Contraception · Long Acting Methods
McAllaster S, Carter G, Simmons RG, Baayd J, Turok DK, Gawron LM
To identify factors associated with unacceptable Patient Acceptable Symptom State (PASS) responses, Visual Analog Scale (VAS) scores, and satisfaction at time of intrauterine device (IUD) placement.
Recruitment occurred at six Utah clinics between 6/24-2/25. Participants completed procedure surveys on demographics, reproductive history, anticipated pain, anxiety, and coping skills. Post-placement surveys assessed PASS responses, experienced pain by VAS (1-100mm) and satisfaction with IUD placement (5-point Likert scale). We determined factors associated with unacceptable PASS responses and a cut point delineating "low" vs "high" pain to assess measure associations.
Of 194 participants, 21% (n = 41) reported an unacceptable PASS, which was associated with higher mean anticipated (65 mm vs 51 mm; padj=0.01) and experienced (76 mm vs 46 mm; padj<0.001) pain, prior sexual assault (55% vs 28%; padj=0.016), or violent death of someone close (25% vs 7%; padj=0.024). In controlled analysis, higher experienced pain predicted unacceptable PASS (OR:1.10;95%CI:1.06, 1.14). "High" pain (≥61mm) occurred in 44% of all participants. Of those with high pain, 55% reported an acceptable PASS response. History of prior pelvic exam (p = 0.02, padj 0.20), prior IUD placement (p = 0.003; padj 0.12), or violent death of someone close (p = 0.011; padj 0.13) influenced unacceptable PASS responses in this group. Of all participants, 21% reported dissatisfaction (n = 16) or neutral response (n = 24) regarding their IUD placement, among which only 13 reported an unacceptable PASS (32%). Satisfaction was influenced by mean VAS score (61 mm dissatisfied/neutral vs 50 mm satisfied; p = 0.01; padj 0.90).
IUD placement pain level may influence satisfaction, but less than half of those with high pain (≥61mm) reported an unacceptable experience.
IUD placement pain experiences are multi-dimensional and cannot be described by pain level alone. High levels of placement pain influence satisfaction and overlap but are not collinear with acceptability responses. Acceptability of IUD may be subject to temporal bias and influenced by whether their goals/needs are met and whether the pain was ultimately worth it.
Wallis B et al., 2026 · Contraception · Free to read
To characterize how commercially available fertility-tracking devices and wearables define ovulation and anovulation, evaluate available comparator evidence, and assess user burden across 19 selected technologies. We conducted a structured landscape analysis of 19 fertility-tracking devices and wearables available in the United States. Technologies were evaluated for biomarker type, operational definitions of ovulation and anovulation, comparator evidence, intended use, regulatory status, and user burden, among other variables. Technologies clustered into four major categories: luteinizing hormone (LH)-only devices, multi-hormone devices, basal body temperature (BBT)-based wearables, and BBT-based thermometers. LH-only devices generally defined ovulation by detecting an LH surge or peak; multi-hormone devices incorporated LH and/or pregnanediol-3-glucuronide (PdG) measurements; and BBT-based technologies relied on thermal shifts. Explicit definitions of anovulation were uncommon and were frequently inferred from the absence of ovulation-associated biomarkers. The existence and design of comparator evidence varied substantially across technologies. Most comparator studies relied on surrogate measures such as urinary or serum hormones, whereas few technologies had comparator evidence against physiological reference standards such as transvaginal ultrasound (TVUS). Comparator studies in irregular-cycle populations were uncommon despite frequent marketing of these devices as appropriate for users with irregular cycles. User burden varied substantially across technologies. Fertility-tracking technologies demonstrate substantial heterogeneity in operational definitions, comparator evidence, and user burden. Greater transparency regarding ovulation and anovulation definitions, clearer reporting of comparator evidence, and more representative evaluation in irregular-cycle populations are needed to support accurate interpretation and integration into reproductive healthcare.
