JMIR Publications

ABSTRACT

Background:

Intrauterine devices (IUD) are safe and effective contraceptive therapies which are also used for treatment for heavy menstrual bleeding, endometrial hyperplasia and early-stage endometrial cancer. Barriers to insertion of IUDs in the outpatient setting are predominantly due to patient discomfort and there is little consensus on effective analgesic strategies to address this. Virtual reality (VR) has demonstrated moderate benefits in acute pain management and has been explored for similar gynaecological procedures including outpatient hysteroscopy with some promising results.

Objective:

To explore the effectiveness of VR at improving patient pain and anxiety during outpatient IUD insertion.

Methods:

This randomised control trial compared the use of a VR headset to standard care during IUD insertion in the outpatient clinic setting. Outcomes measured were patient reported pain and anxiety. Secondary outcomes included clinician reported ease of insertion and time required to complete the procedure.

Results:

A total of 70 patients were recruited with 34 randomised to the control and 36 randomised to VR headset use. Patients with VR headsets reported a pain score of 5.5 +/- 3.2 during IUD insertion, which was not significantly different to 4.3 +/- 3.2 for the control group. Anxiety scores during the procedure were 4.0 +/- 3.0 in the VR group, compared to 4.8 +/- 3.5 in the control group, which was also not significantly different. Anxiety was the most significant predictor of pain and this in turn significantly increased insertion time (p <0.001). Of the patients who did respond and benefit from VR use, their baseline anxiety was significantly less than in those who did not (p <0.05).

Conclusions:

The use of VR headsets did not significantly alter the pain or anxiety experienced by patients during IUD insertion, however satisfaction and recommendation that others use VR was high which may suggest other benefits to their use. Additionally, pre-procedural anxiety appears to have a significant adverse impact on pain scores and the ability of patients to benefit from the VR headsets. This importantly contributes to the previously ambiguous data regarding VR use for gynaecological procedures and highlights a new important avenue for further research into alleviating anxiety prior to procedures to improve pain and patient experience. Clinical Trial: Australia and New Zealand Clinical Trial registration: ACTRN12622000088741p. https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=383191