Background: Intrauterine devices can offer both contraceptive and noncontraceptive benefits to never sexually active adolescents. There are increasing data on intrauterine device use in adolescents; however, most data on intrauterine devices in adolescents are related to contraceptive use. There is very limited literature on intrauterine device placement in adolescents who have never been sexually active., Objective: The objective of the study was to compare intrauterine device insertion success between never sexually active and sexually active cohorts., Study Design: We performed a retrospective chart review of patients aged 10-20 years with attempted intrauterine device insertion at a children's hospital between October 2015 and September 2017., Results: A total of 210 patients were included, of whom 82 were never sexually active. Never sexually active adolescents were younger at insertion (15.6 vs 16.7 years, P < .001), more likely to have at least 1 medical problem (75.6% vs 54.7%, P = .046), and to have special needs (23.2% vs 4.7%, P < .001). Never sexually active adolescents were less likely to have intrauterine device insertion performed in the office setting (52.4% vs 94.5%, P < .001). There was no significant difference in success of intrauterine device insertion on the first attempt (90.2% vs 96.1%, P = .086). In a subanalysis of office insertions alone, never sexually active adolescents were more likely to have an unsuccessful intrauterine device insertion (16.3% vs 4.3%, P = .015) and less likely to tolerate the procedure well (81.4% vs 94.2%, P = .026)., Conclusion: To our knowledge, this is the first study describing intrauterine device insertion in never sexually active patients. Although office success rates were lower, intrauterine device insertion in never sexually active adolescents was very successful overall, and intrauterine devices should be offered to this population., (Copyright © 2018. Published by Elsevier Inc.)