Nantume A et al., 2025 · Drug and alcohol dependence · Free full text on PubMed Central
Substance use disorder (SUD) during pregnancy is associated with an increased risk of adverse maternal and neonatal outcomes, yet many patients face significant barriers to accessing treatment, including experiencing bias and stigma from healthcare providers. To inform improvements in care delivery, this study explored the experiences of healthcare providers who care for pregnant individuals with SUD. Researchers conducted seven focus group discussions (FGD) and fifteen in-depth interviews (IDI) using semi-structured guides, with participants drawn from both rural and urban hospital settings across Utah. All discussions were audio recorded, transcribed verbatim, and examined using the Template Analysis approach. Among FGD participants (n = 37), the sample was predominantly white (94.6 %), female (86.5 %), rural (89.2 %), and comprised of nurses (78.4 %). The IDI sample (n = 15) was more gender diverse (60 % female), had greater representation of physicians (53.3 %), and a higher proportion of urban participants (60.0 %). Template analysis revealed four major themes. First, providers held a range of perceptions toward pregnant individuals with SUD, reflecting both stigma and empathy. Second, many emphasized the importance of building trust through nonjudgmental communication and emotional support. Third, providers reported high levels of burnout, particularly due to limited resources and systemic barriers. Finally, participants highlighted knowledge gaps related to SUD clinical care and confusion around regulatory requirements like mandatory reporting. Despite the challenges described, many providers expressed strong dedication to delivering compassionate, person-centered care. The findings underscore the need for targeted provider education, institutional policies that reduce care barriers, and increased community and institutional resources to better support patients with SUD during pregnancy.
Stanford JB et al., 2024 · Linacre Q · Free full text on PubMed Central
Fertility awareness-based methods (FABMs), also known as natural family planning (NFP), enable couples to identify the days of the menstrual cycle when intercourse may result in pregnancy ("fertile days"), and to avoid intercourse on fertile days if they wish to avoid pregnancy. Thus, these methods are fully dependent on user behavior for effectiveness to avoid pregnancy. For couples and clinicians considering the use of an FABM, one important metric to consider is the highest expected effectiveness (lowest possible pregnancy rate) during the correct use of the method to avoid pregnancy. To assess this, most studies of FABMs have reported a method-related pregnancy rate (a cumulative proportion), which is calculated based on all cycles (or months) in the study. In contrast, the correct use to avoid pregnancy rate (also a cumulative proportion) has the denominator of cycles with the correct use of the FABM to avoid pregnancy. The relationship between these measures has not been evaluated quantitatively. We conducted a series of simulations demonstrating that the method-related pregnancy rate is artificially decreased in direct proportion to the proportion of cycles with intermediate use (any use other than correct use to avoid or targeted use to conceive), which also increases the total pregnancy rate. Thus, as the total pregnancy rate rises (related to intermediate use), the method-related pregnancy rate falls artificially while the correct use pregnancy rate remains constant. For practical application, we propose the core elements needed to assess correct use cycles in FABM studies. Fertility awareness-based methods (FABMs) can be used by couples to avoid pregnancy, by avoiding intercourse on fertile days. Users want to know what the highest effectiveness (lowest pregnancy rate) would be if they use an FABM correctly and consistently to avoid pregnancy. In this simulation study, we compare two different measures: (1) the method-related pregnancy rate; and (2) the correct use pregnancy rate. We show that the method-related pregnancy rate is biased too low if some users in the study are not using the method consistently to avoid pregnancy, while the correct use pregnancy rate obtains an accurate estimate. SHORT In FABM studies, the method-related pregnancy rate is biased too low, but the correct use pregnancy rate is unbiased.
Gawron LM et al., 2021 · Southern medical journal
Women veterans have a high prevalence of comorbidities that increase the risk of adverse pregnancy outcomes. Screening for pregnancy desires in primary care provider (PCP) visits offers an opportunity to optimize preconception health. This pilot quality improvement initiative sought to assess Veterans Healthcare Administration provider preferences on One Key Question (OKQ) implementation, identification of veterans' reproductive needs, and the effect of training on documentation in a women's primary care clinic in Salt Lake City, Utah. We hosted OKQ training sessions for providers and staff, audio recorded group discussions on implementation barriers, and explored themes. Women veterans presenting for a PCP visit in July 2018 self-completed a paper OKQ screening tool. We calculated summary statistics on responses. We conducted a pre-post analysis, with respect to training sessions, to measure for changes in family planning documentation during PCP visits. Nineteen providers and staff completed the training. They acknowledged the importance, but believed that the screening tool should be completed by veterans and not be provider prompted. Forty-two women veterans completed the screening tool: 21% desired pregnancy in the next year and 26% desired contraceptive information. Chart reviews found a nonsignificant increase in current contraceptive method documentation between periods (20% vs 37%; P = 0.08), a decline in documentation of reproductive goals (22% vs 3%; P = 0.02), and no significant change in counseling. Veterans identify reproductive needs via the OKQ screening tool, but provider documentation did not reflect changes in care following training. Further study is necessary to develop an optimal, patient-centered tool and implementation plan to support women veterans in their reproductive goals.
