Virtual Reality for Analgesia During Intrauterine Device Insertion: Randomized Controlled Trial.

Background: Intrauterine devices (IUDs) are safe and effective long-acting reversible contraceptive therapies that are also used as minimally invasive treatment for heavy menstrual bleeding, endometrial hyperplasia, and early-stage endometrial cancer. Despite many advantages, IUDs are underused predominantly due to patient discomfort. Although many techniques have been explored previously in the literature, there is currently little consensus on effective analgesic strategies. Virtual reality (VR) has demonstrated moderate benefits in acute pain management and has been explored for outpatient hysteroscopy. Objective: This study aims to explore the effectiveness of VR in improving patient pain and anxiety during outpatient IUD insertion. Methods: This randomized controlled trial compared the use of a VR headset to standard care during IUD insertion in the outpatient clinic setting. VR content was delivered via smartphone and headset, providing patients with a relaxing 3D video environment. Outcomes measured were patient-reported pain and anxiety, as well as satisfaction reported using a questionnaire. 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 randomized to the control group and 36 randomized to VR headset use. Patients with VR headsets reported a mean pain score of 5.5 (SD 3.2) during IUD insertion, which was not significantly different to 4.3 (SD 3.2) for the control group (P=.15). Mean anxiety scores during the procedure were 4 (SD 3) in the VR group, compared to 4.8 (SD 3.5) in the control group, which was also not significantly different (P=.37). Anxiety was the most significant predictor of pain, and this, in turn, significantly increased insertion time (P<.001). Among patients who responded to and benefitted from VR use, baseline anxiety was significantly lower than in those who did not (P<.001). Satisfaction with the use of VR headsets was overall high, and recommendation scores for the use of VR headsets were also high. There were no significant adverse effects experienced with the use of the intervention, with only 1 patient reporting nausea after IUD insertion. 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 were high, which may suggest other benefits to their use. In addition, preprocedural anxiety appears to have a significant adverse impact on pain scores and the ability of patients to benefit from the VR headsets. This is an important contribution to the previously ambiguous data regarding VR use for gynecological procedures and highlights a new avenue for improving the patient experience.