Meta-analysis finds VR distraction does not reduce pain during IUD insertion but may lower anxiety

OBJECTIVE: This systematic review and meta-analysis aimed to evaluate the effectiveness of immersive virtual reality (VR) in reducing pain and anxiety during intrauterine device (IUD) insertion by synthesizing evidence from existing randomized controlled trials (RCTs). METHODS: No formal protocol was registered or prepared for this review. A systematic search of Google Scholar, PubMed, Scopus, CENTRAL, and Web of Science was conducted for RCTs published up to September-2025. We included only RCTs (excluding quasi-experimental studies) comparing VR distraction with standard care among women undergoing IUD insertion. The revised Cochrane Risk of Bias tool (RoB-2) was used to assess the quality of included studies. The primary outcome was post-procedural pain, and the secondary outcome was post-procedural anxiety. Standardized mean differences (SMD) with 95% confidence intervals (CI) were pooled for analysis using the random-effects model. RESULTS: Four RCTs involving 440 patients were included. The overall study quality was rated as "some concerns of bias" in all RCTs. VR did not significantly reduce post-procedural pain compared to control (n = 4 RCTs, SMD: -0.30, 95% CI [-1.07, 0.46], p = 0.44; I = 93.16%). VR significantly reduced post-procedural anxiety (n = 3 RCTs, SMD: -3.58, 95% CI [-6.64, -0.69], p = 0.02; I = 98.57%), although the pooled effect was unstable in leave-one-out sensitivity analysis. Findings on patient satisfaction were inconsistent, and VR showed a non-significant trend toward increased nausea. CONCLUSION: Based on "very low"/uncertain evidence, immersive VR distraction does not significantly reduce pain or anxiety during IUD insertion. The current findings do not support the routine use of VR for this indication.