den Tonkelaar D et al., 2002 · Eur J Contracept Reprod Health Care
To study the extent to which variation in satisfaction with a birth control method is explained by variation in perceived physical and psychological effects. A population survey among 1466 German women was carried out. Within the overall sample, 1303 women had ever used oral contraceptives, 996 had relied on condoms, 342 had ever used intrauterine devices (IUD), 428 had used natural family planning and 139 women were sterilized. For each method a woman had ever used, she answered questions about satisfaction with the method, concerns about getting pregnant or suffering health risks during use, ease of use, changes in sexual relationship, relationship with the partner and mood. Past and current users of oral contraceptives and IUDs and sterilized women additionally reported changes in menstrual bleeding. Variation in satisfaction was, for a large part, explained by variation in health concerns among oral contraceptive users, by variation in perceived changes in the quality of the sexual relationship among condom users, by perceived ease of use among IUD users and sterilized women, and by variation in pregnancy concern among natural family planning users. Counselling about these perceived experiences is most likely to result in greater satisfaction and therefore improved compliance.
Oddens BJ, 1999 · Contraception
User satisfaction and the physical and psychological effects of five commonly used contraceptive methods were investigated in a population survey among 1466 West German women. The focus was on effects attributed by current and past users to these methods, rather than objectively assessed effects, to shed further light on personal experiences that are highly relevant to the user but often remain unknown to prescribers and unreported in the medical literature. Within the overall sample, 1303 women were surveyed concerning their current or past use of oral contraceptives (OC), 996 regarding condoms, 342 with respect to intrauterine devices (IUD), 428 in regard to natural family planning (NFP), and 139 in relation to sterilization (respondents completed questions about each method used). It emerged that satisfaction was greatest with sterilization (92% of users), followed by OC (68% of ever users), IUD (59%), NFP (43%), and condoms (30%). Almost one in three NFP users had experienced an unwanted pregnancy during use of this method, as compared with one in 20 OC and condom users. The majority of users reported no mood changes during use of the methods studied. The percentages reporting negative mood changes (various items were scored) were up to 16% among OC users, 23% among condom users, and 30% among NFP users. The latter observations suggested that subjective side effects of a contraceptive agent on mood generally reflected, at least in part, the user's sense of confidence in the method concerned (notably, with regard to efficacy and safety). Oral contraceptives, IUD, and sterilization had a broadly positive impact on sex life, whereas that of condoms was often negative. Whereas OC users often reported less heavy and painful menstruation (in up to 56% of cases), IUD were associated with heavier, prolonged, and more painful menstruation (in up to 65% of cases), as also was sterilization, although to a lesser extent (in up to 32% of cases). Overall, the study findings indicated that OC and sterilization had less negative impact on physical and psychological functioning than the other methods studied, in contrast to what the general public often believes.
