Nonsedated Intrauterine Device Experiences Among Transgender and Cisgender Adolescents and Young Adults in the Outpatient Setting

Study Objective: This study compares the demographic characteristics and experiences of three different groups of adolescent and young adults (AYAs) seeking nonsedated intrauterine device (IUD) insertion in the outpatient setting: (1) cisgender individuals, (2) transgender and gender diverse (TGD) individuals receiving gender-affirming testosterone therapy, and (3) TGD individuals not receiving gender-affirming testosterone therapy. Methods: This retrospective cohort study included AYAs age 13-21 years seeking IUD insertion. Data were obtained from the electronic health record via a pre-existing, multi-institutional shared quality improvement collaborative. The patient population was characterized by descriptive statistics; inferential statistics compared procedural complications, outcomes, and patient-reported side effects. Unadjusted Kaplan–Meier and Cox proportional-hazard modeling assessed continuation rates. Results: Of the 683 participants attempting IUD insertion, 623 were cisgender individuals, 18 were TGD individuals on gender-affirming testosterone, and 42 were TGD individuals not on testosterone. There was no difference in insertion indication (P = .25). TGD patients on testosterone were more likely to have experienced a procedural adverse event (17%; P = .04), and to have reported pain beyond expectation (P = .003), although insertional success did not differ significantly between groups (P = .22). Conclusion: TGD AYAs had similar reasons as cisgender patients for seeking the IUD. While TGD individuals on testosterone were more likely to have pain or an adverse procedural event, insertional success did not differ. One-year IUD continuation rates were similarly high in all groups.