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Subject: Intrauterine Device Insertion and Removal
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IUD or IUS
Iodine/Povidine solution in a small basin with cotton balls
Ring forceps or long Kelly
Large absorbant swabs (Scopettes)
Nonsterile gloves for bimanual exam and sterile for IUD insertion
Reversible contraception for patients in a monogamous relationship at low risk for STDs
Consider for women with the following medical conditions:
Menorrhagia/dysmenorrhea (LNG IUS—off-label use)
Breast cancer (Copper IUD only)
Liver disease (Copper IUD only)
Severe dysmenorrhea/menorrhagia (LNG IUS)
Undiagnosed genital bleeding
Wilson’s disease and allergy to copper (copper IUD)
Known or suspected cervical or uterine neoplasia
Pelvic inflammatory disease/septic abortion present or within 3 months of insertion
Severe dysmenorrhea or menorrhagia (copper IUD)
An abnormally shaped uterus, or fibroids that distort the uterine cavity (the uterine cavity should sound to 6 to 10 cm)
Sign of cervicitis or vaginitis on the day of insertion
Patients at high risk for endocarditis (e.g., prosthetic valves, major valve abnormalities, shunt lesions)
Use with great caution with anticoagulation (copper IUD)
PITFALL: A paracervical block takes a few minutes for full effect. Wait 2 to 3 minutes following the injections before initiating the procedure.
PITFALL: Fold the arms right before or during the procedure. Prolonged bending of the arms causes them to release slowly and increases the likelihood of device expulsion.
PITFALL: Do not push the insertion rod upward to elevate the IUD. This practice is painful for the patient and increases the risk of perforation.
PITFALL: Do not cut the strings too short; err on the side of too long because the strings can always be cut again. If the strings are cut too short, they tend to impale the end of the glans penis and cause pain during intercourse.
PITFALL: Despite proper placement, early expulsion is possible. Inform the patient of this possibility, and instruct her to return the IUD to your office. The manufacturer will provide a sterile replacement for reinsertion at no cost.
PITFALL: Make sure that the arms of the IUS are horizontal to the insertion device in order to assure proper loading. The entire tips of the IUS should be loaded into the device prior to insertion.
PITFALL: Only move the slider to the first mark, not all of the way to the end of the slide (which releases the strings.)
PITFALL: Because there is a risk of perforation with this procedure, patients are often referred for hysteroscopic removal at this stage.
Pregnancy (rare <1%)
PID (only in the first 20 days after insertion)
Perforation (extremely rare)
Spontaneous expulsion (most occur within first 6 months)
Lost IUD string (rule out pregnancy, look in endocervical canal)
Actinomyces (usually asymptomatic, pull IUD and treat, replace IUD when actinomyces is no longer present on Pap)
Uterine bleeding and cramping (usually within the first 3 months of insertion)