MacLeod RGK et al., 2023 · The journal of sexual medicine
Approximately half of people with endometriosis experience deep dyspareunia; however, there is no means of objective self-testing of endometriosis-associated deep dyspareunia. The aim of this study was to assess the acceptability, test-retest reliability, and validity of a vaginal insert for a self-assessment of endometriosis-associated deep dyspareunia. Participants were recruited from a tertiary endometriosis center. Inclusion criteria were: 19 to 49 years of age, self-reported deep dyspareunia of ≥4 of 10, and surgically confirmed endometriosis. Participants completed 2 self-assessments using the vaginal insert to self-assess tenderness at the right and left pelvic floor, bladder, cervix-uterus, and posterior cul-de-sac (vaginal fornix). The participants recorded tenderness at each pelvic site and completed a questionnaire regarding the acceptability of the vaginal insert to assess deep dyspareunia. Test-retest reliability was assessed by correlating the tenderness scores between the 2 assessment dates. Over a 4-week period, the participants also recorded deep dyspareunia severity at each penetrative vaginal sex encounter. Validity was assessed by correlating vaginal insert tenderness to deep dyspareunia severity, and also to tenderness reported on a prior gynecologic pelvic examination. The main outcome measures were the acceptability index score, tenderness (0-10) at each pelvic site, and prospective deep dyspareunia scores (0-10) over 4 weeks. There were 19 participants (mean age 34 ± 7 years) who completed the study. The majority identified as female (94.7%), heterosexual (89.5%), and white (89.5%). The median acceptability index score was 0.72 (interquartile range, 0.66-0.81). For test-retest reliability, the intraclass correlation coefficients were 0.79 (P = .001) for the left pelvic floor, 0.82 (P < .001) for the right pelvic floor, 0.54 (P = .07) for the bladder, 0.89 (P < .001) for the cervix-uterus, and 0.77 (P = .003) for the cul-de-sac. The correlation between the highest self-assessed mean tenderness in each participant and self-reported deep dyspareunia over 4 weeks was r = 0.32, but correlations for each pelvic site varied significantly. Tenderness at each site on prior gynecologist pelvic exam was associated with higher self-assessed mean tenderness with the vaginal insert in each participant (effect sizes = 0.42-0.88). The vaginal insert is acceptable and reliable for the objective self-assessment of endometriosis-associated deep dyspareunia, with initial evidence of validity. A strength was the inclusion of participants who were avoiding sexual activity and a limitation was the small sample size. Future studies with larger sample sizes are required to further establish the validity of the vaginal insert for the self-assessment of endometriosis-associated deep dyspareunia.
Vibert J et al., 2026 · Human Reproduction Open · Free full text on PubMed Central
Does IVF worsen pelvic pain in women with endometriosis? Nearly half of women with endometriosis reported perceived worsening of pelvic pain after IVF. Prior studies generally suggested no IVF-related pain worsening, but few assessed delayed flares or longer-term trajectories. International cross-sectional study based on an online survey conducted between September 2024 and April 2025 including 546 respondents. PARTICIPANTS/MATERIALS Women aged ≥18 years with surgically or imaging-confirmed endometriosis and at least one completed IVF cycle. A 25-item questionnaire captured demographics, reproductive history, comorbidities, and patient-reported pain trajectories before, during, and after IVF. The primary outcome was perceived worsening of pelvic pain after IVF (patient-reported outcome measure; PROM). Secondary outcomes were worsening of dysmenorrhoea and dyspareunia. Group comparisons and exploratory multivariable logistic regressions were performed. Predictor analyses were exploratory. MAIN Among 546 respondents, 48.9% reported worsening pelvic pain after IVF, 49.1% reported worsening dysmenorrhoea, and 35.5% worsening dyspareunia. Current pain scores were significantly higher in women reporting worsening versus no worsening (all P < 0.001). In multivariable analyses, immediate post-cycle pain flare emerged as the strongest and most consistent predictor across all pain outcomes, independently associated with worsening of pelvic pain (adjusted odds ratio [aOR] 5.91, 95% CI 3.88-9.14), dysmenorrhoea (aOR 4.03, 95% CI 2.08-8.05), and dyspareunia (aOR 3.17, 95% CI 2.07-4.90) (all P < 0.001). For the primary outcome, reporting oocyte retrieval as the most painful IVF step (aOR 0.53, 95% CI 0.31-0.88; P = 0.016) and achieving a live birth after IVF (aOR 0.63, 95% CI 0.42-0.92; P = 0.020) were independently associated with lower odds of pelvic pain worsening. In secondary outcome models, live birth was associated with lower odds of dysmenorrhoea worsening, while bladder pain syndrome/interstitial cystitis independently predicted worsening of dyspareunia. A formal response rate could not be calculated due to open online dissemination without a known denominator. LIMITATIONS Self-reported, retrospective data are prone to recall and selection bias, and the cross-sectional design precludes causal inference. Recruitment via associations and social media without a denominator limits generalizability, absence of baseline pain scores impedes assessment of change, and incomplete capture of peri-IVF hormonal regimens may confound results. IVF may not be pain-neutral in endometriosis. Monitoring pain trajectories at key IVF milestones may help identify women at risk of long-term exacerbation. Prospective studies should test whether early monitoring combined with tailored interventions-optimized analgesia, psychological support, or adapted stimulation protocols-can mitigate chronic pain trajectories throughout the IVF journey and ultimately improve quality of life. No specific funding; authors declare no conflicts of interest. N/A.
