Higgins Chloe, Zecena Morales Claudia, Hocking Judi, Tyson Kate, Leung Cheryl, Larmour Luke, Leong Paul, Vollenhoven Beverley
Women's and Newborn Program, Monash Health, 246 Clayton Rd, Melbourne, 3168, Australia, 61 395946666.
Department of Obstetrics and Gynaecology, Monash University, Melbourne, Australia.
JMIR Serious Games. 2025 Sep 8;13:e72917. doi: 10.2196/72917.
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.
This study aims to explore the effectiveness of VR in improving patient pain and anxiety during outpatient IUD insertion.
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.
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.
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.
宫内节育器（IUD）是安全有效的长效可逆避孕方法，也被用作治疗月经过多、子宫内膜增生和早期子宫内膜癌的微创疗法。尽管有诸多优点，但由于患者不适，IUD的使用并不充分。尽管此前文献中已探索了多种技术，但目前对于有效的镇痛策略几乎没有共识。虚拟现实（VR）已在急性疼痛管理中显示出一定益处，并已被用于门诊宫腔镜检查。
本研究旨在探讨VR在改善门诊放置IUD期间患者疼痛和焦虑方面的有效性。
这项随机对照试验比较了在门诊放置IUD期间使用VR头戴设备与标准护理的效果。VR内容通过智能手机和头戴设备提供，为患者营造一个轻松的3D视频环境。测量的结果包括患者报告的疼痛和焦虑，以及使用问卷报告的满意度。次要结果包括临床医生报告的放置难易程度和完成手术所需时间。
共招募了70名患者，其中34名随机分配到对照组，36名随机分配使用VR头戴设备。使用VR头戴设备的患者在放置IUD期间报告的平均疼痛评分为5.5（标准差3.2），与对照组的4.3（标准差3.2）无显著差异（P = 0.15）。手术期间VR组的平均焦虑评分为4（标准差3），对照组为4.8（标准差3.5），差异也无统计学意义（P = 0.37）。焦虑是疼痛的最显著预测因素，而这又显著增加了放置时间（P < 0.001）。在对VR使用有反应并从中受益的患者中，基线焦虑显著低于未受益的患者（P < 0.001）。对VR头戴设备使用的总体满意度较高，对使用VR头戴设备的推荐评分也较高。使用该干预措施未出现显著不良反应，只有1名患者在放置IUD后报告恶心。
使用VR头戴设备并未显著改变患者在放置IUD期间所经历的疼痛或焦虑；然而，满意度和向他人推荐使用VR的意愿较高，这可能表明其使用还有其他益处。此外，术前焦虑似乎对疼痛评分以及患者从VR头戴设备中受益的能力有显著不利影响。这对先前关于VR用于妇科手术的模糊数据做出了重要贡献，并突出了改善患者体验的新途径。
