moderate to severe pain was experienced in 5910 (81%) of IUD insertions, in contrast with the 5% estimate in national guidelines. We also found evidence that pre\u2010insertion antispasmodic medication was associated with higher moderate to severe pain. Our findings emphasize the need to update guidelines to recognize IUD insertion pain and provide options to manage discomfort.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ijgo.71026","type":"journal-article","created":{"date-parts":[[2026,4,21]],"date-time":"2026-04-21T11:28:18Z","timestamp":1776770898000},"page":"358-364","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Pain at intrauterine device placement in a Brazilian center"],"prefix":"10.1002","volume":"175","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-5747-5957","authenticated-orcid":false,"given":"Ana Luiza","family":"Savi","sequence":"first","affiliation":[{"name":"Faculty of Epidemiology and Population Health London School of Hygiene and Tropical Medicine  London 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Medicine  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7356-8428","authenticated-orcid":false,"given":"Luis","family":"Bahamondes","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Universidade Estadual de Campinas Faculty of Medical Sciences  Campinas SP Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,4,21]]},"reference":[{"key":"e_1_2_9_2_1","volume-title":"Selected Practice Recommendations for Contraceptive Use","author":"World Health Organization","year":"2025"},{"key":"e_1_2_9_3_1","unstructured":"Instituto Brasileiro de Geografia e Estat\u00edstica (IBGE).Pesquisa Nacional de Sa\u00fade 2019: Ciclos de Vida [online].2021Accessed December 5 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